Intra-operative use of remifentanil may have a dose-response effect on inducing hyperalgesia and consequentially increasing post-operative pain.
Intrathecal clonidine slightly improves the analgesic effects of intrathecal morphine, though increases hypotension (harm ratio 1.8).
Intraoperative dexamethasone is not associated with wound infection or delayed healing, but does increase post-operative blood glucose levels.
Intraoperative dexamethasone produces a small, though clinically insignificant post-operative analgesic benefit.
The use of ultrasound for peripheral nerve blockade reduces the incidence of systemic local anesthetic toxicity by at least 65%, possibly 80%.
In patients not receiving intrathecal morphine, TAP block after caesarean section reduced opioid use at 6, 12 and 24 hours, along with nausea at 12h.
Intermittent intraperitoneal lidocaine at 50 mg/h reduces post-operative morphine consumption by almost 50% after open abdominal hysterectomy.
Intermittent intraperitoneal lidocaine at 50mg/h during open abdominal hysterectomy exerts analgesic effects via local mechanisms rather than central.
Dexamethasone provides effective PONV prophylaxis (NNT 3.7). There is however no benefit of an 8 to 10 mg IV dose over a lower 4 to 5 mg dose.
TAP block reduced early and late pain at rest after laparoscopic surgery, though not pain with movement.
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