Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1997
Epidural analgesia following upper abdominal surgery: United Kingdom practice.
Epidural Analgesia (EA) may be used to provide pain relief after upper abdominal surgery. A variety of drugs and combinations may be used. Potential side effects lead some to believe EA should be restricted to high care areas. ⋯ EA is widely used in the United Kingdom following upper abdominal surgery. A degree of consensus exists on the choice of drug types, their method of administration and duration. There is no consensus as to whether the technique should be used on a general ward, which opioid should be used or the timing of heparin.
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About three quarters of patients with advanced cancer experience pain. Most of these have multiple pains. Causes of pain fall into four broad categories: the cancer itself, related to the cancer +/- debility, related to treatment, concurrent disorder. ⋯ Recognition of functional muscle pain is important. Patients with severe chronic pain do not necessarily look in pain because of the absence of autonomic concomitants. Whatever the cause, pain is a "somatopsychic' experience.
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The aim of the present study was to analyse the opioid consumption in the 10 most opioid-consuming countries in relation to the Danish consumption. The results revealed, that the total opioid consumption has increased in all of the 10 most opioid consuming countries (range 26-1423%). In Denmark, the total opioid consumption increased 353% from 1981 to 1993, exceeding 1.45 million defined daily doses per 1 million inhabitants in 1993, which is the highest in the world. ⋯ The consumption of long-acting opioids (morphine sustained release, methadone, buprenorphine) and short acting opioids (others) increased 1427% and 105%, respectively. Analysis of a sample of 1854 prescriptions made by general practitioners for opioids revealed, that less than 10% of the prescriptions were issued for cancer pain conditions. In conclusion of other countries consider Denmark as worthy of imitation concerning opioid treatment in cancer pain, attention should be paid to the pattern of the Danish opioid consumption, which is outstanding with respect to quantity.
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Acta Anaesthesiol Scand · Jan 1997
Pharmacological approaches other than opioids in chronic non-cancer pain management.
Many pains are controlled by non-addictive procedures ranging from exercise to a variety of analgesic medications. Some pains are controlled by analgesic drugs, but at the cost of intolerable side effects. This is true both for non-steroidal anti-inflammatory drugs and opioids. ⋯ Cyclobenzaprine is best used in short term treatment, but may be used intermittently for chronic pain. Antidepressants, neuroleptics, anticonvulsants and some other drugs can be used long term. Topical analgesic agents may also be used.
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Acta Anaesthesiol Scand · Jan 1997
Randomized Controlled Trial Clinical TrialPharmacokinetics and pharmacodynamics of controlled-release opioids.
While pharmacokinetic/pharmacodynamic relationships for opioids have not been consistently demonstrable or sufficiently predictive, there remain compelling reasons to pursue such relationships. Among the reasons for pursuing pharmacokinetic/ pharmacodynamic relationships is the prospect of predicting the time-action characteristics of new therapeutics on the basis of early studies in normals using pharmacodynamic surrogates for analgesia. The realization of such a model could improve the efficiency of development of analgesics. ⋯ Concurrent assessments included vital signs and opioid effect VAS questionnaires. The studies demonstrated significant relationships between plasma oxycodone (but not oxymorphone) and pharmacodynamic surrogates (particularly VAS "drug effect") and were predictive of the 12-hour duration of pain control and prompt onset of analgesia subsequently demonstrated in multiple clinical studies involving patients with various pathological pain syndromes. The results suggest that investigators can make earlier, accurate predictions of opioid analgesic pharmacodynamics in patients based on pharmacokinetic/pharmacodynamic studies in normal volunteers.