Multimodal Analgesia, Current Concepts, and Acute Pain Considerations

Helander, Erik; Menard, Bethany L.; Harmon, Chris M.; Homra, Ben; Allain, Alexander V.; Bordelon, Gregory J.; Wyche, Melville Q.; Padnos, Ira W.; Lavrova, Anna; Kaye, Alan D.

doi:10.1007/s11916-017-0607-y

Cited by 125 publications

(61 citation statements)

References 103 publications

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“…For example, the overall use of opioids and the opioid-sparing effect of meloxicam IV were greater in orthopedic surgeries than in other surgery types. The use of multimodal and complementary medications to reduce opioid consumption is a goal cited by recent guidelines, 11,33 and the magnitude of the opioid-reducing effect observed in this study is clinically meaningful within this context.…”

Section: Discussionmentioning

confidence: 69%

A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

Bergese

Melson

Candiotti

et al. 2019

Clinical Pharm in Drug Dev

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An intravenous (IV) formulation of meloxicam is being studied for moderate to severe pain management. This phase 3, randomized, multicenter, double‐blind, placebo‐controlled trial evaluated the safety of once‐daily meloxicam IV 30 mg in subjects following major elective surgery. Eligible subjects were randomized (3:1) to receive meloxicam IV 30 mg or placebo administered once daily. Safety was evaluated via adverse events, clinical laboratory tests, vital signs, wound healing, and opioid consumption. The incidence of adverse events was similar between meloxicam IV– and placebo‐treated subjects (63.0% versus 65.0%). Investigators assessed most adverse events as mild or moderate in intensity and unrelated to treatment. Adverse events of interest (injection‐site reactions, bleeding, cardiovascular, hepatic, renal, thrombotic, and wound‐healing events) were similar between groups. Over the treatment period, meloxicam IV was associated with a 23.6% (P = .0531) reduction in total opioid use (9.2 mg morphine equivalent) compared to placebo‐treated subjects. The results suggest that meloxicam IV had a safety profile similar to that of placebo with respect to numbers and frequencies of adverse events and reduced opioid consumption in subjects with moderate to severe postoperative pain following major elective surgery.

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Section: Discussionmentioning

confidence: 69%

A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

Bergese

Melson

Candiotti

et al. 2019

Clinical Pharm in Drug Dev

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“…In order to deal with opioid crisis happening during traditional pain management, concept of multimodal analgesia is introduced. Local anesthetics (LAs) is one of the most frequently-used and safest analgesics in multimodal regimens [2,3]. However, limited duration (less than 24 h) and potential toxicity (cardiac and central nervous malfunction) restrict its application and raise the urgency to counterbalance the side effects and prolonged analgesia [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Advances of Nano-Structured Extended-Release Local Anesthetics

Qin

Huang

et al. 2020

Nanoscale Res Lett

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Extended-release local anesthetics (LAs) have drawn increasing attention with their promising role in improving analgesia and reducing adverse events of LAs. Nano-structured carriers such as liposomes and polymersomes optimally meet the demands of/for extended-release, and have been utilized in drug delivery over decades and showed satisfactory results with extended-release. Based on mature technology of liposomes, EXPAREL, the first approved liposomal LA loaded with bupivacaine, has seen its success in an extended-release form. At the same time, polymersomes has advances over liposomes with complementary profiles, which inspires the emergence of hybrid carriers. This article summarized the recent research successes on nano-structured extended-release LAs, of which liposomal and polymeric are mainstream systems. Furthermore, with continual optimization, drug delivery systems carry properties beyond simple transportation, such as specificity and responsiveness. In the near future, we may achieve targeted delivery and controlled-release properties to satisfy various analgesic requirements.

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“…La implementación creciente de la evaluación estandarizada del dolor y protocolos de tratamiento y analgesia multimodal son necesarios para mejorar la calidad de atención y la satisfacción del paciente 4,5 . El concepto de analgesia multimodal (llamada también analgesia balanceada) se introdujo con el objetivo de mejorar la eficacia y seguridad del tratamiento, combinando fármacos y técnicas analgésicas con efectos aditivos o sinérgicos, lo que permite ahorrar opioides y disminuir la incidencia de efectos adversos medicamentosos [6][7][8] .…”

Section: Introductionunclassified