Acta anaesthesiologica Scandinavica. Supplementum
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Long-term treatment for malignant pain with morphine epidurally poses some technical problems: infection and contamination of epidural space, fixation of the epidural cannula, personal hygiene of the patient, etc. We suggest that a solution to these problems is subcutaneous tunnelling of the epidural cannula. This paper describes our technique and presents the case histories of two patients. In one case, a single epidural cannula was used for 207 days for treatment with morphine epidurally without any complication.
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Acta Anaesthesiol Scand Suppl · Jan 1982
Pain treatment in a palliative unit or team of a university hospital.
A Palliative Care Unit and Team provides a model for delivering care, in which narcotic analgesics can be optimally effective in the treatment of cancer pain. Our rapidly expanding knowledge of pain physiology and narcotic pharmacokinetics will not benefit patients unless we design more appropriate organizational structures to implement therapy and to teach symptom control. The Palliative Care Service model, as developed at several university hospitals in Canada, is designed to assist and complement oncology departments. ⋯ Hospital organization must reflect the fact that environmental and psychosocial factors alter pain perception and response. Oral morphine is more effective when administered in a Palliative Care Unit than when it is given to patients in other settings. The Unit provides personnel skilled in analgesic titration and a supportive environment in which psychological, social and spiritual components of the pain experience can be evaluated and treated.
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The single-dose kinetics and the oral and rectal bioavailability of ketobemidone have been studied in patients after surgery. Plasma concentrations were determined following intravenous administration of Ketogin 2 ml, containing ketobemidone chloride 10 mg and the spasmolytic substance N, N-dimethyl-3, 3-diphenyl-l-methylallylamine chloride 50 mg and following oral or rectal administration of Ketogin. ⋯ After rectal administration the plasma half-life was somewhat prolonged (3.27 h), probably due to late absorption., The bioavailability of oral ketobemidone was 34% +/- 16% s.d. (n = 6), and when given rectally 44% +/- 9% s.d. (n = 5). In contrast to earlier investigations performed without plasma analysis, ketobemidone was found to have a rapid elimination when given intravenously, orally or rectally.