Articles: opioid.
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Chronic postsurgical pain (CPSP) is a common and underreported but significant outcome following surgery. Pharmacological treatment with analgesics, including non-opioids and opioids, is frequently used. It has been debated whether neuraxial anesthesia can reduce persistent analgesic use. We aimed to survey long-term analgesic prescription after different surgeries under general and neuraxial anesthesia, using a nationwide database. ⋯ Neuraxial anesthesia may be associated with lower rates of long-term analgesic and opioid prescription after some surgeries, especially herniorrhaphy and lower-limb ORIF.
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J Pain Palliat Care Pharmacother · Dec 2021
ReviewPain Management Strategies in Rheumatoid Arthritis: A Narrative Review.
Rheumatoid Arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and progressive deterioration of the joints, which generates pain and stiffness. The origin of this pain is multifactorial, with inflammation, secondary osteoarthritis, as well as central and peripheral sensitization playing important roles in the development. Up to 90.4% of RA patients visit a health professional for severe pain, and despite new therapies and sophisticated treatments, there are a limited number of options for analgesic management. ⋯ DMARDs are the mainstay of RA treatment, although many patients continue to experience pain despite optimal management. Medications such as glucocorticoids, NSAIDs, topical capsaicin, and weak opioids are key elements when achieving analgesia in RA. Other pharmacological groups such as neuromodulators, antidepressants, muscle relaxants and cannabinoids currently do not have enough evidence to be recommended.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewGeneral anesthetic techniques for enhanced recovery after surgery: Current controversies.
General anesthesia technique can influence not only immediate postoperative outcomes, but also long-term outcomes beyond hospital stay (e.g., readmission after discharge from hospital). There is lack of evidence regarding superiority of total intravenous anesthesia over inhalation anesthesia with regards to postoperative outcomes even in high-risk population including cancer patients. ⋯ Given that the residual effects of drugs used during anesthesia can increase postoperative morbidity and delay recovery, it is prudent to use a minimal number of drug combinations, and the drugs used are shorter-acting and administered at the lowest possible dose. It is imperative that the discerning anesthesiologist consider whether each drug used is really necessary for accomplishing perioperative goals.
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J Pain Palliat Care Pharmacother · Dec 2021
Evaluation of Extended-Release Oxycodone Administered through Enteral Tubes for the Management of Pain in Patients with Head and Neck Cancer: A Case Series.
An abuse-deterrent, microsphere-in-capsule extended-release formulation of oxycodone myristate (Xtampza® ER, Collegium Pharmaceutical Inc, Canton, Massachusetts), was approved by the FDA in 2016 for the management of pain. The advantage of this formulation of oxycodone is that the microspheres can be administered via enteral tubes without compromising the long-acting formulation. This case series characterizes the experiences of five head and neck cancer patients initiated on oxycodone myristate through enteral tube administration for control of cancer-related pain. ⋯ The median time to pain control was 4 days. The safety profile of oxycodone myristate was consistent with the package insert with no new findings reported. Oxycodone myristate can be an appropriate long-acting opioid analgesic option for patients requiring enteral tube administration of medications to achieve adequate cancer-related pain control.
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Reg Anesth Pain Med · Dec 2021
Trajectories of opioid consumption from day of surgery to 28 days postoperatively: a prospective cohort study in patients undergoing abdominal, joint, or spine surgery.
Descriptions of opioid use trajectories and their association with postsurgical pain and opioid consumption are limited. We hypothesized that trajectories of opioid consumption in the first 28 days following surgery would be associated with unique patterns of pain and duration of opioid use. ⋯ We observed distinct opioid use trajectories following abdominal and joint or spine surgery that were associated with different patterns of pain and duration of opioid use postoperatively. Prediction of postoperative opioid use trajectory groups may be clinically important for identifying risk of prolonged opioid use.