American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Apr 2004
ReviewEmerging techniques in the treatment of postoperative pain.
Causes of inadequate postoperative pain control, challenges with currently available analgesic therapies, characteristics of optimal postoperative analgesic therapy, a liposome-encapsulated, sustained-release dosage form of morphine, and other investigational analgesic therapies are described. ⋯ Opioid analgesics remain the mainstay of postoperative analgesic therapy, but the development of infusion pumps with improved reliability; needle-free technologies, parenteral dosage forms of acetaminophen, selective cyclooxygenase-2 inhibitors, and other non-opioid therapies; and new opioid analgesic agents that provide analgesia without the adverse effects of currently available opioid analgesics may substantially improve postoperative analgesia and health-related quality of life in the postoperative pain patient in the future.
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The mechanisms of persistent postoperative pain, rationale for multimodal pain therapy, and limitations of currently available analgesic agents and administration routes and techniques are described. ⋯ Research is needed to identify analgesic agents and administration techniques with greater efficacy and safety than those currently available.
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The implications of recent studies for guidelines that pertain to stress ulcer prophylaxis in the postoperative period are discussed. ⋯ The frequency of clinically important bleeding reported in recent studies is low. The majority of recently published prospective studies and meta-analyses found little significant reduction in bleeding with pharmacologic prophylaxis.
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The effects of wide temperature variations on the stability of atropine, epinephrine, and lidocaine stored under field conditions in advanced life support (ALS) paramedic units were evaluated. ⋯ Atropine, epinephrine, and lidocaine can be stored at temperatures of up to 84.1 degrees F (28.9 degrees C) for up to 45 days and tolerate temperature spikes of up to 125 degrees F (51.7 degrees C) for a cumulative time of 795 minutes (13.25 hours) without undergoing degradation.