Der Schmerz
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The efficacy of morphine and other opioids in the treatment of severe pain, especially cancer pain, is undoubted. If opioids are used according to the WHO guidelines no severe side effects or psychological dependence develop. In Germany the use of strong opioids is controlled by law and requires a special prescription with offical forms and difficult regulations. ⋯ The prescription patterns we found demonstrate inadequate medical care of patients with severe pain. Continuous pain therapy with strong opioids was found in only a few cases. The main reason for this situation is the law pertaining the use of opioid drugs, with its difficult and restrictive regulations. This law cannot stop the development of increasing illegal drug consumption, but obstructs the medical care of patients with severe pain.
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Intravenous administration of local anaesthetics has repeatedly been recommended for the treatment of chronic pain. Some authors have also reported on their use in postoperative pain management. However, most of these publications are case reports or refer to rather old studies or investigations based on study designs that fail to meet present scientific standards. ⋯ During the first 24 h after surgery 12 patients in the lidocaine group required a total of 550 mg meperidine in addition, while 8 patients in the control group required a total of 300 mg meperidine. The postoperative meperidine consumption was not significantly diffent between the lidocaine group and the control group. Intravenous lidocaine infusion did not significantly reduce postoperative pain after tonsillectomy in the dosage used.