Articles: postoperative.
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Review Meta Analysis
Low-Dose Naloxone for Prophylaxis of Postoperative Nausea and Vomiting: A Systematic Review and Meta-analysis.
To determine whether postoperative administration of low-dose intravenous naloxone decreases the incidence of postoperative nausea and vomiting (PONV) and its impact on postoperative opioid requirements and pain scores. ⋯ This pooled analysis of data suggests that low-dose naloxone plays no role in preventing PONV, while exhibiting no significant effects on postoperative opioid needs and pain scores. The reduction demonstrated in postoperative nausea did not translate into decreases in postoperative vomiting.
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Review Meta Analysis
Perioperative pregabalin administration does not prevent chronic postoperative pain. Systematic review with a meta-analysis of randomized trials.
The efficacy of perioperative pregabalin treatment for preventing chronic pain remains a matter of debate. We searched the MEDLINE, EMBASE, LILACS, Cochrane, and Clinical Trial Register databases, and other sources, for randomized controlled trials comparing the effects of pregabalin and placebo. The primary outcome was the incidence of chronic postsurgical pain (CPSP) at 3 months. ⋯ Subgroup analysis by publication status, daily dose, type of administration, and type of surgery did not highlight any differences between subgroups. Insufficient data concerning the incidence of chronic postsurgical neuropathic pain were available for any firm recommendation to be made. Pooled data from published and unpublished studies provide no support for the efficacy of pregabalin for preventing CPSP.
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Review Meta Analysis
Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis.
No formal systematic review or meta-analysis was performed up to now to summarize the risk factors of delirium after hip surgery. ⋯ Related prophylaxis strategies should be implemented in elderly patients involved with above-mentioned risk factors to prevent delirium after hip surgery.
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Postoperative pain management protocols that use patient-controlled analgesia (PCA) can hinder mobility due to attached machinery and tubing. Immobility in the postoperative setting can increase complications, length of stay (LOS), and costs. Early and enhanced mobilization can reduce the cost of care while improving patient outcomes. A needle-free, compact, patient-activated, and portable fentanyl iontophoretic transdermal system (fentanyl ITS, IONSYS; The Medicines Company, Parsippany NJ) has been shown to provide comparable efficacy and tolerability to intravenous (IV) PCA morphine that promotes improved mobility. ⋯ Due to improved mobility with fentanyl ITS, complications are expected to be less frequent than with IV PCA and epidural PCA. Incorporation of this strategy into postoperative pain management protocols may reduce LOS and total hospital costs.
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Minerva anestesiologica · Feb 2017
Meta AnalysisAnalgesia-Nociception monitoring for opioid guidance: meta-analysis of randomized clinical trials.
The adequate suppression of nociception is, besides induction of unconsciousness and immobility, the main objective during anesthesia. Analgesics, most commonly opioids, are usually titrated by established clinical surrogates of nociception. Recently, monitoring techniques became available to evaluate analgesia/nociception during anesthesia and provide better measures then clinical evaluation alone. They are primarily derived from autonomic response on physiologic standard measures. ⋯ Monitoring analgesia/nociception is often reliant on regular physiologic conditions, like sinus rhythm. Opioid guidance dependent on analgesia/nociception monitoring during anesthesia may have beneficial and clinically relevant effects, however the number of currently available randomized controlled studies is low and conclusions are hampered by heterogeneity. More studies with focussed clinical endpoints are therefore needed.