{"title":"Non-opioid medication in pain medicine","authors":"Bharti Seth","doi":"10.1016/j.mpaic.2025.03.003","DOIUrl":"10.1016/j.mpaic.2025.03.003","url":null,"abstract":"<div><div>The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in such terms of such damage.” Analgesics can be broadly classified according to their role primarily on nociception as well as pain perception, both of which are intimately integrated to the pain experience. An understanding of the pain pathway is inherent to a good understanding of how therapeutic targets can act as analgesics. An overview is discussed in this article to understand the rationale for therapeutic intervention. Opioids are substances that act on opioid receptors to produce morphine-like effects. All other analgesics that do not produce analgesia through a primary effect on opioid receptors can be labelled as non-opioid analgesics (NOAs). Opioids increase the risk of addiction and overdose and there is limited evidence supporting their long-term use for chronic pain management. This article will aim to provide an overview of the pain pathway in relation to the therapeutic targets for providing analgesia, commonly used NAOs and their brief introduction.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 267-271"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medicines optimization in acute and chronic pain","authors":"Richard Berwick, Bernhard Frank","doi":"10.1016/j.mpaic.2025.01.003","DOIUrl":"10.1016/j.mpaic.2025.01.003","url":null,"abstract":"<div><div>Pain is a complex condition and warrants a multidisciplinary approach based on a bio-psycho-social model. Whilst often successful in acute pain, pharmacological treatment is rarely successful on its own in the management of chronic pain due to the high number of patients needed to treat to achieve a clinically meaningful improvement in function, quality of life and pain scores. There are also significant side effects in the short and long term. Recent re-analysis of clinic trial data focused on individual responder rates, showed that there is a cohort of patients who achieve 50% pain relief with subsequent improvement in physical function. To avoid intolerable side effects from medication used for chronic pain, titration needs to be slow and aimed towards the agreed risk benefit between patients and treating physician with a clear plan for weaning and cessation if these goals are not achieved. Pain-orientated physiotherapy, either on its own or as part of a pain management programme, should be offered and medication reduced or weaned after restoration of function has been achieved.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 272-280"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Opioids in pain medicine","authors":"Adam Green, Helen Laycock","doi":"10.1016/j.mpaic.2025.03.002","DOIUrl":"10.1016/j.mpaic.2025.03.002","url":null,"abstract":"<div><div>Opioids represent an important class of analgesic medication and are effective in moderate to severe acute and cancer pain management. Opioids bind to G protein coupled receptors leading to a variety of physiological effects, including analgesia. Choosing the most appropriate opioid for each individual patient will depend upon the opioids individual pharmacokinetics and pharmacodynamics, their actions across different physiological systems, side effect profiles, available routes of administration and patient factors that impact on drug efficacy. Appropriate governance and opioid stewardship is required to ensure safety and avoidance of misuse.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 260-266"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The genesis of pain","authors":"Mike Hudspith","doi":"10.1016/j.mpaic.2025.01.007","DOIUrl":"10.1016/j.mpaic.2025.01.007","url":null,"abstract":"<div><div>This article explores mechanisms that generate pain as a multidimensional and embodied construct rather than a simple sensory state. The shortcomings of existing models of pain will be considered alongside contemporary cognitive neuroscience theories of predictive processing, to provide a potential explanation of chronic pain states. The focus is an exploration of integrated corticothalamic-limbic processing as opposed to peripheral nociceptive mechanisms.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 235-239"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anxiolytics, sedatives and hypnotics","authors":"Stephanie Ruth Roberts, Oliver Harrison","doi":"10.1016/j.mpaic.2025.02.011","DOIUrl":"10.1016/j.mpaic.2025.02.011","url":null,"abstract":"<div><div>Anxiolytics, sedatives, and hypnotics play a pivotal role in modern clinical practice, facilitating procedures, managing anxiety, and ensuring adequate sedation in various healthcare settings. This article provides a comprehensive overview of their mechanisms of action, highlighting how these agents modulate central nervous system activity to achieve therapeutic effects. Benzodiazepines and α-2 adrenergic agonists are discussed as cornerstone agents, detailing their pharmacodynamic and pharmacokinetic profiles. The article further explores the properties of intravenous (IV) and inhalational anaesthetic agents, comparing their efficacy, onset, duration of action, and safety profiles. Special emphasis is placed on the clinical scenarios dictating the choice of agents, as well as considerations for patient-specific factors such as co-morbidities and procedural requirements. By integrating pharmacological insights with practical applications, this review aims to guide clinicians in the optimal use of anxiolytics, sedatives, and hypnotics, ensuring patient safety and procedural success.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 362-370"},"PeriodicalIF":0.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victoria Howell, Tom Bashford, Arthur Kwizera, Daphne K Kabatoro
{"title":"Tropical diseases and anaesthesia","authors":"Victoria Howell, Tom Bashford, Arthur Kwizera, Daphne K Kabatoro","doi":"10.1016/j.mpaic.2025.04.009","DOIUrl":"10.1016/j.mpaic.2025.04.009","url":null,"abstract":"<div><div>The range of infectious diseases encountered whilst working in resource-limited settings varies enormously depending on where in the world one is working, although the majority of low- and middle-income countries lie within the tropics. Human immunodeficiency virus (HIV), tuberculosis (TB) and malaria are commonly encountered when working in tropical countries and may have implications upon the conduct of anaesthesia, either as a direct result of the condition, or due to interaction with the drugs used in its management. Other infections, such as dengue, are less likely to be encountered in a patient undergoing anaesthesia but may be seen in patients in a high-dependency or intensive-care unit. Furthermore, the chronic effects of some of these diseases may impact upon anaesthesia or have complications that require surgery. It is essential therefore that the anaesthetist working within these populations has an appreciation of the tropical diseases that are endemic, set against the wider backdrop of a resource-limited population where malnutrition, poorly managed non-communicable disease and trauma may all complicate the clinical picture.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 379-384"},"PeriodicalIF":0.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regional anaesthesia for caesarean birth and what to do if it fails","authors":"Siobhan Williams, Danielle Eusuf","doi":"10.1016/j.mpaic.2025.02.005","DOIUrl":"10.1016/j.mpaic.2025.02.005","url":null,"abstract":"<div><div>Regional anaesthetic techniques are the commonest type of anaesthetic for caesarean birth primarily due to their safety profile compared to general anaesthesia in pregnant women. The selection of a regional technique is influenced by both patient and surgical factors. Caution is essential regarding the timing of regional anaesthesia in patients who are receiving anticoagulation or have clotting abnormalities. Information on the risks and benefits of regional anaesthesia should be provided to facilitate informed decision-making. Prior to any operative obstetric intervention a full blood count, group and save should be performed and antacid prophylaxis should be administered. A 15° left lateral tilt must be maintained until delivery along with implementation of strategies to manage hypotension. Confirmation of adequate anaesthesia and appropriate block height is required following the administration of the regional technique before initiating the surgery and plans for addressing potential failures of regional anaesthesia should be established. Breakthrough pain during the caesarean birth is a significant concern that must be recognized and managed. Intravenous fast-acting opioids may be employed, while other analgesic options include nitrous oxide, ketamine, and local anaesthetic infiltration. If effective analgesia is deemed unlikely through these alternative methods, general anaesthesia should be considered. Postoperative follow-up is crucial for identifying any complications related to regional anaesthesia and ensure sufficient postoperative pain management.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 308-313"},"PeriodicalIF":0.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurological complications in obstetric regional anaesthesia","authors":"Jennifer Watson, Nico Zin","doi":"10.1016/j.mpaic.2025.02.013","DOIUrl":"10.1016/j.mpaic.2025.02.013","url":null,"abstract":"<div><div>Central neuraxial blocks represent the most executed procedures in the field of obstetric anaesthesia. Most neurological complications observed in the post-partum period arise from obstetric palsies associated with the natural process of labour. It is crucial for anaesthetists to adopt a systematic methodology when evaluating neurological injuries to differentiate between causes related to anaesthesia and those that are not. Additionally, it is vital to promptly recognize circumstances that necessitate urgent investigation and intervention to avert lasting damage. Anaesthetists should possess a thorough understanding of the principles of safe practice while conducting a neuraxial block. This encompasses implementing recommended precautions to reduce the likelihood of neurological complications, such as assessing coagulation status, following infection control protocols, ensuring proper positioning and technique, maintaining effective communication with the patient throughout the procedure, and monitoring the resolution of the neuraxial block using regional anaesthesia bracelets. Moreover, anaesthetists must engage in a multidisciplinary approach to minimize risks by consulting with obstetricians, haematologists, and neurologists, as well as ensuring appropriate follow-up care and management for patients who are affected.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 314-320"},"PeriodicalIF":0.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Consent in obstetrics","authors":"Jack Hollinghurst, Paul McConnell","doi":"10.1016/j.mpaic.2025.02.006","DOIUrl":"10.1016/j.mpaic.2025.02.006","url":null,"abstract":"<div><div>Medical consent, the process of agreeing the benefits and risks of a treatment or procedure, has specific challenges in pregnancy and labour. Consent should take the form of a discussion about risk and include the alternatives. It should be an ongoing process with the right to withdraw consent or seek further information if the person chooses. Ideally all risks to which the patient might attach significance should be discussed. To consent, a person must have capacity. It is accepted that while labour can involve stress, pain, and fatigue, and will not infrequently be in a time-critical situation, women will normally retain the capacity to consent. This includes the right to make decisions outside of societal norms or which put at risk the life of herself or unborn child. In rare circumstances where an incapacitated woman requires medical intervention in pregnancy this should be done in accordance with appropriate legislation acting in the best interests of the mother.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 358-361"},"PeriodicalIF":0.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anaesthetic considerations for cardiac disease in pregnancy","authors":"Noha Tageldin, Kailash Bhatia","doi":"10.1016/j.mpaic.2025.02.004","DOIUrl":"10.1016/j.mpaic.2025.02.004","url":null,"abstract":"<div><div>Cardiovascular disease remains one of the leading causes of pregnancy-related mortality in the developed world. Preconception counselling is essential to highlight individualized maternal, fetal, and cardiac risks. Pregnant individuals with a high-risk cardiac condition should be managed by a multidisciplinary cardio-obstetrics team comprising a high-risk obstetrician, cardiologist, neonatologist, and an anaesthetist in a tertiary centre. Anaesthetists as peripartum physicians need to comprehend the haemodynamic changes occurring during pregnancy, labour and postpartum period which can exacerbate pre-existing cardiac conditions resulting in haemodynamic compromise. Individualized patient care plans that incorporate risk-stratification, advice on timing, location, mode of delivery, haemodynamic monitoring, use of uterotonics, recommended analgesia/anaesthesia techniques along with postpartum follow-up are recommended to optimize maternal and fetal outcomes in individuals with cardiac disease in pregnancy. Anaesthesia and analgesia should be integral components of the core outcome set in studies reporting maternal and fetal outcomes in pregnant individuals with cardiac disease.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 334-341"},"PeriodicalIF":0.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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