Articles: opioid-analgesics.
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Oral medication is the simplest way in treatment of chronic pain. For cancer pain oral analgesics are efficacious in more than 90% of the patients. When a causal therapy of pain (e.g. chemotherapy, operation) fails an analgesic ladder with oral analgesics is instituted. ⋯ In any state of pain the response to the different groups of drugs should be evaluated first. Then a stepwise pharmacological approach should be performed. In most cases pain can be treated effectively by oral drugs.
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Regional anesthesia · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialEpidural analgesia during and after cesarean delivery. Comparison of five opioids.
A randomized, double-blind study was designed to determine the effects on maternal intraoperative analgesia of adding one of the following opioids to the local anesthetic at the onset of epidural block, before surgery and neonatal delivery: morphine (3 mg), fentanyl (75 micrograms), sufentanil (50 micrograms), buprenorphine (0.3 mg) and oxymorphone (1 mg). The duration of postoperative analgesia, the presence of side effects and the neonatal outcome were also studied. Ninety healthy multiparas, at term, undergoing elective cesarean delivery using lumbar epidural anesthesia with 2% lidocaine were randomized in six equal groups to receive one of the opioids or saline. ⋯ Morphine provided the longest pain-free interval, followed by oxymorphone, buprenorphine, sufentanil and fentanyl. Postoperatively, the number of patients having pruritus and vomiting was significantly higher in the morphine and buprenorphine groups, respectively (p less than 0.01 versus others). No adverse neonatal effects were noted in any group.
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Cahiers d'anesthésiologie · Jan 1991
Review[Opioids by the perimedullary route: mechanisms of opioid analgesia].
The identification of multiple opioid receptors and opioid peptides in the 1970 was the starting point of an increasing knowledge on opioid physiology and pharmacology. The mechanisms of action of spinally supraspinal levels. At the spinal level, opioids act by a modulation of specific supraspinal effect is the consequence of the migration of opioids, other in the bloodstream or in the cerebrospinal fluid, towards the encephalon. ⋯ At the receptor level, opioid agonists act, hypothetically via the system of adenylcylase, more certainly via a modulation of membrane tonic channels. Thus, opioids modify sodium, calcium and potassium currents, and modify the successives phases of the membrane action potential. The result is an hyperpolarization which is responsible of an inhibition of the release of various neurotransmitters such as P substance.