Journal of pain and symptom management
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J Pain Symptom Manage · Jul 1992
ReviewSufentanil: clinical use as postoperative analgesic--epidural/intrathecal route.
Although morphine and fentanyl remain the predominant epidural opioids, sufentanil offers some unique advantages. Because of its greater lipophilicity and mu-receptor binding capacity, sufentanil has a faster onset of action and longer duration than epidural fentanyl. Compared with morphine, sufentanil has been associated with a lower incidence of side effects, particularly delayed respiratory depression. ⋯ The synergistic effect of combined sufentanil and low-concentration bupivacaine offers advantages over sufentanil alone. High doses of epidural sufentanil have been uniquely associated with cessation of shivering and hypothermia. As with fentanyl, the intrathecal administration of sufentanil for postoperative analgesia is limited by its short duration of action.
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J Pain Symptom Manage · Jul 1992
ReviewComprehensive and multidimensional assessment and measurement of pain.
Current theories of pain and clinical experience support a multidimensional framework for the experience of pain that has implications for assessment and management in any setting. Six major dimensions have been identified: physiologic, sensory, affective, cognitive, behavioral, and sociocultural. Any clinical assessment process must address relevant dimensions of pain in the given setting. ⋯ The clinician in any setting must use appropriate tools that provide useful information. Guidelines helpful in a selection process include identification of relevant dimensions of pain, type of pain, patient population and setting, psychometric properties of the tool, and issues of time, clinical relevance, and feasibility. When a careful selection process occurs, the resulting data should simultaneously meet clinicians' needs for information as well as provide the foundation for initiation of multidisciplinary interventions.