Articles: postoperative.
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Randomized Controlled Trial
Managing Postoperative Analgesic Failure: Tramadol Versus Morphine for Refractory Pain in the Post-Operative Recovery Unit.
This study aimed to discover whether co-analgesia with tramadol or additional morphine was more effective for patients who still had severe pain despite being given 10 mg intravenous morphine in the post-anesthesia care unit (PACU). ⋯ We found no difference between additional morphine and co-analgesia with tramadol in this study. Patients who don’t respond to reasonable doses of opioids in PACU are very likely to be unresponsive to further opioids, and other non-opioid analgesic techniques (such as regional anesthesia) should be considered early in this group of patients.
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Opioids are often used for pain treatment, but the response is often insufficient and dependent on e.g. the pain condition, genetic factors and drug class. Thus, there is an urgent need to identify biomarkers to enable selection of the appropriate drug for the individual patient, a concept known as personalized medicine. Quantitative sensory testing (QST) and clinical parameters can provide some guidance for response, but better and more objective biomarkers are urgently warranted. Electroencephalography (EEG) may be suitable since it assesses the central nervous system where opioids mediate their effects. ⋯ The current clinical study demonstrates the viability of EEG as a biomarker and with results consistent with previous experimental results. The combined method of machine learning and electroencephalography offers promising results for future developments of personalized pain treatment.
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We describe the first case of severe hypernatremia associated to laparoscopic surgery for hydatid cyst in an adult patient after the use of hypertonic saline solution with complete resolution. Severe hypernatremia is an unusual fact at the immediate postoperative period but may have fatal consequences for the patient and need immediate action. ⋯ The relation between this surgical technique and the severe complication is discussed. More experience is needed in terms of safety for the patient.
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Prediction of Postoperative Pain from Electrical Pain Thresholds after Laparoscopic Cholecystectomy.
Early postoperative pain correlates to persisting pain, psychosocial distress, and delayed mobilization with thromboembolic and infectious complications. Electrical pain thresholds (EPT) have shown promising results in being able to predict postoperative pain, but the results are conflicting. The aim of this study was to test whether EPT levels can be used to predict the postoperative pain in patients of both sexes. ⋯ Levels of EPT are reproducible, and the technique is well tolerated. However, it can be used to predict postoperative pain only in women. A weak correlation with the postoperative pain intensity, found here as well as previously, and the high sex dependency of the EPT levels obtained considerably limit the predictive value of this technique for routine use in perioperative clinical practice.