Articles from American journal of hospital pharmacy

Am J Hosp Pharm · Jun 1994

Review Comparative Study

Effect of analgesic treatment on the physiological consequences of acute pain.

Physiological responses to acute pain are described, and the effects of different analgesic techniques on these responses are discussed. The body's response to acute pain can cause adverse physiological effects. Pain can impede the return of normal pulmonary function, modify certain aspects of the stress response to injury, and alter hemodynamic values and cardiovascular function. ⋯ Adequate analgesia through the use of local anesthetics and narcotics postoperatively generally results in improved cardiovascular function, decreased pulmonary morbidity and mortality, earlier ambulation, and decreased likelihood of deep vein thrombosis. Some data suggest that improved patient outcome occurs with adequate analgesia. Block of afferent and efferent neural pathways by local anesthetics seems to be the most effective analgesic modality in lessening the physiologic response to pain and injury.

Pharmacoeconomic analysis of ondansetron versus metoclopramide for cisplatin-induced nausea and vomiting.

A pharmacoeconomic analysis of ondansetron versus metoclopramide use in patients receiving high-dose cisplatin therapy is reported. A meta-analysis of the literature was performed to synthesize the results of clinical trials of ondansetron and metoclopramide for the prevention of nausea and vomiting in patients receiving high-dose cisplatin therapy. A cost-benefit analysis was performed by constructing a decision tree of the possible outcomes of treatment with ondansetron or metoclopramide. ⋯ The cost-utility analysis yielded an incremental cost of ondansetron of $168,391 ($407,667) per QALY in 40-kg (70-kg) patients. Sensitivity analysis showed robustness of the expected outcomes except in a best-case scenario. A cost-utility analysis suggested that, compared with metoclopramide, ondansetron provides a small antiemetic benefit at a large additional cost.

expand abstract… mark as read…

Am J Hosp Pharm · Jun 1994

Randomized Controlled Trial Comparative Study Clinical Trial

Patient-controlled analgesia versus intramuscular analgesic therapy.

The pharmacy and nursing time requirements, quality of postoperative pain control, and cost of patient-controlled analgesia (PCA) and intramuscular (i.m.) analgesic therapy were studied. All timings were conducted with a stopwatch on a single nursing unit that primarily receives gynecologic surgery patients. The various work elements involved in each type of therapy were timed individually. ⋯ The median pain scores were moderate for i.m. patients and mild for PCA patients. Scores tended to be lower for PCA patients at 16 and 20 hours. Although equal numbers of patients in the two groups experienced nausea, i.m. patients needed more doses of antiemetics than PCA patients.(ABSTRACT TRUNCATED AT 250 WORDS)