Articles: pain-management.
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Opioid dose titration is a fundamental process of opioid therapy in cancer pain. ⋯ This review provides the most recent insights on the different modalities of opioid dose titration in cancer pain management.
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In Mongolia, pediatric anesthesia has advanced during the past 25 years through expanded, standardized education programs and international collaboration. Pediatric anesthesia is a recognized specialty, covering all surgical services, including cardiac and transplant, using physicians and nurses. ⋯ As a Low- and Middle-Income Country (LMIC) with low population density and extreme weather, the challenges include insufficient equipment, supplies, and clinician numbers, matching few clinicians to many varied patient locations, and covering surgical emergencies over distance and weather. In Thailand, education and training in pediatric anesthesia remain a focus: Pediatric anesthesia is an official subspecialty, the fellowship is accredited, using a competency-based curriculum with milestones of Direct Observation of Procedural Skills and Entrusted Professional Activities. The Bangkok Anesthesia Regional Training Center (BARTC)-Pediatrics, jointly sponsored by the World Federation of Societies of Anesthesiologists (WFSA) and the Society for Pediatric Anesthesia (SPA), have expanded training to anesthesiologists worldwide. Challenges include difficulty balancing service workload and education, as well as attracting pediatric anesthesia fellows due to the strong private sector job market.
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Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain refractory to medical management. An SCS system comprised one or more leads implanted in the epidural space, typically connected to an implantable pulse generator. This review discusses the history, indications, surgical technique, technological advances, and future directions of SCS.
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Postoperative patient-centred outcome measures are essential to capture the patient's experience after surgery. Although a large number of pharmacologic opioid minimisation strategies (i.e. opioid alternatives) are used for patients undergoing surgery, it remains unclear which strategies are most promising in terms of patient-centred outcome improvements. This scoping review had two main objectives: (1) to map and describe evidence from clinical trials assessing the patient-centred effectiveness of pharmacologic intraoperative opioid minimisation strategies in adult surgical patients, and (2) to identify promising pharmacologic opioid minimisation strategies. ⋯ OSF - https://osf.io/7kea3.
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Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. ⋯ We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas.