British Journal of Pain最新文献

{"title":"Deprescribing opioids post-surgery - whose responsibility is it?","authors":"Neetu Bansal","doi":"10.1177/20494637231154370","DOIUrl":"https://doi.org/10.1177/20494637231154370","url":null,"abstract":"As a surgical pharmacist on the wards, I recall numerous heart-sinking occasions reviewing the medication of patients admitted to the hospital for a different complaint but still taking opioids initially prescribed during their previous admission for surgery. The question arises repeatedly in discussions with colleagues – whose responsibility is it to deprescribe opioids commenced post-operatively? Although opioids remain themainstay of post-operative pain management following both minor and major surgical procedures, there is a lack of robust evidence-based literature to guide the optimal analgesicmedicine use (type and duration) and effective deprescribing strategies postdischarge. Opioid prescriptions after surgery are a risk factor for subsequent opioid dependence, whichmay be as high as 6.5% in previously opioid naı̈ve patients. Currently, in the UK, we lack knowledge of the true prevalence of long-term opioid use after surgery. With more complex surgical procedures being undertaken as a day case or short stay and the introduction of enhanced recovery programmes resulting in a shorter post-operative length of hospital stay, patients are no longer being fully weaned off their analgesics by the time of hospital discharge. The responsibility for managing post-operative analgesia may change hands from the surgeon to primary care without exploring the reasons for ongoing opioid therapy. Furthermore, discharging patients home with opioids poses a risk of unused opioids at home, hence the risk of illicit diversion to friends and family who may describe pain. In 2021, the UK Faculty of Pain Medicine issued guidance around the best practice of opioids and surgery. This document states that all healthcare professionals involved in surgery and peri-operative care must collaborate to ensure robust opioid stewardship. Currently, there is a lack of national guidance on perioperative opioid prescribing. Furthermore shared decision-making in healthcare has been around for a long time. Increasing evidence has shown involving patients in decisions around their care leads to positive outcomes, and it is imperative to ensure peri-operative plans are drawn up collaboratively with patients. A collaborative effort of all healthcare teams across the secondary and primary care interfaces is needed to promote opioid stewardship.The focus should be on effectivewritten communication to GPs on opioid tapering plans and any perceived problems and ensuring patients are providedwith written information in the form of leaflets/pamphlets The emphasis should also be on all healthcare teams reciting the same mantra with opioid use and ensuring appropriate review at every encounter with the patient.","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"17 1","pages":"4-5"},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9940256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10823596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain management for people with dementia: a cross-setting systematic review and meta-ethnography.","authors":"Toby O Smith,&nbsp;Dawn Lockey,&nbsp;Helen Johnson,&nbsp;Lauren Rice,&nbsp;Jay Heard,&nbsp;Lisa Irving","doi":"10.1177/20494637221119588","DOIUrl":"https://doi.org/10.1177/20494637221119588","url":null,"abstract":"<p><strong>Background: </strong>Pain management for people with dementia is challenging. There is limited understanding on the experiences of pain management from people with dementia, but also from those who support them. This study synthesised the qualitative evidence to explore the perspectives of people with dementia, their family, friends, carers and healthcare professionals to pain management.</p><p><strong>Methods: </strong>A systematic literature review was undertaken of published and unpublished literature databases (to 01 November 2021). All qualitative research studies reporting the perspectives of people with dementia, their family, friends, carers and healthcare professionals to managing pain were included. Eligible studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative appraisal tool. A meta-ethnography analysis approach was adopted, with findings assessed against the GRADE-CERQual framework.</p><p><strong>Results: </strong>Of the 3994 citations screened, 33 studies were eligible. Seven themes were identified from the data. There was moderate evidence from six studies indicating inequity of pain management for people with dementia. There was moderate evidence from 22 studies regarding anxieties on cascading pain information. There was moderate evidence from nine studies that familiarisation of the person with pain, their preferences, routines and behaviours were key factors to better pain management. Consistently, carers and healthcare professionals had a low opinion of the management of pain for people with dementia, with tensions over the 'best' treatment options to offer. This was associated with poor training and understanding on how pain 'should' be managed.</p><p><strong>Conclusion: </strong>The findings highlight the challenges faced by people with dementia and pain, and those who support them. Improvements in education for people who support these individuals would be valuable across health and social care pathways. Supporting family members and relatives on pain experiences and treatment options could improve awareness to improve quality of life for people with dementia and pain and those who support them.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"17 1","pages":"6-22"},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9940246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10823602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous conditioned serum for chronic pain in patients with osteoarthritis: A feasibility observational study.","authors":"Mariachiara Ippolito, Giulia Spurio, Viviana Compagno, Alessandra Rizzo, Marta Di Simone, Anna Maria Corsale, Giuseppina Mazzola, Antonino Giarratano, Serena Meraviglia, Andrea Cortegiani, Antonietta Alongi","doi":"10.1177/20494637221134169","DOIUrl":"10.1177/20494637221134169","url":null,"abstract":"<p><strong>Background: </strong>Autologous conditioned serum is a product of blood origin, with fragmented evidence of therapeutic properties in osteoarthritis chronic pain. This pilot observational prospective study aimed to evaluate the feasibility of a treatment with conditional autologous serum (ACS) in patients with severe chronic pain and grade I-III osteoarthritis and to describe its cytokine content.</p><p><strong>Methods: </strong>We prospectively collected data on consecutive patients affected by osteoarthritis grade I to III and treated with four weekly injections of ACS at our outpatient pain service. The primary outcome was pain intensity, measured with the visual analogic scale (VAS). Additional outcomes were symptoms evaluated using joint district-specific scales. The study also evaluated concentrations of 48 cytokines and chemokines involved in the balance pro-inflammation/anti-inflammation and tissue repair in the ACS.</p><p><strong>Results: </strong>We included 26 patients, mostly female (65.4%), with a median age of 63.5 years [IQR 58.25-73]. A median reduction of VAS of -3 cm [-5; -1.25] was observed 6 months after the first injection of ACS. The analysis showed a statistically significant difference between the values of VAS (<i>p</i> < .01; X² = 69.6; df = 6, <i>N</i> = 26) at the different time points. No adverse events were observed or reported by patients during the entire study period.</p><p><strong>Conclusions: </strong>Conditional autologous serum may be a feasible option for patients with chronic pain due to grade I-III osteoarthritis refractory to other treatments. These preliminary findings should be confirmed in studies with adequate design.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"17 1","pages":"103-111"},"PeriodicalIF":1.8,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9940252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10765178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selected abstracts from the Welsh Pain Society – Annual Scientific Meeting 2022","authors":"","doi":"10.1177/20494637221148288","DOIUrl":"https://doi.org/10.1177/20494637221148288","url":null,"abstract":"","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"17 1","pages":"330 - 331"},"PeriodicalIF":1.8,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48530604","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":"Educating and engaging a new target audience about the problem of pain for society.","authors":"Elizabeth Devonshire, Stella Dodds, Daniel Costa, Rebecca Denham, Kylie Fitzgerald, Carl R Schneider","doi":"10.1177/20494637221116560","DOIUrl":"10.1177/20494637221116560","url":null,"abstract":"<p><p><b>Background:</b> Pain education initiatives are typically targeted at health professionals, with less attention being placed on the education of other target audiences. Recent curriculum changes across undergraduate liberal studies degree programs at The University of Sydney presented an opportunity to develop an online course entitled Health Challenges: Pain and Society, which was aimed at a non-traditional target audience. To promote student engagement about the problem of pain for society, the course was designed using the Community of Inquiry framework. <b>Research Design:</b> This paper reports on an Educational Design Research study, investigating the effectiveness of the course in engaging students across two cohorts, in 2019 and 2020. <b>Data Collection:</b> Learning analytics were collected from the Learning Management System each year. The level of student engagement in non-assessable tasks was measured using multiple linear regression. Students' degree type and majors were recorded. In 2020, the quality of student workbook responses was recorded. <b>Results:</b> In both cohorts, engagement with the workbooks was a predictor of academic achievement. In 2020, a significant interaction effect between quantity and quality of engagement was observed. <b>Conclusions:</b> Our findings highlight the importance of designing online learning to facilitate successful engagement for non-traditional target audiences about the issue of chronic pain for society.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"16 6","pages":"641-650"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40723203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The patient acceptability of a remotely delivered pain management programme for people with persistent musculoskeletal pain: A qualitative evaluation.","authors":"Gregory Booth, Sonia Zala, Chloe Mitchell, Roxaneh Zarnegar, Andrew Lucas, Anthony W Gilbert","doi":"10.1177/20494637221106411","DOIUrl":"10.1177/20494637221106411","url":null,"abstract":"<p><strong>Introduction: </strong>Remotely delivered pain management programmes have been offered in place of in-person programmes by many chronic pain services since the onset of the COVID-19 pandemic. There is a lack of evidence regarding the acceptability of these programmes. In this evaluation, we have explored patients' acceptability of a remotely delivered pain management programme for patients with persistent musculoskeletal pain.</p><p><strong>Methods: </strong>Qualitative data were collected using focus groups with participants who had previously attended the remote pain management programme. Data were analysed using abductive analysis.</p><p><strong>Results: </strong>Three focus groups were conducted with a total of 13 participants. The programmme was either entirely acceptable, had some acceptable components or was not acceptable to patients. Factors leading to the programme being acceptable include learning to manage pain from home, receiving high quality care from home, enhancing the potential of rehabilitation using technology, enabling attendance on a pain management programme from home, overcoming social distancing requirements of COVID-19 using technology, and virtual peer support. Factors leading to the programme not being acceptable include having an inappropriate home environment for virtual therapy, communication challenges with virtual therapy, technological issues and concerns regarding the quality of care.</p><p><strong>Conclusions: </strong>There is a spectrum of acceptability with respect to the remote programme. The factors that influence this are dynamic, individual and situational. Hybrid programmes have the potential to enhance access to pain management programmes and improve patient experience and programme outcomes in the future.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"16 6","pages":"581-592"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40723201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is dihydrocodeine the ideal opioid for use after discharge from hospital?","authors":"Nicholas Levy","doi":"10.1177/20494637221141177","DOIUrl":"10.1177/20494637221141177","url":null,"abstract":"It is now recognised that there is a global prescribed opioid crisis, and that this crisis has many causes. One of these causes is the benevolent action of medical staff in treating patients with acute pain, who then transition to chronic opioid users/misusers. To try and prevent this transition, there are multiple guidelines that now promote opioid stewardship to mitigate the harms from prescribed opioids. And whilst they all promote the regular administration of simple analgesics, there is no consensus on the ideal opioid to be used on discharge from hospital. This is probably due to the complexity of the issue, and the heuristics of prescribers. However, it is acknowledged that various pharmacological properties of the opioids increase the risk of opioid dependence and other adverse drug events. These properties are multiple and can be categorised (Table 1). Conversely, the opioid must also be effective, and prodrugs that are subject to genetic polymorphism for activation and have an unpredictable analgesic activity should probably be avoided. This is because the individual patient may not experience the intended analgesic benefit. No single opioid is devoid of all these adverse properties. However, from an academic exercise it does appear that dihydrocodeine 30 mg in a pack size of 28 tablets has the least number of intrinsic pharmacological adverse properties. Furthermore, dihydrocodeine is the recommended opioid for lactating mothers on discharge from hospital after operative delivery. This is because it is minimally metabolised to further active compounds, unlike codeine and tramadol, and it causes less neonatal sedation than codeine, tramadol and oxycodone. It is also noteworthy that following a literature review, dihydrocodeine became an essential component of the discharge medication for day-case lower limb arthroplasty service at a major London teaching hospital. An additional advantage of dihydrocodeine 30 mg is that it is a schedule 5 CD. This means that it can be stocked and dispensed from clinical areas such as Accident and Emergency, the delivery ward, day surgery units and other surgical wards, thus facilitating patient flow. Nevertheless, whichever opioid is prescribed, the prescriber has a responsibility to ensure that the principles of opioid stewardship are adhered to and that the patient is presented with both verbal and written information. This information includes having a plan for discontinuation; safe disposal of unused opioids; the promotion of a short duration of opioid use; and the avoidance of drug driving, repeat prescriptions and opioid diversion. This important patient safety","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"16 6","pages":"578-580"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic potential of macrodoses and microdoses of classical psychedelics in chronic pain sufferers: a population survey.","authors":"Valerie Bonnelle, Will J Smith, Natasha L Mason, Mauro Cavarra, Pamela Kryskow, Kim Pc Kuypers, Johannes G Ramaekers, Amanda Feilding","doi":"10.1177/20494637221114962","DOIUrl":"10.1177/20494637221114962","url":null,"abstract":"<p><p>Although several studies and reports have shown the potential analgesic use of serotonergic psychedelics in cancer pain, phantom limb pain and cluster headache, evidence supporting their use for chronic pain is still limited. The past years have seen a considerable renewal of interest toward the therapeutic use of these compounds for mood disorders, resulting in a marked increase in the number of people turning to psychedelics in an attempt to self-medicate a health condition or improve their wellbeing. In western countries particularly, this population of users overlaps substantially with chronic pain sufferers, representing a unique opportunity to evaluate the effects these compounds have on pain and wellbeing. Here, we report results from an online survey conducted between August 2020 and July 2021 in a population of 250 chronic pain sufferers who had experience with psychedelics, either in microdoses (small sub-hallucinogenic doses), macrodoses (hallucinogenic doses), or both. Macrodoses, while less often used for analgesic purposes than microdoses, were reported to induce a higher level of pain relief than both microdoses and conventional pain medications (including opioids and cannabis). Although the effects were weaker and potentially more prone to expectation bias than with macrodoses, our results also suggested some benefits of psychedelics in microdoses for pain management. The reported analgesic effect appeared unrelated to mood improvements associated with psychedelic use, or the advocacy of psychedelic use. Taken together, our findings indicate interesting potential analgesic applications for psychedelics that warrant further clinical research.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"16 6","pages":"619-631"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost effectiveness of virtual reality game compared to clinic based McKenzie extension therapy for chronic non-specific low back pain.","authors":"Francis Fatoye,&nbsp;Tadesse Gebrye,&nbsp;Chidozie Emmanuel Mbada,&nbsp;Clara T Fatoye,&nbsp;Moses O Makinde,&nbsp;Salami Ayomide,&nbsp;Blessing Ige","doi":"10.1177/20494637221109108","DOIUrl":"https://doi.org/10.1177/20494637221109108","url":null,"abstract":"<p><strong>Background: </strong>Low-back pain (LBP) is a major public health problem globally and its direct and indirect healthcare costs are growing rapidly. Virtual reality involving the use of video games or non-game applications are alternatives to conventional face-to-face physical therapy for LBP. The purpose of this study was to assess the cost-effectiveness of Back Extension-Virtual Reality Game (BE-VRG) compared to Clinic-based McKenzie therapy (CBMT) for chronic non-specific LBP in Nigeria.</p><p><strong>Methods: </strong>Patients with chronic non-specific LBP were randomised into either BE-VRG or CBMT group. Patients' level of disability was assessed using Oswestry Disability Index (ODI) at week 4 and week 8. ODI was mapped to SF-6D to generate quality adjusted life years (QALYs) used for cost-effectiveness analysis. Resource use and costs were assessed based on rehabilitation services from a healthcare perspective. Cost-effectiveness analysis which included direct healthcare costs was conducted. Incremental cost per QALY was also calculated.</p><p><strong>Results: </strong>Forty-six patients (BE-VRG, <i>n</i> = 22; CBMT, <i>n</i> = 24) with the mean (±SD) age of 32.6 ± (11.5) years for BE-VRG and 48.8 ± (10.2) years for CBMT intervention completed in this study. The mean direct health costs per patient were USD100.67 and USD106.3 for BE-VRG and CBMT, respectively. The mean quality adjusted life years at week 4 and week 8 were (BE-VRG, 0.0574 ± (0.002); CBMT, 0.0548 ± (0.002)); and (BE-VRG; 0.116 ± (0.002); CBMT; 0.114 ± (0.004)), respectively. Incremental cost-effectiveness ratio showed that BE-VRG arm was less costly and more effective than CBMT.</p><p><strong>Conclusion: </strong>The findings of this study suggest that BE-VRG was cost saving for chronic non-specific LBP compared to CBMT. This evidence could guide policy makers, payers and clinicians in evaluating BE-VRG as a treatment option for people with chronic non-specific LBP.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"16 6","pages":"601-609"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40723204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-shot spinal diamorphine for laparoscopic nephrectomy: A retrospective study.","authors":"R Vicary-Watts, K Hall, O Passmore-Szilagyi, B Zelhof","doi":"10.1177/20494637221115926","DOIUrl":"10.1177/20494637221115926","url":null,"abstract":"<p><p>Single-shot spinal diamorphine is becoming common practice in urological surgery to aid post-operative pain; however, its safety and efficacy require investigation. This study is a retrospective analysis of 113 laparoscopic or robotic-assisted nephrectomies over 4 years under one consultant urologist. Data were collected on demographic, pre-operative scores, anaesthesia, surgical information, post-operative outcomes and opioid consumption. Two main groups were established: no spinal diamorphine (NSD) and spinal diamorphine (SD). Four subgroups were then created, separating those who received patient-controlled anaesthesia (PCA) or not: Group 1 [general anaesthetic (GA)]; Group 2 [GA and PCA]; Group 3 [GA and spinal diamorphine] and Group 4 [GA, spinal diamorphine and PCA]. Ninety-eight eligible patients were identified. At 6 hours, pain scores were significantly higher for all non-spinal groups (<i>p</i> < 0.05); at 9 h, pain scores were significantly higher in NSD patients compared to SD (<i>p</i> = 0.026); at 12 h, pain scores were significantly higher for NSD patients compared to SD (<i>p</i> = 0.024), and Group 1 compared to Group 3 (<i>p</i> = 0.023). Total opioid consumption in the first 24 h post-surgery was higher in Group 1 compared to Group 3 (<i>p</i> = 0.024). There was no higher incidence of urinary retention, or any neurological complications reported within the SD patients. The study found a reduction in post-operative pain scores with the use of spinal diamorphine prior to laparoscopic and robotic-assisted nephrectomies. The findings may also suggest that pre-operative spinal diamorphine use can reduce the total volume of opioids administered via other routes in the first 24 h post-operatively. It recommends its routine administration but encourages prospective investigation.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":"16 6","pages":"632-640"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}