Systemic analgesics in children – update

Abstract: A multimodal analgesic approach is key to providing safe and effective analgesia in children. The use of age-appropriate pain scoring systems with regular monitoring and pain assessment is essential to guide treatment and to achieve optimal pain control, while ensuring safety and minimizing unwanted effects.Due to neuroplasticity of immature pain pathways, pain in early life has been shown to lead to heightened sensitivity to pain on future exposure. Effective pain control has therefore the dual benefit of good analgesic control during an episode of pain, as well as reducing the potential for longer term pain pathway neurodevelopmental changes.An understanding of the developmental changes in pharmacokinetics and pharmacodynamics of analgesic drugs in neonates, infants and children is key to safe and effective dosing of analgesic agents across this age range. Considerations for safe and effective use of paracetamol, non-steroidal anti-inflammatory drugs opioids and adjuvant analgesics in children will be discussed.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Authors: Tags: Paediatric Anaesthesia Source Type: research

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ConclusionAlthough CISB significantly improved postoperative pain control and early (in the first 6  weeks) functional outcomes following arthroscopic rotator cuff repair, there was no significant difference between the CISB group and CISB + GA group at 6 months.Level of evidenceLevel II, Randomized Controlled Trial, Treatment Study.
Source: European Journal of Orthopaedic Surgery and Traumatology - Category: Orthopaedics Source Type: research
This study compares the postoperative pain and opioid use in patients managed for surgery with general anesthesia (GA) with patients who were given combined epidural and general anesthesia (E/GA) with continuing postoperative epidural analgesia. Methods All patients who underwent penile inversion vaginoplasty between May of 2016 and May of 2018 under the care of single surgeon were identified retrospectively, 18 patients of which met the inclusion criteria. A retrospective chart review was conducted. Outcome measures were postoperative pain using visual analog scale, type and dosage of postoperatively administered intra...
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Reconstructive Surgery Source Type: research
Conclusions Continuous or intermittent wound infusion is safe and effective in reducing pain scores and opioid consumption in plastic surgery. Though the overall pain-lowering effect appears to be modest, ease of catheter insertion and patient satisfaction make this technique an alluring alternative to more validated approaches such as neuraxial or peripheral nerve blocks.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Review Paper Source Type: research
Publication date: Available online 11 November 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Başak Altiparmak, Melike Korkmaz Toker, Ali İhsan Uysal, Yağmur Kuşçu, Semra Gümüş DemirbilekAbstractBackground and objectivesThe primary aim of this study is to assess the effect of US-ESP on postoperative opioid consumption after laparoscopic cholecystectomy. The secondary aims are to assess the effects of ESP block on intraoperative fentanyl need and postoperative pain scores.MethodsPatients between 18–70 years old, ASA I-II were included in the study and randomly allocat...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 11 November 2019Source: Fuß &SprunggelenkAuthor(s): N. Maffulli, R. AicaleAbstractIn the past three decades, the incidence of overuse tendinopathy has risen. Tendinopathy affects also middle-aged overweight patients with no history of increased physical activity. Tendinopathy is the result of a chronic failure of healing response. Several conservative therapeutic options have been proposed.The management of tendinopathy is primarily conservative, and many patients respond to such measures. Eccentric exercises and shock wave therapy provide promising excellent clinical results. H...
Source: Fuss and Sprunggelenk - Category: Podiatry Source Type: research
AbstractPurpose of ReviewIn this review, we discuss the essential iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) anatomy, block technique as well as potential complications, contraindications, and relevant literature evaluating the efficacy of the iPACK block.Recent FindingsRecent literature supports the efficacy of the iPACK in controlling pain, improving postoperative physical therapy performance, and decreasing hospital length of stay (LOS). Cadaver studies have demonstrated that injection of dye in the tissue plane between the popliteal artery and the femoral shaft cranial to femoral condyles...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
Publication date: Available online 10 November 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Fabrice Ferré, Jean-Mathieu Mastantuono, Charlotte Martin, Anne Ferrier, Philippe Marty, Pierre Laumonerie, Nicolas Bonnevialle, Vincent MinvilleAbstractBackground and objectivesThe frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavi...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 9 November 2019Source: Neuroscience ResearchAuthor(s): Kounosuke Hirata, Yuto Nishiki, Ryosuke Goto, Mikito Inagaki, Katsuo Oshima, Yoshihito Shimazu, Mamoru TakedaAbstractSystemic administration of the dietary constituent, resveratrol, was previously shown to inhibit the nociceptive jaw-opening reflex (JOR) via the endogenous opioid system. The present study investigated whether resveratrol could similarly affect the JOR under in vivo conditions via 5 H T3 receptor-mediated GABAergic inhibition. We used electrical stimulation of the tongue in pentobarbital-anesthetized rats...
Source: Neuroscience Research - Category: Neuroscience Source Type: research
Adjuvant medications are combined with local anesthetic solutions for the maintenance of neuraxial labor analgesia due to their synergistic and additive analgesic effects.1 –3 Co-administration with local anesthetic results in local anesthetic dose-sparing effects which may decrease motor block, hypotension and rates of assisted vaginal delivery.4 Lipophilic opioids are widely used for neuraxial labor analgesia but are associated with unpleasant dose-dependent side e ffects including pruritus, nausea and vomiting and urinary retention.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
Discussion and conclusionThe Authors, as a result of the present study, suggest that office hysteroscopy should be sussessful at the first attempt, because the majority of patients (58%), in case of a failed procedure, do not undergo a repeat hysteroscopy in a reasonable time and important diagnosis, such as that of endometrial cancer, may be missed or delayed. In order to increase the procedure success rate, prior to the scheduled hysteroscopy they recommend to counsel all patients, identifying those who may benefit from pharmacological cervical softening, local anesthetic injection or the use of small caliber hysteroscopes.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
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