Articles: opioid-analgesics.
-
Most pain in cancer should be easily relieved because it responds in a predictable way to opioid analgesic drugs. Some pains do not respond so well but can usually be ameliorated by the judicious use of adjuvant analgesics, non-drug measures, and the active involvement of the multidisciplinary team.
-
Acta Anaesthesiol Scand · Jan 1992
Randomized Controlled Trial Clinical TrialEpidural bupivacaine, sufentanil or the combination for post-thoracotomy pain.
Analgesia with epidural bupivacaine, sufentanil or the combination was studied in 50 patients who had undergone thoracotomy. During operation all patients received an initial dose of bupivacaine 0.5% with adrenaline 5 micrograms.ml-1 (5-10 ml) by thoracic epidural catheter. One hour later the patients were divided into three groups: the bupivacaine group (bupivacaine 0.125%), the sufentanil group (50 micrograms sufentanil in 60 ml normal saline) and the combination group (50 micrograms sufentanil in 60 ml bupivacaine 0.125%). ⋯ The sufentanil group had much better pain scores, but on exercise these patients experienced more pain than the combination group. The combination group had, overall, better pain scores. In the combination group, there were better respiratory results.
-
The intracranial hemodynamic and metabolic effects of 20 micrograms/kg sufentanil were studied in ten mongrel dogs. Anesthesia was maintained with 0.7 vol.% end-tidal isoflurane and 50% nitrous oxide in oxygen. Catheters were inserted into both femoral arteries and veins, the superior sagittal sinus, the left atrium, and the lateral cerebral ventricle for blood pressure measurement, arterial and sagittal sinus blood sampling, radioactive microsphere injections, and intracranial pressure (ICP) monitoring. ⋯ These data are in contrast to studies in dogs, where sufentanil produced non-dose-dependent increases in CBF and ICP. Our results are more consistent with studies in humans and rats where administration of sufentanil was associated with either no change or decreases in cerebral hemodynamics, metabolism, and ICP. We conclude that in dogs with normal intracranial physiology sufentanil decreases regional and global CBF in response to a decrease in cerebral metabolic demand without significantly affecting ICP.
-
Cahiers d'anesthésiologie · Jan 1992
Review[Fetal and neonatal effects of perimedullary opioids used in obstetrical anesthesia].
The use of spinal or epidural narcotics is more and more frequent in obstetric patients since it enhances the analgesia induced by local anesthetics. However, specific information regarding their fetal and neonatal effects is rare. Fetal effects are mainly dependent on the respiratory and hemodynamic maternal effects, and thus usually limited when usual low dosages of intraspinal narcotics are used. ⋯ In contrast, the evaluation of Apgar and neurobehavioral scores, performed for all the narcotics used, shows little changes when low dosages are used. However, the use of larger dosages epidurally is associated with an increased frequency of low neurobehavioral scores. Therefore, the use of low dosages of epidural narcotics is recommended since there is little available information about the risk of neonatal respiratory depression and no clear maternal advantage of higher dosages.