Journal of pain and symptom management
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J Pain Symptom Manage · May 1995
Randomized Controlled Trial Clinical TrialThe morphine-sparing effect of propacetamol in orthopedic postoperative pain.
The analgesic efficacy and safety of propacetamol (Pro-Dafalgan), an injectable prodrug of acetaminophen, in combination with morphine administered by patient-controlled analgesia (PCA) were studied in 60 patients (56 men, 4 women; age 18-40 years; mean age, 26 years) after knee ligamentoplasty. Using a double-blind, randomized, parallel-group design, the effects of four (every 6 hr) intravenous injections of 2 g propacetamol (= 1 g acetaminophen) were compared with four injections of placebo (PL) in the recovery room immediately after surgery. Efficacy was assessed over 24 hr by automatic recording on the PCA device of the cumulative dose of morphine and the number of boluses requested. ⋯ A five-point global efficacy scale was also administered. Any side effects were recorded throughout the duration of the study, and the ability to tolerate the drug was assessed by recording arterial pressure, cardiac and respiratory frequency, and sedation at the same assessment times as the pain scores. The 24-hr morphine consumption was significantly decreased in the propacetamol group (number of 1 mg boluses: 14.7 +/- 11.3 versus 23.2 +/- 13.8, P = 0.01; PCA usage: 26.4 +/- 12.3 mg versus 34.6 +/- 15.4 mg, P = 0.03; PCA usage + titration: 34.5 +/- 12.7 mg versus 43.1 +/- 15.9 mg, P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Pain Symptom Manage · May 1995
Case ReportsEffective treatment of severe cancer pain of the head using low-dose ketamine in an opioid-tolerant patient.
We report the case of a 39-year-old man with severe pain due to unresectable squamous-cell carcinoma of the maxillary sinus that had invaded cranial bone and had metastasized to the cervical spine. Tolerance to opioids had developed, and high doses of transdermal, continuous intravenous, and epidural opioids did not control his pain. ⋯ Ketamine may be a good co-analgesic for breakthrough pain and for severe pain caused by terminal cancer when invasive techniques are inappropriate. Its mechanism of action may include reversal of opioid tolerance in addition to an inherent analgesic effect.
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J Pain Symptom Manage · Apr 1995
Randomized Controlled Trial Comparative Study Clinical TrialBuffered lidocaine for skin infiltration prior to hemodialysis.
This study compared the effects of buffered versus unbuffered lidocaine when used as local anesthetic in preparation for cannulation of the arterial and venous sites of children requiring hemodialysis. The subjects for this study were seven children, ages 6-18 years, observed during 101 dialysis treatments. For each subject undergoing hemodialysis on a given day, one syringe containing 1% lidocaine (L) and one containing buffered lidocaine (BL) were prepared. ⋯ Speed of injection was not controlled. Comparisons of self-reported pain and behavioral observations for L versus BL revealed no significant differences for pain of infiltration or pain of cannulation. Technique variables such as the speed of injection, which tended to be very slow for these children, appear to significantly influence infiltration pain and the relative merits of buffering.
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J Pain Symptom Manage · Apr 1995
Severe undertreatment of cancer pain: a 3-year survey of the German situation.
The aim of this survey was to determine the prescribing patterns of German physicians in the treatment of cancer pain. The computerized patient records of 330 practices, which treated a total number of 1,104,435 patients over a 3-year period, were analyzed. "Strong" opioids, widely accepted in the management of severe cancer pain, were prescribed to just 322 of 16,630 cancer patients (1.9%). ⋯ Germany is still a developing country in terms of pain therapy. This situation is symptomatic of many countries and reflects the continuing prejudice against opioids.
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J Pain Symptom Manage · Feb 1995
ReviewPsychosocial issues in palliative care: the patient, the family, and the process and outcome of care.
This article presents a synopsis of the psychosocial needs of patients and families in the terminal phase of malignant disease, as well as approaches to auditing the care of these clients. Recommendations for future research from the National Cancer Institute of Canada Workshop on Symptom Control and Supportive Care in Patients with Advanced Cancer are presented. These include recommendations on the need for more effective tools to measure the symptoms and burden of illness; an improved taxonomy to describe terminal illness; and studies to (1) measure the impact of interventions for improved symptom relief on the psychosocial distress of patients and families, (2) determine the impact of psychosocial interventions on the symptomatology associated with terminal illness, (3) operationalize "good palliative care" and the optimal delivery of palliative care, (4) assess the auditing of palliative care, (5) develop family typologies of adaptation to terminal illness, (6) describe high risk families, and (7) measure the impact of staff support programs on improving patient/family care.