Ann Acad Med Singap
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In recent years tremendous progress has been made in our understanding of peripheral, spinal cord and brain mechanisms involved in acute pain and in the neurophysiologic description of nociceptive pathways, receptors and mediators. Great strides have been made in our knowledge of pharmacokinetics and pharmacodynamics of drugs used to treat pain. However, in spite of unprecedented interest in pain and its management, most patients undergoing surgery still receive treatments that have changed little in the past decades. ⋯ Various combinations of the above are also possible. However, it is increasingly recognised that the solution to the problem of inadequate pain relief on surgical wards lies not so much in the development of new drugs and new techniques but in the development of a formal organisation for better use of existing drugs and techniques. A simple, low-cost organisation model for acute pain services (APS) is described.
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The development of new non-depolarizing neuromuscular blocking drugs starting with the introduction of the intermediate-acting agents atracurium and vecuronium has made it possible to avoid the use of succinylcholine for elective cases. Recently 4 new drugs have become available; the short-acting mivacurium, the intermediate-acting rocuronium and the 2 long-acting drugs doxacurium and pipecuronium. The pharmacokinetic and pharmacodynamic profile of these drugs are reviewed in this paper.
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Patients undergoing surgery move through a continuum of medical care to which a primary care physician, an internist, an anaesthesiologist, and a surgeon contribute to ensure the best outcome possible. No aspect of medicine requires greater cooperation than the performance of surgery and the perioperative care of a patient. For the anaesthesiologist, this responsibility should start in a preoperative clinic. ⋯ At a time when medical information is encyclopaedic, it is difficult for even the most conscientious anaesthesiologist or surgeon to keep abreast of medical issues relevant to perioperative patient management. Thus, a proposed preoperative assessment clinic facilitates those most sought-after goals, increased quality and reduced costs. As part of this process, ordering only laboratory tests warranted by a patient's symptoms and medical history is important to avoid risks of unnecessary testing and of follow-up of false-positive results.
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialSingle-blind comparative analgesic and safety study of single doses of intramuscularly administered ketorolac tromethamine and pethidine hydrochloride in patients with pain following orthopaedic surgery.
Ketorolac tromethamine, a potent non-narcotic prostaglandin synthetase inhibiting analgesic was compared with pethidine for relief of moderate to severe postoperative pain. Forty-eight patients received Ketorolac 0.5 mg/kg and 52 received pethidine 1.25 mg/kg. The degree of pain prior to the administration of the drug and pain relief that followed were quantified using a vertical visual analogue scale (VAS) and monitored at hourly intervals. ⋯ The incidence of side effects was significantly greater with pethidine (40.4%) as compared to Ketorolac (10.4%). The similar analgesic efficacy to pethidine makes Ketorolac an appropriate drug for the relief of postoperative pain especially in day surgery settings where observation following administration of the drug as in the case of pethidine can be dispensed with and patients sent home earlier because of the minimal side effects associated with its use. Caution must be exercised with the use of large doses of Ketorolac especially if the drug is used for more than 5 days to avoid serious complications like renal failure and gastrointestinal bleeding.