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Anesthesia and analgesia · Jun 2019
Hypertonic Saline in Human Sepsis: A Systematic Review of Randomized Controlled Trials.
Hypertonic saline use in sepsis reduces resuscitation fluid volume but has no effect on survival.
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The new Score for Prediction Of Postoperative Respiratory Complications (SPORC-2) more reliably predicts the need for early post-operative re-intubation.
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Subcostal transversus abdominis plane (TAP) block does not improve analgesia after laparoscopic cholecystectomy.
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Review Meta Analysis
Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis.
Ketamine is a phencyclidine intravenous anaesthetic that blocks N-methyl-d-aspartate receptors and HCN channels in the CNS. Lately it has gained acceptance in a low-dose form, with studies showing an analgesic benefit in orthopaedic surgery. Our goal was to critically appraise and synthesise current evidence regarding use of low-dose ketamine in major, painful orthopaedic surgeries. ⋯ Low-dose ketamine is an effective adjuvant that decreases pain and opioid requirements in painful orthopaedic procedures, especially in the first 24 h after procedure. Future research should focus on arthroscopic procedures and the incidence of chronic pain.
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Previous studies have shown a robust correlation between variability of clinical pain scores and responsiveness to placebo (but not active drug) in pain studies, but explanations for these relationships are lacking. We investigated this further by assessing relationship between the Focused Analgesia Selection Test (FAST), a psychophysical method that quantifies pain reporting variability in response to experimental stimuli, variability of daily clinical pain scores as captured using diary, and response to treatment in the context of a randomized controlled crossover trial of naproxen vs placebo in knee osteoarthritis. Evoked pain using the Staircase-Evoked Pain Procedure served as the primary efficacy endpoint. ⋯ Both correlated with the placebo response (r = 0.393, P = 0.004; r =-0.371, P = 0.009; respectively), but only the FAST predicted the treatment difference between naproxen and placebo, as demonstrated both in a regression model (P = 0.002, Beta = 0.456, t = 3.342) and in a receiver operating characteristic curve (0.721) analysis. Our results extend previous findings to include a correlation between experimental pain variability and the placebo response and suggest that experimental pain variability is a better predictor of patients who respond preferentially to drug over placebo. A theoretical model unifying these observations is proposed, and practical implications are discussed.