Journal of pain and symptom management
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J Pain Symptom Manage · Oct 1990
Ambulatory infusion devices in the continuing care of patients with advanced diseases.
Until recently, patients who required hydration or parenteral administration of narcotics or antiemetics remained in hospitals until death. The period of admission, which varied between days and months, resulted in a decreased quality of life for the patient and family. With the development of portable infusion pumps, patients with these needs can now be safely discharged home for long periods of time, thereby significantly reducing the cost of medical care and improving quality of life for patients and families. ⋯ The high cost of portable pumps and supplies are a major obstacle for the establishment of large programs for home parenteral drug administration. More research is needed to better characterize the pharmacokinetics of different drugs when administered subcutaneously, and to develop simpler and more effective portable infusion devices. The results of this research will have a major impact on the quality of life of patients and their families.
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This article describes the use of a subcutaneous infusion of midazolam to control restlessness and agitation in 23 patients during the final stages of advanced cancer. Midazolam effectively controlled symptoms in 22 of the patients at an initial dose of 0.4-0.8 mg/hr rising to a mean maximum dose of 2.9 mg/hr. ⋯ At high doses, the volume of injection required presented some practical difficulties, but otherwise there were no major problems with this technique. Midazolam by subcutaneous infusion is a well-tolerated, safe and effective treatment for terminal restlessness and agitation, and deserves more extensive evaluation.
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J Pain Symptom Manage · Aug 1990
Clinical TrialPostoperative patient-controlled analgesia with alfentanil: analgesic efficacy and minimum effective concentrations.
Forty ASA I-III patients recovering from major abdominal or orthopedic operations were investigated in an open clinical study to evaluate analgesic efficacy and threshold plasma concentrations of alfentanil during the early postoperative period using patient-controlled analgesia (PCA) by means of the On-Demand Analgesia Computer. Alfentanil demand dose was 212 micrograms, continuous infusion rate 25 micrograms/hr, hourly maximum dose 1.5 mg/hr; the lockout time was set to 1 min. The duration of PCA was 18.1 +/- 5.2 hr (mean, SD) during which time 23.8 +/- 14.2 demands per patient were recorded, resulting in an average alfentanil consumption of 4.99 +/- 3.03 micrograms/kg/hr. ⋯ Based on our own earlier PCA experience with other opiate analgesics, alfentanil proved to be about 1/15th as potent an analgesic as fentanyl and about 6-7 times more potent than morphine if both intensity and duration of effect were considered. Minimum effective alfentanil plasma concentration (MEC) varied greatly and could be best described by a lognormal distribution (range 0.6-99.2 ng/mL, median 14.9 ng/mL). Intraindividual MEC variability was consistently lower than intersubject variability (37.0% vs 65.2%).
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J Pain Symptom Manage · Aug 1990
New method for measuring young children's self-report of fear and pain.
The purposes of this paper are (a) to describe the conceptual development of the Children's Global Rating Scale (CGRS), a technique for measuring young children's self-report of such constructs as pain and fear that was designed to address the methodological limitations of existing techniques, and (b) to report the findings of a study investigating the convergent and predictive validity of the CGRS in a sample of children undergoing an invasive medical procedure. Anticipatory procedural distress in 145 children between the ages of 4 and 8 was assessed in outpatient phlebotomy using three independent rating sources: children, parents, and a trained clinical observer. Phlebotomists' ratings as to whether or not children's distress during the actual procedure extended the time it usually takes to perform the procedure was used as the outcome criterion in a discriminate analysis in determining the degree to which anticipatory ratings would predict actual clinical distress during the medical procedure. Results provide preliminary support for the convergent and predictive validity of the CGRS revealing significant correlations with the other independent measures of children's anticipatory distress and also revealed that the CGRS was one of the significant variables in predicting children who extended and did not extend the medical procedure.
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Spinal opioids have become increasingly popular agents for providing analgesia during labor, augmenting anesthesia during cesarean section, and providing pain relief after operative delivery. The development of spinal opioids in the management of obstetric pain is reviewed.