Articles: analgesics.
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Opioid analgesics continue to be the most important drugs in modifying the response to pain. Their versatility is attested by their frequent use in both postoperative and intraoperative management of pain. Recent findings regarding the mechanism of action of opioids may signal the introduction of newer, more effective, and less addictive agents. ⋯ The adverse effects of nausea and dysphoria and the more serious effects of respiratory depression continue to be a problem, as does the possibility of abuse. Nonetheless, the clinical experience with opioids in control of pain is uncontested. Until better drugs are developed, opioids will form the basis for the control of acute pain by the dental practitioner.
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Randomized Controlled Trial Clinical Trial
The analgesic effect of a low dose of alfentanil.
The effect of a single small dose of alfentanil (6 micrograms/kg) on postoperative pain was compared with saline using a double blind study. Pain was assessed using a linear analogue scale and shown to decrease at 2, 5 and 10 minutes after injection of alfentanil (p less than 0.01). ⋯ There were no changes in pain or PE'CO2 in the control group throughout the study. Intravenous alfentanil given to patients in pain provides quick effective analgesia for a short period of time, but respiratory depression may occur.
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Three double blind, placebo controlled, cross-over studies were conducted to assess the activity of analgesics in healthy volunteers using a modified submaximal effort tourniquet test (SETT). On each study day tests were performed in a silent cubicle at 21 degrees C immediately before and then hourly after drug administration. After exsanguination of the dominant arm trained subjects performed intermittent, isometric hand-grip exercise for 1 min and then rated pain intensity continuously on a visual analogue scale generated and scored by microcomputer. ⋯ Scores on visual analogues scales for alertness and reports of side effects as well as the absence of analgesic activity of diazepam showed that analgesia was not related to sedation. The computerisation of pain ratings and standardisation of experimental conditions probably account for the sensitivity of this model. The difference between responses to opiates and anti-inflammatory drugs is discussed.
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Int J Clin Pharmacol Ther Toxicol · Jun 1984
Review Comparative StudyEpidural and intrathecal opiates in obstetrics.
The use of epidural and intrathecal opiates in obstetrics is reviewed. Opiate receptors in the substantia gelatinosa of the spinal cord appear to be the main site of drug action after both epidural and intrathecal modes of drug administration. However, an additional systemic effect for this selective spinal analgesia cannot be excluded, especially after epidural drug administration. ⋯ After intrathecal injection of opiates, there was a strong analgesic action during delivery, but an unacceptable amount of side effects prevents their routine use. In post-cesarean patients, epidurally administered opiates are quite effective analgesics, but they still have one serious unwanted effect: respiratory depression of delayed onset. Thus, in routine obstetric practice, epidural or intrathecal opiates play only a limited role.
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The search for new anesthetic and analgesic drugs will be aided by analysis of the structures of chemical compounds which variously stimulate the five proposed opioid receptors or the benzodiazepine receptors. The mechanism of interaction between the benzodiazepines, opioids, and the neuroleptics will be further elucidated. These studies will result in discovery of drugs with fewer side-effects and more specific clinical effects.