Articles: analgesics.
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Randomized Controlled Trial Clinical Trial
Clinical analgesic assay of repeated and single doses of heroin and hydromorphone.
A direct comparison of the analgesic activities of heroin and hydromorphone was carried out in cancer patients with postsurgical pain. Intramuscular doses of 5 and 10 mg of heroin were compared with 1 and 2 mg of hydromorphone in a randomized, double-blind, 4-point parallel group assay. Design innovations in the study provided that about half the patients would receive prior repeated doses of the same drug as the test medication, and half would receive the alternate medication. ⋯ Covariate analysis indicated that time since last analgesic was positively related to analgesia, and amount of prior opioid had a negative relationship. To a lesser extent, increase in patient age was associated with an increase in analgesic scores. Taking these covariates into account served to increase the sensitivity of the analysis.
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Narcotic analgesics, although frequently used in adult patients, are at present relatively minor drugs in pediatric anesthesia. This review discusses indications, clinical applications, and side effects of opiates for pre-medication, induction and maintenance of anesthesia, and postoperative pain therapy in infants and children. Opiates do not represent the agents at first choice for preoperative anxiolysis or amnesia. ⋯ It has been shown, however, that opiate-supplemented general anesthesia can be used for pediatric surgery in an equally effective and safe manner. Finally, there is an essential need for more narcotic analgesics in the treatment of early postoperative pain, when antipyretic-antiphlogistic analgesics alone prove ineffective. It thus seems that in pediatric anesthesia today opiates are prescribed at the wrong time and withheld when they are most urgently needed.
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Comparative Study
Spinal antinociception: comparison of a dermorphin tetrapeptide analogue, [D-arginine2, sarcosine4]-dermorphin (1-4) and morphine in rats.
Intracerebroventricular injections of [D-arginine2, sarcosine4]-dermorphin (1-4) (DAS-DER 1-4) and morphine produced a dose-dependent inhibition of the tail-flick response to thermal stimulation. The ED50 value for each drug was 3.23 (1.35-7.73) nmol/rat and 32.0 (13.3-76.6) nmol/rat, respectively. When injected into the spinal subarachnoid space, the ED50 value was 0.035 (0.015-0.086) nmol/rat for the tetrapeptide and 11.9 (5.7-25.2) nmol/rat for morphine, respectively. ⋯ After spinal transection, the antinociceptive potency of systemically-administered morphine was significantly reduced while that of DAS-DER 1-4 was unaltered. The activity of DAS-DER 1-4 and morphine was also reversed by naloxone in spinal animals. It is concluded that DAS-DER 1-4, a dermorphin analogue, has a minor supraspinal action but acts mainly at the level of the spinal cord, in contrast to the action of morphine.
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La Revue du praticien · Mar 1990
[Analgesia-sedation in pediatric resuscitation: indications, modalities].
Recently in pediatric intensive care, sedative and analgesic drugs are being used more frequently, not only for painful and stressful procedures, but also to improve the techniques of intensive care and the patient's comfort. Benzodiazepines are the most common drugs used for sedation, and narcotics for pain.