Articles: postoperative.
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Reg Anesth Pain Med · May 2021
Review Meta AnalysisEfficacy and safety of caudal dexmedetomidine in pediatric infra-umbilical surgery: a meta-analysis and trial-sequential analysis of randomized controlled trials.
Caudal dexmedetomidine improves analgesia duration & reduces analgesia need without increasing complications, when compared to local anaesthesia alone in children.
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Reg Anesth Pain Med · May 2021
Risk of chronic opioid use after simultaneous versus staged bilateral knee arthroplasty.
Several studies have identified excess risk associated with undergoing simultaneous (compared with unilateral or staged) bilateral total knee arthroplasty (BTKA). However, few have addressed subsequent chronic opioid use. Given the substantial morbidity and mortality associated with prolonged opioid use, we evaluated the incidence of postoperative chronic opioid use following simultaneous versus staged BTKA, based on the different timing strategies of staged procedures. ⋯ Although patients undergoing staged BTKA <6 months apart were prescribed greater quantities of opioids on discharge, there was no significant difference in the odds of postoperative chronic opioid use compared with simultaneous BTKA. The timing of BTKA procedures does not appear to influence the likelihood of postoperative chronic opioid dependence.
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Best practices in opioid prescribing after elective surgery have been developed for most surgical subspecialties, including spine. However, some percentage of patients will become chronic users. ⋯ For opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.
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Reg Anesth Pain Med · May 2021
ReviewPain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations.
Effective pain control improves postoperative rehabilitation and enhances recovery. The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after open liver resection using Procedure-Specific Postoperative Pain Management (PROSPECT) methodology. ⋯ Based on the results of this review, we suggest an analgesic strategy for open liver resection, including acetaminophen and non-steroidal anti-inflammatory drugs, combined with thoracic epidural analgesia or bilateral oblique subcostal TAP blocks. Systemic opioids should be considered as rescue analgesics. Further high-quality RCTs are needed to confirm and clarify the efficacy of the recommended analgesic regimen in the context of an enhanced recovery program.