English:
Adjuncts
The appreciation that postoperative pain may have a neuropathic element suggests that drugs other than conventional painkillers may be useful. The gabapentinoids (gabapentin and pregabalin) administered preoperatively have been evaluated in a number of surgical procedures including hysterectomy, lower limb arthroplasty and otorhinolaryngology. systematic reviews have demonstrated that they provide opioid-sparing and reduced opioid-related side-effects, and, in some studies. reduced pain scores, anxiolysis and anti-emetic effects.' Doses used ranged from 300 mg to 1200 mg administered about 2 hours before surgery. Side-effects. in general. are not troublesome although drowsiness may limit use in the day case setting. It is likely that these drugs will become widely used especially in those proce- dures where there is a high risk of neuropathic pain such as amputation. There is insufficient evidence so far to indicate whether these drugs should be continued postoperatively and for how long. and whether they reduce the incidence of chronic post. surgical pain.
The alpha-2 adrenergic agonist. clonidine. and the anaesthetic drug ketamine can both enhance pain control especially for those patients where more conventional approaches are ineffectual. Both can produce significant side-effects, however. Clonidine may cause bradycardia, hypotension and drowsiness while ket amine can cause sedation and dysphoria. For these reasons these drugs should be used in an environment where patients can be monitored closely and such side effects can be managed safely for example theatre recovery or the high-dependency unit.
English:
Adjuncts
The appreciation that postoperative pain may have a neuropathic element suggests that drugs other than conventional painkillers may be useful. The gabapentinoids (gabapentin and pregabalin) administered preoperatively have been evaluated in a number of surgical procedures including hysterectomy, lower limb arthroplasty and otorhinolaryngology. systematic reviews have demonstrated that they provide opioid-sparing and reduced opioid-related side-effects, and, in some studies. reduced pain scores, anxiolysis and anti-emetic effects.' Doses used ranged from 300 mg to 1200 mg administered about 2 hours before surgery. Side-effects. in general. are not troublesome although drowsiness may limit use in the day case setting. It is likely that these drugs will become widely used especially in those proce- dures where there is a high risk of neuropathic pain such as amputation. There is insufficient evidence so far to indicate whether these drugs should be continued postoperatively and for how long. and whether they reduce the incidence of chronic post. surgical pain.
The alpha-2 adrenergic agonist. clonidine. and the anaesthetic drug ketamine can both enhance pain control especially for those patients where more conventional approaches are ineffectual. Both can produce significant side-effects, however. Clonidine may cause bradycardia, hypotension and drowsiness while ket amine can cause sedation and dysphoria. For these reasons these drugs should be used in an environment where patients can be monitored closely and such side effects can be managed safely for example theatre recovery or the high-dependency unit.
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