BACKGROUND This is an updated version of the original Cochrane overview published in Issue 9, 2011. That overview considered both efficacy and adverse events, but adverse events are now dealt with in a separate overview.Thirty-nine Cochrane reviews of randomised trials have examined the analgesic efficacy of individual drug interventions in acute postoperative pain. This overview brings togethe...

Pain management in the perioperative period of cardiac surgery is traditionally managed with liberal use opioids. High-dose narcotic therapy allows hemodynamic stability anesthesia due to diminution chirurgical stress response. However, opioids has several limits (hyperalgesia, gastrointestinal alterations, prolonged mechanical ventilation, respiratory depression, etc).1Beloeil H Opioid-free an...

A 60-yr-old man, 160 cm tall, weighing 75 kg, with American Society of Anesthesiologists physical status class II, was admitted for elective right shoulder surgery. His medical history was unremarkable except for recent mild diabetes with no related neuropathy, controlled by diet and glimepiride. Physical examination results were unremarkable, and the results of laboratory studies were all with...

Editor—Intraoperative nociception is the consequence of interactions multiple noxious stimuli that promote peripheral and central sensitisation. Opioid-based anaesthesia increases postoperative complications alters immunomodulatory signalling pathways.1Sacerdote P. Franchi S. Panerai A.E. Non-analgesic effects opioids: mechanisms potential clinical relevance opioid-induced immunodepression.Curr...