Articles: opioid-analgesics.
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154 cancer pain patients were treated from 1988 to 1990 according to the three-step analgesic ladder (TSAL) recommended by the WHO. The patients were assigned into 4 groups: WHO-I: patients were treated only with non-opioids, WHO-II: patients received a combination of non-opioid plus a weak opioid, WHO-III: patients were treated with strong opioids or a combination of a strong opioid plus a non-opioid; and the 4th group consisted of patients receiving a strong opioid epidurally. ⋯ Also the mean duration of the patients' sleep was increased by more than one hour. An improvement of mood was observed, and the stabilisation of mood lasted longer.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sufentanil-nitrous oxide anaesthesia with fentanyl-nitrous oxide anaesthesia in geriatric patients undergoing major abdominal surgery.
We have measured haemodynamic changes and plasma concentrations of catecholamines during sufentanil-nitrous oxide and fentanyl-nitrous oxide anaesthesia in a controlled, randomized, double-blind study of 20 geriatric patients (age 65-86 yr) undergoing major abdominal surgery. Fentanyl 7 micrograms kg-1 followed by infusion of 3 micrograms kg-1 h-1 was compared with sufentanil 1 micrograms kg-1 followed by 0.4 micrograms kg-1 h-1. The opioid was supplemented with 60-67% nitrous oxide in oxygen. ⋯ Haemodynamic state was stable during induction and tracheal intubation in both groups, while during stressful operative periods there were increases in mean arterial pressure (17% in the fentanyl group; 11% in the sufentanil group), heart rate (fentanyl 20%, sufentanil 14%) and plasma concentrations of catecholamines (adrenaline: fentanyl 316%, sufentanil 86%; noradrenaline: fentanyl 78%, sufentanil 186%) in both groups. Sufentanil was similar to fentanyl in attenuating the haemodynamic and hormonal responses to surgical stimulation. In two patients in the fentanyl group and three in the sufentanil group, myocardial lactate production was observed temporarily, indicating myocardial ischaemia caused by surgical stress.
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Acta Anaesthesiol Scand · Aug 1991
Randomized Controlled Trial Comparative Study Clinical TrialPremedication before elective breast surgery, a comparison between ketobemidone and midazolam.
One hundred female patients scheduled for elective breast surgery (mean age 60 +/- 11 years were randomly assigned to receive one of two premedications: ketobemidone (Ketogan) 1-1.5 ml or midazolam 4-5 mg, intramuscularly. The effects on preoperative anxiety and postoperative emetic sequelae were studied. All patients were anaesthetised with thiopentone, fentanyl and atracurium, and ventilated with a mixture of nitrous oxide in oxygen with supplementary isoflurane. ⋯ No difference was seen in the frequency of emetic sequelae: 20 patients in the midazolam group and 14 patients in the ketobemidone group vomited once or more during the 24-h observation period. There was no difference between the two groups in time until an analgetic was required. In conclusion, midazolam seemed more effective in reducing preoperative anxiety than ketobemidone without any negative effects on postoperative emesis or time until an analgetic was required.
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Ugeskrift for laeger · Jun 1991
[Continuous epidural treatment of cancer pain using a portable infusion pump].
Treatment of cancer pain with opioids through an epidural catheter, with a portable infuser has been recorded in 20 patients retrospective. In general there was a good acceptance of the treatment, which often could liberate the patients from close contacts to the pain clinic. ⋯ One patient had systemic adverse effects because of a very high daily opioid dose. The Pharmacia Deltec infuser employed has proven very secure and easy to handle.