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Transdermal fentanyl for cancer pain

Fentanyl patches placed on the skin produced good pain relief for most people with moderate or severe cancer pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Fentanyl for neuropathic pain in adults

There is no good evidence to support or refute the suggestion that fentanyl works in any neuropathic pain condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Intranasal fentanyl for the treatment of children in acute pain

Pain is the most common reason why patients are seen in emergency departments (EDs). The challenging nature of treating children in acute severe pain is reflected in the medical literature by poor pain management in this population. We reviewed evidence on the effect of intranasal fentanyl (INF) (a strong pain relief drug, similar to morphine) compared with any other pain‐relieving technique for treatment of children in acute severe pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain

Care pathways are packages of care designed to ensure that patients have appropriate and effective care in particular situations. Such pathways are commonly used, and often produce good results, but they can also be used as a tick box solution that acts as a barrier to good care. Care pathways have been used to ensure appropriate care for people who are dying in hospice settings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Local anaesthetic nerve block for pain management in labour

Most women find labour painful, although a few do not. Women who give birth more than once, can find very different levels of pain in their different labours. Women generally seek ways to help themselves cope with the labour, and some women look for additional help to manage the pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Drugs for preventing headache after a lumbar puncture

Lumbar puncture is an invasive procedure that medical personnel use to get a sample of cerebrospinal fluid for diagnostic purposes (e.g. to diagnose meningitis or subarachnoid haemorrhage) by inserting a needle into the lower spinal region. It can also be used to inject medications such as anaesthetics and analgesics (to perform regional anaesthesia), chemotherapy or radiological contrast agents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Use of drug and non‐drug interventions to reduce pain associated with rocuronium bromide injection in patients undergoing general anaesthesia

Rocuronium bromide is a muscle relaxant used as part of general anaesthesia for surgery. Muscle relaxants are used to relax the muscles of the airway to enable endotracheal intubation (placing a breathing tube in the windpipe to support the airway while the person is unconscious) and to facilitate the surgery. However, rocuronium bromide can cause intense pain as it is injected in some people. We wanted to find out whether giving another drug, such as a painkiller or another anaesthetic, or a non‐drug intervention, such as diluting the rocuronium, would be useful in reducing the pain experienced by some people on injection of rocuronium.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Does the perioperative administration of tramadol provide effective and safe postoperative analgesia in children?

Children experience pain after surgery (‘postoperative pain’) and according to recently published trials the management of this pain is of major concern. A combination of drugs may be the best way to treat postoperative pain, for example drugs called ‘opioids’, like morphine and codeine. However, there are concerns about severe side effects (adverse events) when using opioids. Tramadol is a weak opioid that is used worldwide to treat children with moderate to severe acute or chronic pain. Tramadol can be given to children before surgery to help reduce pain afterwards. It is believed that tramadol administration might be associated with a lower risk for respiratory or haemodynamic depression and might therefore be the ideal analgesic drug for children in the perioperative period. Our systematic review assessed the efficacy and adverse events of tramadol administration compared to placebo or other opioids. In July 2014 we found 20 small randomised controlled trials involving 1170 patients. These small trials had limited data but tramadol may be better than placebo. In five trials, mostly preschool children undergoing minor surgery (for example tonsillectomy) were treated with tramadol or placebo before the start of surgery. Children needed less rescue medication in the postoperative care unit when given tramadol, indicating better analgesia with tramadol. Due to the low amount of usable data, the evidence focusing on the comparison of tramadol with other opioids (for example morphine, nalbuphine, pethidine, fentanyl) is currently unclear. Adverse events were generally only poorly reported in the trials so that the side effects as a result of tramadol administration were not clear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Dexmedetomidine for prevention of acute pain after abdominal surgery in adults

Acute pain after surgery is a problem for patients undergoing abdominal surgery. In addition to postoperative pain, the side effects of treatment with pain killers, in particular those of opioids (drugs resembling morphine), need to be reduced. Dexmedetomidine is an opioid sparing drug (reduces the need for opioids). We reviewed the evidence about the effectiveness of dexmedetomidine in reducing the need for opioids and in preventing acute pain after abdominal surgery in adults. We wanted to discover how safe dexmedetomidine was and whether it was effective in preventing some of the known side effects of opioids, such as nausea and vomiting, reduced bowel function and delayed mobilization (getting up and moving around) after abdominal surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Is dexmedetomidine a good option for patients undergoing awake fibreoptic intubation?

This is a review of the clinical evidence from randomized controlled trials on the effect of dexmedetomidine in the management of awake fibreoptic intubation. The review was conducted by researchers in The Cochrane Collaboration. Awake fibreoptic intubation (AFOI) is indicated for the management of patients with a difficult or unstable (critical) airway, such as those with airway deformity or tumour, airway injury or spinal cord instability. It is necessary in such a situation to maintain patient co‐operation and reduce patient anxiety without causing severe adverse effects during the AFOI. Many agents, including fentanyl, remifentanil, midazolam and propofol, have been reported to assist with AFOI. However, these agents can cause respiratory arrest, loss of airway control or reduced cardiovascular (heart) function, especially when used in high doses, thus increasing the risk of low oxygen levels (hypoxaemia), aspiration, low blood pressure (hypotension) or slow heart rate (bradycardia).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Comparison of propofol (an anaesthetic drug) with other drug options for sedating people undergoing painful procedures in emergency departments

Propofol is a drug frequently used as a general anaesthetic to sedate (calm) people for surgery in the operating theatre. It is administered into a vein. There is increasing evidence that propofol can be used outside of the operating theatre to sedate people undergoing painful procedures (e.g. when relocating a joint that is out of its normal position because of an injury) in the emergency department (ED) setting.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Systemic drugs for the prevention of chronic pain after surgery

Pain associated with surgery generally resolves within one to two weeks, however in some situations surgical patients are left with longstanding pain for months or even years after the surgical procedure. Researchers have studied the ability of various drug treatments to prevent the development of chronic pain after surgery and this systematic review evaluated published studies in this field. Available studies suggest a modest effect of ketamine, compared to placebo, for prevention of chronic pain after surgery, however small study size could lead to an overestimation of this effect. Studies of other drugs such as gabapentin and pregabalin did not suggest the same preventative effect. Additional large studies using improved research methods are necessary to more clearly identify treatments that are beneficial for preventing chronic postsurgical pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Opioids for abdominal pain in acute pancreatitis

The pancreas is a gland behind the stomach and close to the first part of the small intestine. It produces digestive juices, amylase, secreted into the small intestine and releases hormones, insulin and glucagon, into the bloodstream. Acute pancreatitis refers to a sudden inflammation of the pancreas. It happens when digestive juices become active inside the pancreas, causing swelling, bleeding and damage to the pancreas and its blood vessels. It is a serious condition and can lead to further problems. Common symptoms are severe pain in the upper abdomen, nausea, and vomiting. Treatment is usually a few days in hospital for fluids, antibiotics, and medicines to relieve pain, delivered by drip.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Agitation in children after sevoflurane anaesthesia

We reviewed the evidence looking at how often children wake up agitated after a sevoflurane general anaesthetic compared with other general anaesthetics. We also reviewed evidence looking at the effects of other treatments (e.g. a medication given during the anaesthetic, the presence of a parent when a child wakes up) on how often children wake up agitated after receiving a sevoflurane anaesthetic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Morphine injections for pain relief after knee arthroscopy

Knee arthroscopy is a surgical procedure on the knee. The surgery is minimally invasive, which means that only a small cut (incision) is needed. An examination, and sometimes treatment, of damage is performed using an arthroscope, which is inserted into the joint through the small incision. Knee arthroscopy is used to assess or treat many orthopaedic (musculoskeletal) conditions, and patients may have pain after surgery. Morphine injected directly into the knee (intra‐articular morphine) to relieve pain has been widely studied, but we do not know how well it works.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Opioids for agitation in dementia

Opioids (such as morphine and codeine) are strong painkillers best known as treatments for post‐surgical and cancer pain. They are also used for long‐term painful conditions other than cancer and sometimes for symptoms other than pain. They have a number of important adverse effects and their use involves a balance of risks and benefits.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Clonidine premedication for postoperative pain in children

We reviewed the evidence about the effect of giving clonidine before anaesthesia (that is, as a premedication) on postoperative pain in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Methadone for long‐term non‐cancer pain

The three studies included in our review provide very limited evidence of the effectiveness of methadone for chronic non‐cancer pain. We were unable to combine results statistically, and there were too few participants in each study to be confident in their results. No conclusions can be made regarding differences in effectiveness or side effects between methadone and placebo, other opioids, or other treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Buprenorphine for treating people with cancer pain

Buprenorphine produced good pain relief for most people with moderate or severe cancer pain, but its role in the treatment of cancer pain is still unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Reducing prescribed opioid use in chronic non‐cancer pain

About 1 in 5 adults suffer from moderate or severe chronic pain that is not caused by cancer. Some people with this type of pain are treated with opioids (typically with drugs like morphine, codeine, oxycodone, fentanyl, or buprenorphine, either as tablets or as patches placed on the skin). It is not unusual for this medication to be ineffective or to stop working over time, and, sometimes, effective pain relief is not achieved despite doses being increased. Stopping using opioid drugs is not easy, especially when they have been used for some time, because stopping abruptly can cause unpleasant side effects. This review looked for high quality studies (randomised controlled trials) of treatments to help people safely stop taking opioids prescribed for their pain. Only two studies were found, and they investigated only 86 people. No conclusions can be drawn from this small amount of information. Non‐randomised studies, not included in this review, do indicate that in most people intensive rehabilitation packages can bring about major reduction in opioid use. Reducing prescribed opioid use in chronic non‐cancer pain is an important topic in need of more research.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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