Clinics in podiatric medicine and surgery
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Pain is a common and complex problem in the geriatric population. Successful pain management in this patient population requires a comprehensive approach involving both pharmacologic and nonpharmacologic interventions.
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When surgery is planned, postoperative pain management requires careful consideration. Many medications and techniques can greatly reduce a patient's postsurgical discomfort, including nonsteroidal anti-inflammatory drugs, long-acting local anesthetics, corticosteroids, narcotics, ice, and compression. Pain management should begin preoperatively, continue through surgery, and be fully managed postoperatively. Successful management of postoperative pain greatly affects patients' overall impressions of their surgery.
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Recent evidence has documented the deleterious physiologic effects of pain. The treatment of pain in children may be guided by a step-wise approach depending on its severity (Table 2). ⋯ Several approaches may be taken for the treatment of severe pain, including regional anesthetic techniques or the use of PCA to deliver intravenous narcotics. When such techniques fail, consultation with specialists in the field of pediatric pain management may be helpful.
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Narcotic analgesics may be used safely in most patients. Common adverse effects may be managed successfully with naloxone. PCA is a newer approach to the management of postoperative pain. The authors' survey results indicate that most podiatric physicians would benefit from the understanding of the considerations in the patient subgroups with renal or hepatic dysfunction that required postoperative pain control.
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The aminoglycosides continue to be the cornerstone of antibiotic therapy for serious infections caused by gram-negative aerobic pathogens, even with the recent introduction of potent beta-lactams and the fluoroquinolones. Two of these newer agents are imipenem and aztreonam. ⋯ It is not, however, simply a nonnephrotoxic replacement for aminoglycoside therapy. This article reviews the basic pharmacology and clinical utility of the aminoglycosides, imipenem, and aztreonam.