Articles: palliative-care.
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J Pain Symptom Manage · Nov 1993
Intrathecal infusional analgesia for nonmalignant pain: analgesic efficacy of intrathecal opioid with or without bupivacaine.
We report on the analgesic efficacy of intrathecal infusions of opioids alone or in combination with bupivacaine in 16 nonmalignant pain patients with implanted pumps. Three patients had nociceptive pain, five had neuropathic pain, and 8 had mixed pain syndromes. Infusional therapy was delivered over a combined monthly total of 445 mo of therapy (mean, 27.8 mo). ⋯ Thirteen patients (81%) reported good to excellent results with opioid alone or opioid combined with bupivacaine. The addition of bupivacaine improved analgesia in two of three patients with nociceptive pain (66.7%), compared to eight of ten patients with a pure or mixed neuropathic component to their pain (80%). We conclude that intrathecal opioids alone or in combination with bupivacaine are efficacious for the treatment of nonmalignant pain states and are relatively free of significant side effects or tolerance.
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Despite the recent wide applicability of the bidirectional cavopulmonary shunt, there is limited reported experience in performing these shunts in infants 6 months or younger. ⋯ Early bidirectional cavopulmonary shunt in young infants has shown encouraging early results and provides improved oxygenation with low morbidity and mortality. We speculate that an early bidirectional cavopulmonary shunt on an elective basis may reduce the deleterious sequelae of chronic hypoxemia, long-term ventricular volume overload, and repeated palliative procedures, thus yielding a more suitable Fontan candidate.
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Palliative medicine in hospice is emerging as a growing discipline, committed to holistic and compassionate, comforting care for seriously ill patients. It is essential to include aggressive medical therapy for pain relief; even more important to the issue is that the patient be the central figure in decisions of care.
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It is currently believed that the home is not the most adequate place to die. Ninety percent of the deaths happen in hospitals. The home care of terminally ill cases by a palliative care team is analyzed. ⋯ Home care increase the percentage of deaths in the home if adequate alleviation of symptoms, permanent communication and constant family support are provided.