Articles: pain.
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Diclofenac is commonly used for acute pain in children, but is not licensed for this indication in all age groups. ⋯ Diclofenac is an effective analgesic for perioperative acute pain in children. It causes similar types of serious adverse reactions in children as in adults, but these are rare. More research on optimum dosing and safety in asthmatic children is required.
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Meta Analysis
Transdermal fentanyl as a front-line approach to moderate-severe pain: a meta-analysis of randomized clinical trials.
The safety of transdermal fentanyl (TF) in comparison with slow-release oral morphine (SROM) in moderate-severe pain was assessed. ⋯ TF and SROM seem to have a different side effects profile, and TF seems to be preferred by patients. The hierarchical approach traditionally recommended by the main scientific societies (oral morphine and then TF) could be replaced by a front-line approach based on patients' characteristics and needs.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisLocal anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief.
Caesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation. Local anaesthetics, either on their own or in combination with opioids or nonsteroidal antiinflammatory drugs, have been employed as an adjunct to other postoperative pain relief strategies. Conflicting reports were noted. ⋯ Local analgesia infiltration and abdominal nerve blocks as adjuncts to regional analgesia and general anaesthesia are of benefit in caesarean section by reducing opioid consumption. Nonsteroidal anti-inflammatory drugs as an adjuvant may confer additional pain relief.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisTransient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics.
Spinal anaesthesia has been in use since 1898. During the last decade there has been an increase in the number of reports implicating lidocaine as a possible cause of temporary and permanent neurologic complications after spinal anaesthesia. Follow up of patients who received uncomplicated spinal anaesthesia revealed that some of them developed pain in the lower extremities after an initial full recovery. This painful condition that occurs in the immediate postoperative period was named 'transient neurologic symptoms' (TNS). ⋯ The risk of developing TNS after spinal anaesthesia with lidocaine was significantly higher than when bupivacaine, prilocaine, or procaine were used. The term 'transient neurological symptoms' implies neurologic pathology. Failing identification of the pathogenesis of TNS, consideration should be given to choosing a neutral descriptive term which does not imply a particular causation. One study about the impact of TNS on patient satisfaction and functional impairment demonstrated that non-TNS patients were more satisfied and had less functional impairment after surgery than TNS patients, but this did not influence their willingness to recommend spinal anaesthesia.
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Clinical therapeutics · Jan 2009
Review Meta AnalysisPsychological interventions for reducing pain and distress during routine childhood immunizations: a systematic review.
Immunizations are a common source of pain and distress for children. Psychological interventions consist of a variety of techniques for relaxing and distracting children during immunization with the goal of reducing pain and distress. ⋯ Evidence suggests that breathing exercises, child-directed distraction, nurse-led distraction, and combined cognitive-behavioral interventions are effective in reducing the pain and distress associated with routine childhood immunizations. Although additional well-designed trials examining psychological interventions are needed, parents and health care professionals should be advised to incorporate psychological interventions to reduce the pain and distress experienced by children during immunization.