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Introduction: Postoperative pain is one of the common causes of increased postoperative morbidity and delayed recovery. Pain causes adverse effects such as hypertension, tachycardia, myocardial ischaemia, decreased alveolar ventilation, poor wound healing, and postoperative morbidity. Vitamin C and N-acetylcysteine (NAC), which is a novel co-analgesic, are being studied to reduce postoperative pain and opioid consumption. Aim: To study the effect of intravenous Vitamin C and NAC on postoperative surgical pain and opioid consumption after laparoscopic gynaecologic oncosurgeries. Materials and Methods: The present study was a randomised controlled study conducted at the Department of Anaesthesiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India on 300 patients of American Society of Anaesthesiologists (ASA) physical status 1 and 2 scheduled for laparoscopic Gynaeconcology surgery after obtaining written informed consent. All the selected patients were randomly allocated into three groups. Group P was the control group in Group N patients received intravenous injections of NAC (50 mg/kg) and vitamin C infusion (50 mg/kg) in Group C. Patients were explained about the visual analogue pain scale preoperatively. In the postoperative period, VAS scores were recorded and noted along with the rescue analgesics received and side-effects. Results: Haemodynamic variables were comparable among all three groups. The number of patients who had VAS scores of more than 4 was lower in group C (Vitamin C) at various time intervals when compared to the NAC and placebo groups. It was also statistically significant at 45 minutes, 60 minutes, 90 minutes, 150 minutes, 180 minutes, 300 minutes, and 10 hours (p-value=0.014,

Purpose of the Review: Acute postoperative pain impacts a significant number of patients and is associated with various complications, such as a higher occurrence of chronic postsurgical pain as well as increased morbidity and mortality. Recent Findings: Opioids are often used to manage severe pain, but they come with serious adverse effects, such as sedation, respiratory depression, postoperative nausea and vomiting, and impaired bowel function. Therefore, most enhanced recovery after surgery protocols promote multimodal analgesia, which includes adjuvant analgesics, to provide optimal pain control. In this article, we aim to offer a comprehensive review of the contemporary literature on adjuvant analgesics in the management of acute pain, especially in the perioperative setting. Summary: Adjuvant analgesics have proven efficacy in treating postoperative pain and reducing need for opioids. While ketamine is an established option for opioid-dependent patients, magnesium and α2-agonists have, in addition to their analgetic effect, the potential to attenuate hemodynamic responses, which make them especially useful in painful laparoscopic procedures. Furthermore, α2-agonists and dexamethasone can extend the analgesic effect of regional anesthesia techniques. However, findings for lidocaine remain inconclusive. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative pain is one of the common causes of increased postoperative morbidity and delayed recovery. Pain causes adverse effects such as hypertension, tachycardia, myocardial ischaemia, decreased alveolar ventilation, poor wound healing, and postoperative morbidity. Vitamin C and N-acetylcysteine (NAC), which is a novel co-analgesic, are being studied to reduce postoperative pain and opioid consumption. Aim: To study the effect of intravenous Vitamin C and NAC on postoperative surgical pain and opioid consumption after laparoscopic gynaecologic oncosurgeries. Materials and Methods: The present study was a randomised controlled study conducted at the Department of Anaesthesiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India on 300 patients of American Society of Anaesthesiologists (ASA) physical status 1 and 2 scheduled for laparoscopic Gynaeconcology surgery after obtaining written informed consent. All the selected patients were randomly allocated into three groups. Group P was the control group in Group N patients received intravenous injections of NAC (50 mg/kg) and vitamin C infusion (50 mg/kg) in Group C. Patients were explained about the visual analogue pain scale preoperatively. In the postoperative period, VAS scores were recorded and noted along with the rescue analgesics received and side-effects. Results: Haemodynamic variables were comparable among all three groups. The number of patients who had VAS scores of more than 4 was lower in group C (Vitamin C) at various time intervals when compared to the NAC and placebo groups. It was also statistically significant at 45 minutes, 60 minutes, 90 minutes, 150 minutes, 180 minutes, 300 minutes, and 10 hours (p-value=0.014, <0.001, <0.001, <0.001, 0.003, 0.005, 0.006, respectively). Postoperative opioid consumption was significantly reduced in group C (Vitamin C) compared to the other two groups (p-value <0.001). Conclusion: Intraoperative Vitamin C usage reduced postoperative pain and fentanyl consumption in the postoperative period, and NAC can be used as a part of multimodal analgesia. [ABSTRACT FROM AUTHOR]

Treatment for pain syndromes is one of the most relevant areas of modern medicine, which is of high social, economic and, individual importance. One of the most difficult questions is therapy for chronic pain (CP). This therapy should be based on a thorough analysis of the causes of pain. It is necessary to use combinations of drugs that potentiate the analgesic effects of each other and have a low risk of complications. The concept of adjuvant analgesics as one of the promising areas of treatment for chronic kidney disease is discussed.

To provide an overview of the pharmacologic management of cancer pain. Peer-reviewed articles, textbooks, Internet. Medications are the mainstay of cancer pain management. Evidence exists for multimodal use of opioids, non-opioids, and co-analgesics to optimally manage cancer pain. Oncology nurses are the front line of pharmacologic pain management for patients. Patient education regarding analgesic administration and potential side effects is paramount to optimizing safe and effective pain management. [ABSTRACT FROM AUTHOR]

Corticosteroids are commonly used as co-analgesics with opioids for cancer pain; however limited quality data exist supporting their efficacy for this purpose. Further, little is known about individual prescribing practices. The current study surveyed members of the Australian New Zealand Society of Palliative Medicine about their use of corticosteroids as adjuvant analgesics in cancer pain. It confirmed high rates of utilisation and found variability in starting doses and associated decision-making. Further research is required to determine the efficacy and safety of corticosteroids as co-analgesics in cancer pain management. [ABSTRACT FROM AUTHOR]

The pain medication more often as co-analgesics are used antiepileptic drugs and antidepressants. In clinical practice, they may come to adverse interactions with other drugs, and the consequence of these interactions can be reduced efficacy and increased risk of adverse events. The paper presents the most important interactions in clinical practice, antidepressant and antiepileptic drugs used in pain pharmacotherapy to treat pain. [ABSTRACT FROM AUTHOR]

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Pain ranges in prevalence from 14–100% among cancer patients and occurs in 50–70% of those in active treatment. Cancer pain may result from direct invasion of tumor into nerves, bones, soft tissue, ligaments, and fascia, and may induce visceral pain through distension and obstruction. Cancer pain is multifaceted. Clinicians may describe cancer pain as acute, chronic, nociceptive (somatic), visceral, or neuropathic. Despite implementation of the WHO guidelines, reports of undertreatment of cancer pain persist in various clinical settings and in spite of decades of work to reduce unnecessary discomfort. Substantial obstacles to adequate pain relief with opioids include specific concerns of patients themselves, their family members, physicians, nurses, and the healthcare system. The WHO analgesic ladder serves as the mainstay of treatment for the relief of cancer pain in concert with tumoricidal, surgical, interventional, radiotherapeutic, psychological, and rehabilitative modalities. This multidimensional approach offers the greatest potential for maximizing analgesia and minimizing adverse effects. Primary therapies are directed at the source of the cancer pain and may enhance a patient's function, longevity, and comfort. Adjuvant therapies include nonopioids that confer analgesic effects in certain medical conditions but primarily treat conditions that do not involve pain. Nonopioid medications (over-the-counter agents) are useful in the management of mild to moderate pain, and their continuation through step 3 of the WHO ladder is an option after weighing a drug's risks and benefits in individual patients. Symptomatic treatment of severe cancer pain should begin with an opioid, regardless of the mechanism of the pain. They are very effective analgesics, titrate easily, and offer a favorable risk/benefit ratio. Cancer pain remains inadequately controlled despite the diagnostic and therapeutic means of ensuring that patients feel comfortable during their illness. Therefore, all practitioners need to make control of cancer pain a professional duty, even if they can only use the most basic and least expensive analgesic medications, such as morphine, codeine, and acetaminophen, to reduce human suffering. [ABSTRACT FROM AUTHOR]

Copyright of Douleur et Analgésie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The treatment received by 158 patients with advanced cancer admitted over one year to the Continuing Care Unit at the Royal Marsden Hospital has been reviewed. The unit is an integral part of the hospital and this is reflected in the fact that 46 patients (29%) received radiotherapy, hormone therapy, chemotherapy or surgery in addition to symptomatic treatment for palliation of troublesome symptoms. One hundred and thirty-one patients received oral morphine in doses ranging from 2.5 mg 4-hourly to 700 mg 4-hourly. Patients with renal or hepatic impairment required lower doses of morphine and there was a highly significant inverse relationship between morphine dose and age. Eighty-five patients (54%) received parenteral diamorphine at some time due to their inability to take oral morphine. One hundred and twenty-three patients (78%) received a co-analgesic drug and anti-emetics were required by 78 patients (49% overall; 56% of those receiving morphine). Transcutaneous electrical nerve stimulation, acupuncture and relaxation were employed in selected patients, and graduated compression sleeves were used to treat lymphoedema. These data highlight the wide range of therapeutic options available to control the symptoms of advanced cancer and also indicate that tumoricidal treatments used in conjunction with symptomatic treatments may have a significant part to play. [ABSTRACT FROM AUTHOR]

Introduction: Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain., Areas Covered: The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based. The principles are a stepladder approach using non-opioids, weak and then strong opioids. In addition, adjuvants can be added at any step to address specific situations such as bone or neuropathic pain. Patients, even if they are on long-acting opioids, need to be provided with immediate-release opioids for breakthrough pain. In case of inefficacy or severe adverse effects of one opioid, rotation to another opioid is recommended., Expert Opinion: There is a major need for more and better randomized controlled trials in the setting of cancer pain as the lack of evidence is hampering the improvement of current treatment guidelines.