Articles: opioid.
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Opioids are commonly used in the neonatal intensive care unit (NICU). Negative neurodevelopmental effects in the short-term setting have been associated with opioids ; however, long-term studies have been limited. ⋯ When controlling for other variables, the cumulative fentanyl dose did not correlate with neurodevelopmental outcomes. Further evaluation of benefits and risks of opioids in premature infants are needed.
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Moderate-to-severe postoperative pain is usually controlled using a multimodal approach, including opioids. Intravenously administered patient-controlled analgesia (IV PCA) with opioids, popular for over 40 years, enables patients to control their level of analgesia and has advantages over a nurse-administered approach, including more satisfied patients and improved pain relief. ⋯ Complicating IV PCA is the problem of commonly used compounds, morphine and hydromorphone, having significantly reduced brain/effector-site permeability and active metabolites, both of which create the risk of delayed adverse events. Novel patient-controlled modalities that incorporate rapid effector site-permeating opioids and non-invasive routes of administration offer great promise to enhance both patient and caregiver experiences with postoperative analgesia systems.
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Best Pract Res Clin Anaesthesiol · Mar 2014
Perioperative analgesia: ever-changing technology and pharmacology.
Our understanding of pain and its long-term implications have dramatically changed with the advent of advancements in molecular mechanisms involved in acute or postoperative pain and chronic pain. This better understanding has led to multiple pharmacologic advancements to better treat pain with minimal side effects. Currently, we are still struggling to find the right balance between all of the different modalities that we have at our leisure. ⋯ However, despite using a multimodal approach that includes newer technologies, we still have a long way to go before we can guarantee a pain-free postoperative course or a comfortable end for a terminally ill patient. These arms of anesthesiology are ever changing. Anesthesiologists have taken a leadership role in perioperative pain management and clinical research designed for the improvement of pain.
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Opioids are among the most frequently used analgesics for treatment of severe pain. However, certain of their side-effects, particularly ventilatory disturbances, often restrict their use. Separation of analgesia from respiratory depression has long been a goal in the basic research and therapeutic use of opioids. This report briefly describes opioid-induced respiratory depression and possible pharmacological strategies to counteract this without affecting analgesia.