Regional techniques and outcome: what is the evidence?

Hanna, Marie N.; Murphy, Jamie D.; Kumar, Kanupriya; Wu, Christopher L.

doi:10.1097/aco.0b013e32832f330a

Cited by 70 publications

(38 citation statements)

References 60 publications

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“…Their use may benefit the elderly more than younger patients, due to the relatively greater risk of side-effects in the older adult if opioids were otherwise used [13,[66][67][68], although, as ever, more research is required comparing postoperative opioid with regional analgesia in the elderly. Age-related alterations in both anatomy and neural micro-anatomy may make correct siting of any block technically more difficult, and drug effects less predictable [69], blockade being achieved with lower doses of local anaesthetic [70] and lasting longer [71].…”

Section: Local/regional Analgesiamentioning

confidence: 99%

The assessment and management of peri‐operative pain in older adults

Schofield

2013

Anaesthesia

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SummaryA number of recent reports have highlighted the inadequate provision of pain relief for older inpatients. Despite the availability of numerous validated pain measures, pain remains poorly assessed in some cases and, particularly, in the cognitively impaired. Without proper assessment, patients may receive inadequate or inappropriate analgesia, both of which can worsen outcome. Most drugs and techniques that are used for analgesia in younger patients are also suitable for older patients, although dosages may have to be adjusted to avoid the side‐effects that are consequent upon age‐related changes in drug pharmacokinetics and pharmacodynamics, co‐morbidity, frailty, cognitive impairment and polypharmacy. This paper reviews current guidelines and methods of assessing pain in the older adult, and describes the use of, and problems with, mild, moderate, strong, adjuvant and local anaesthetic drugs in the older population for analgesia, advocating multimodal intervention to reduce dose‐related side‐effects, particularly of opioids.

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Section: Local/regional Analgesiamentioning

confidence: 99%

The assessment and management of peri‐operative pain in older adults

Schofield

2013

Anaesthesia

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“…ASA status, as stated in the literature, correlates with perioperative mortality "even better than other classifi cations of mortality and morbidity" 7,8 . TEA is considered to exert some protective eff ect against POAF 9 . Arterial hypertension was not confi rmed as a risk factor for POAF, in contrast to the 2014 American Heart Association Atrial Fibrillation Guidelines and relevant literature 1,2,4 .…”

Section: Discussionmentioning

confidence: 99%

Postoperative Atrial Fibrillation Prophylaxis and Lung Resection – Our Experience with 608 Consecutive Patients

Karadža

Stančić-Rokotov

Macan

et al. 2017

acc

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SUMMARY -Postoperative atrial fi brillation is a common complication after lung resection. It is burdened by increased mortality and morbidity, prolonged hospitalization, and higher resource utilization in thoracic surgery patients. Th erefore, some kind of pharmacological prophylaxis is recommended. In our patients, diltiazem, a calcium antagonist, is administered. We collected data on all 608 patients having undergone lung resection (no less than lobectomy) between November 2012 and May 2015. Th is period included patients having received diltiazem during their postoperative stay in our Intensive Care Unit and surgical ward, and those that did not receive it. Patients having had atrial fi brillation before the surgery and patients with cardiac pacemaker were excluded from the trial. Other patients were divided into three groups: patients with some kind of antiarrhythmic therapy before and continued after the surgery; patients with diltiazem prophylaxis; and patients without any antiarrhythmic prophylaxis. Th e data collected were statistically analyzed. We found no statistically signifi cant diff erence in the incidence of postoperative atrial fi brillation among the groups (p<0.05).

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“…The number of patients was based on the literature 12 . To detect a difference of approximately 30% between groups, assuming an alpha error of 0.5% and a beta error of 20%, we estimated at 20 the required the number of patients in each group totaling 40 patients.…”

Section: Methodsmentioning

confidence: 99%

Analgesia pós-operatória: comparação entre infusão contínua de anestésico local e opioide via cateter peridural e infusão contínua de anestésico local via cateter na ferida operatória

Almeida

Locks

Gomes

et al. 2011

Rev. Bras. Anestesiol.

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Background and objectives:Continuous wound infusion has been investigated as a method of postoperative pain control and its efficacy has been demonstrated when compared to saline infusion. The objective of this study was to compare the quality of postoperative analgesia, the use of opioids as rescue analgesia, patient satisfaction, and the incidence of complications between epidural catheter infusion of local anesthetic and opioids and continuous wound infusion of local anesthetic.

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Regional techniques and outcome: what is the evidence?

Cited by 70 publications

References 60 publications

The assessment and management of peri‐operative pain in older adults

The assessment and management of peri‐operative pain in older adults

Postoperative Atrial Fibrillation Prophylaxis and Lung Resection – Our Experience with 608 Consecutive Patients

Analgesia pós-operatória: comparação entre infusão contínua de anestésico local e opioide via cateter peridural e infusão contínua de anestésico local via cateter na ferida operatória

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