Journal of pain and symptom management
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Opioids (narcotic analgesics) are widely used in the practice of anesthesia for preanesthetic medication, systemic and spinal analgesia, supplementation of general anesthetic agents, and as primary anesthetics. The last use is particularly widespread for major surgical operations, especially those involving patients with cardiovascular disease. The use of opioids in anesthetic doses is based on the absence of cardiac depression by the opioids. ⋯ Although there is a very wide margin of safety, allowing administration of enormous doses intraoperatively when the patient's ventilation is supported mechanically, the disadvantage of using doses far in excess of the individual patient's need is a prolonged recovery from anesthesia with the risk of postoperative ventilatory depression. Titration of the dose can be facilitated by computer-controlled infusion pumps with the benefit that the recovery time from anesthetic doses can be appropriate for the individual patient and surgical procedure, and postoperative analgesia can be continued by patient-controlled analgesia, which is another example of computer-controlled opioid infusion. Although specific opioid antagonists are available, their use to antagonize residual anesthetic effects is potentially hazardous.
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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.
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J Pain Symptom Manage · May 1992
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the Hopkins Pain Rating Instrument with standard visual analogue and verbal descriptor scales in patients with cancer pain.
A self-contained, portable, pain rating instrument that provides an immediate result for documentation purposes was developed to improve pain assessment in cancer patients. The Hopkins Pain Rating Instrument (HPRI) is a 5 x 20 cm plastic visual analogue scale (VAS) with a sliding marker that moves within a groove that measures 10 cm. The side facing the patient resembles a traditional VAS while the opposite side is marked in cm to quantify pain intensity. ⋯ The most common pain sites were the back, leg, and epigastric areas. On initial and repeat testing, there were high correlations between the HPRI and the VAS (r = 0.99, P less than 0.0001) and the VDS (r = 0.85, P less than 0.0001). The correlation coefficients for test--retest reliability for the HPRI, VAS, and VDS were 0.97, 0.97, and 0.94 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Pain Symptom Manage · Apr 1992
Case ReportsResponse of central pain syndromes to intravenous lidocaine.
In this study, 8 patients with central pain syndromes, 6 with hemispheric lesions, and 2 with spinal cord lesions were treated with a 1 mg/kg dose of intravenous lidocaine. Patients first received the same volume of normal saline, in single-blind fashion, to monitor placebo effects. Of the 8 patients, 7 responded to lidocaine, and only 1 responded to normal saline. ⋯ In addition, 3 patients had pain relief that lasted for 8-20 wk. These findings, which are in agreement with two previous open-label studies, suggest that a single dose of a local anesthetic, lidocaine, can provide lasting pain relief for patients with central pain syndromes. This analgesic action may be central, and possibly supraspinal, at least in patients with hemispheric lesions.