Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery

Richebé, Philippe; Brulotte, Véronique; Raft, Julien

doi:10.1097/aco.0000000000000796

Cited by 23 publications

(14 citation statements)

References 70 publications

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“…A variety of methods can be used for postoperative analgesia of LC, of which local anesthetic incision infiltration was used for somatic pain, besides warming and humidifying the carbon dioxide (CO 2 ) used for referred pain [ 4 , 5 ]. For patients, suffering from visceral pain for day LC, weaker opioids are recommended currently [ 6 ]. As a classical μ -opioid receptor, morphine is a very effective measure of opioid pharmacodynamics, with a definite analgesic effect.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Analgesic Effects of Different κ‐Receptor Agonists Used in Daytime Laparoscopic Cholecystectomy

Zhou

Wang

et al. 2021

BioMed Research International

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Background. Comparing the effect of two different κ-receptor agonists, nalbuphine and oxycodone, and regular morphine in patients for prophylactic analgesia of acute pain after daytime laparoscopic cholecystectomy. Methods. One hundred and twenty-four patients undergoing laparoscopic cholecystectomy were randomly allocated to receive nalbuphine (group N), oxycodone (group O), and morphine (group M). The three groups were all given intravenous injection (iv.) of 0.15 mg/kg injection before incision and 0.05 mg/kg injection at the end of pneumoperitoneum. The Visual Analogue Scale (VAS) scores (incision, visceral, and shoulder) and Ramsay sedation scores at 1, 2, 4, 8, 12, 16, 20, and 24 hours after surgery, the time of extubation, the incidence of postoperative adverse events, the satisfaction of pain treatment, and the duration of stay after surgery were all recorded. Results. Compared with group M, the VAS scores of visceral pain at rest decreased in group N and group O at 1-8 h after surgery ( P < 0.05 ). The VAS scores of visceral pain at movement in group N decreased longer than those in group O ( P < 0.05 ). Compared with that of group M, the postoperative time in Ramsay sedation score of group O increased longer than that of group N ( P < 0.05 ). Compared with group N, patients had worse sleep quality in group O, longer length of stay in group M, and lower satisfaction in both groups. Conclusion. Compared with morphine, prophylactic use of the κ-receptor agonists, nalbuphine and oxycodone, during laparoscopic cholecystectomy can reduce postoperative visceral pain. Furthermore, the nalbuphine group had fewer adverse reactions, better analgesia, and better satisfaction.

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Section: Introductionmentioning

confidence: 99%

[Retracted] Analgesic Effects of Different κ‐Receptor Agonists Used in Daytime Laparoscopic Cholecystectomy

Zhou

Wang

et al. 2021

BioMed Research International

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“…In consideration that most of the ESD procedure are performed with intubation under general anesthesia, clinicians should not only concern the postoperative complications of ESD but also adverse events of general anesthesia such as hypoxemia, respiratory depression, delayed recovery, agitation, and regurgitation aspiration [ 21 ]. As a consequence, acetaminophen, NSAIDS, and other kinds of medicine owning moderate analgesia effects become the optional choice in ambulatory surgeries such as endoscopic treatment rather than opioids which should be avoided or reduced for analgesia [ 22 ]. Dexmedetomidine exerts special analgesia effect reducing anxiety and opioid-sparing effect [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of dexmedetomidine on postoperative pain in patients undergoing gastric and esophageal endoscopic submucosal dissection: a study protocol for a randomized controlled prospective trial

Luo

Chen

et al. 2022

Trials

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Background Endoscopic submucosal dissection (ESD) is widely used as an effective treatment of early gastric and esophageal tumors, as it is minimally invasive, safe, and convenient. Epigastric pain is a common complication of ESD. In the traditional cognition, the postoperative pain of ESD is not serious and does not attach too much attention. However, previous studies found that the incidence of moderate to severe pain after ESD can be as high as 44.9~62.8%. At present, there is no unified understanding of how to carry out good postoperative analgesia in patients undergoing ESD of stomach and esophagus. The purpose of present study is to investigate the efficacy of intraoperative dexmedetomidine (DEX) using on postoperative pain though observing the postoperative visual analog scale (VAS) score within 48 h after ESD surgery, so as to explore an effective analgesia and anesthetic method in patients undergoing gastric and esophagus ESD. Methods/design This study is a prospective, single-center, two-arm, randomized control trail. In total, 120 patients undergoing endoscopic submucosal dissection were stratified by type of surgery (i.e., gastric or esophagus ESD) and randomized into two treatment groups, DEX group (group D, n = 60) and control group (group C, n = 60). Patients in the experimental group (DEX group) will be administrated a loading dose of DEX at 1 μg/kg for 15 min and a continuous infusion at 0.6 μg/kg/h until 30 min before the end of operation. In control group, the same volume of normal saline was infused. The primary outcome is VAS at 2 h after ESD surgery. The secondary outcome will be VAS at 1 h, 4 h, 6 h,18 h, 24 h, and 48 h, the status of perioperative hemodynamics, the use of remedial analgesics, sedation score, shivering, postoperative nausea and vomiting (PONV), and satisfaction scores of patient and complication of ESD (such as bleeding, perforation, aspiration pneumonia). Discussion The results of this study will demonstrate that intraoperative application of DEX is beneficial for postoperative pain treatment in patients undergoing ESD. This study will not only confirm that postoperative pain treatment is necessary for patients undergoing ESD but also provides an effective anesthesia method for postoperative analgesia. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR2100043837, registered on March 4, 2021, http://www.chictr.org.cn.

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“…Additionally, this benefit appears following a variety of different anesthetics, including remifentanil-induced shivering as well as following subarachnoid blocks [52,53]. Tramadol continues to draw interest as one component of a multimodal postoperative pain management strategy [54].…”

Section: Tramadolmentioning

confidence: 99%

“…The principle considerations of SNRIs in the acute postoperative period are related to their efficacy, as part of a multimodal postoperative pain strategy and as a risk factor for the development of serotonin. Multimodal analgesia has emerged as a central component of pain management following surgery [54,67]. Additionally, this care practice is a critical component in enhanced recovery after surgery (ERAS) protocols.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations

Fanelli

Weller

Liu

2021

Neurology International

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Serotonin-norepinephrine reuptake inhibitors (SNRIs) inhibit the presynaptic neuronal uptake of serotonin and norepinephrine and prolong the effects of the monoamines in the synaptic cleft within the central nervous system, leading to increased postsynaptic receptor activation and neuronal activities. Serotonin-norepinephrine reuptake inhibitors can have multiple clinical indications, including as the first-line agents for the management of depression and anxiety, and as analgesics in the treatment of chronic pain. The effects of reuptake inhibition of norepinephrine and serotonin are often dose-dependent and agent-dependent. There are five FDA-approved serotonin-norepinephrine reuptake inhibitors (desvenlafaxine, duloxetine, levomilnacipran, milnacipran and sibutramine) currently being marketed in the United States. As the COVID-19 pandemic significantly increased the incidence and prevalence of anxiety and depression across the country, there are significantly increased prescriptions of these medications perioperatively. Thus, anesthesiologists are more likely than ever to have patients administered with these agents and scheduled for elective or emergency surgical procedures. A thorough understanding of these commonly prescribed serotonin-norepinephrine reuptake inhibitors and their interactions with commonly utilized anesthetic agents is paramount. There are two potentially increased risks related to the continuation of SNRIs through the perioperative period: intraoperative bleeding and serotonin syndrome. SNRIs have some off-label uses, more new indications, and ever-increasing new applications in perioperative practice. This article aims to review the commonly prescribed serotonin-norepinephrine reuptake inhibitors and the current clinical evidence regarding their considerations in perioperative anesthesia and analgesia.

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Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery

Cited by 23 publications

References 70 publications

[Retracted] Analgesic Effects of Different κ‐Receptor Agonists Used in Daytime Laparoscopic Cholecystectomy

[Retracted] Analgesic Effects of Different κ‐Receptor Agonists Used in Daytime Laparoscopic Cholecystectomy

Efficacy of dexmedetomidine on postoperative pain in patients undergoing gastric and esophageal endoscopic submucosal dissection: a study protocol for a randomized controlled prospective trial

New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations

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