Articles: analgesics.
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The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. ⋯ Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.
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Cahiers d'anesthésiologie · Jan 1991
Review[Secondary effects of opioids administered by the regional route].
The administration of narcotics in the subarachnoid or the epidural space is gaining acceptance for postoperative pain relief. However, the potential side effects of intrathecal and epidural use of opioids are the following: early and late respiratory depression, pruritus, nausea and vomiting, urinary retention. ⋯ Naloxone can be used to reverse the depression. Pruritus can occur in 10 to 30% of patients receiving morphine; 10 to 30% nausea and vomiting, and urinary retention occurs in 20 to 50% of patients.
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Each class (mu, delta kappa and epsilon) of opioid receptors has a characteristic pattern of distribution in the nervous system, which may, however, exhibit species differences. The effects of opioid receptor stimulation depend on the class of receptor involved, the localization of these specific receptors and the animal species under investigation. Endogenous ligands of opioid receptors, which include more than twenty peptides, derive from three precursors:proopiomelanocortin (beta-endorphin), proenkephalin A (enkephalins) and prodynorphin (dynorphins, neo-endorphins). ⋯ At this level, opioids reduce the activity of spinal neurones that convey the nociceptive messages. The classes of opioid receptors (certainly mu [mu 2?] and a, perhaps kappa) involved in this effect, and their pre- or postsynaptic location are not firmly established to date. Further developments on these points can be expected from the use of new ligands which are highly selective of the various classes of opioid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional anesthesia · Jan 1991
Randomized Controlled Trial Clinical TrialAnalgesic efficacy of low doses of intravenously administered lidocaine on experimental laser-induced pain: a placebo controlled study.
The analgesic efficacy of low doses of intravenously administered lidocaine on experimental laser-induced pain was studied. Lidocaine or placebo was infused intravenously in ten healthy volunteers on 2 separate days according to a double-blind, randomized, cross-over design. Analgesia was assessed by argon laser-induced sensory and pain thresholds and pain evoked potentials after doses of 0.7, 1.85 and 3.7 mg/kg of lidocaine, infused over 15, 45 and 75 minutes, respectively. ⋯ Although administration of the highest dose of lidocaine (mean plasma concentration, 8.5 mumol/l) caused significant increases in pain and sensory thresholds, the magnitude of these increases was no greater than those that occurred during placebo infusion. The power of the pain evoked potentials was significantly decreased by the highest dose of lidocaine (p = 0.0024) compared with placebo. These results probably reflect that the effect of lidocaine on subjective pain perception might be caused primarily by sedation.
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Cahiers d'anesthésiologie · Jan 1991
Review[Mechanism of action and clinical use of opioids administered by the peripheral perineural route].
Experimental studies have shown that opioids could produce two types of effect on neuronal excitability. The first one, aspecific, is a local anesthetic action on the nerve fiber with a diminution of sodium and potassium conductance. ⋯ Clinical studies have proved that opioid injection in peripheral nervous trunks and specially in the brachial plexus produce a prolonged analgesia status in the post operative period but also and mostly in the chronic pain. The more liposoluble opioids like fentanyl and buprenorphine are the more effective.