Articles: opioid-analgesics.
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The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. ⋯ Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.
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Each class (mu, delta kappa and epsilon) of opioid receptors has a characteristic pattern of distribution in the nervous system, which may, however, exhibit species differences. The effects of opioid receptor stimulation depend on the class of receptor involved, the localization of these specific receptors and the animal species under investigation. Endogenous ligands of opioid receptors, which include more than twenty peptides, derive from three precursors:proopiomelanocortin (beta-endorphin), proenkephalin A (enkephalins) and prodynorphin (dynorphins, neo-endorphins). ⋯ At this level, opioids reduce the activity of spinal neurones that convey the nociceptive messages. The classes of opioid receptors (certainly mu [mu 2?] and a, perhaps kappa) involved in this effect, and their pre- or postsynaptic location are not firmly established to date. Further developments on these points can be expected from the use of new ligands which are highly selective of the various classes of opioid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cahiers d'anesthésiologie · Jan 1991
Review[Mechanism of action and clinical use of opioids administered by the peripheral perineural route].
Experimental studies have shown that opioids could produce two types of effect on neuronal excitability. The first one, aspecific, is a local anesthetic action on the nerve fiber with a diminution of sodium and potassium conductance. ⋯ Clinical studies have proved that opioid injection in peripheral nervous trunks and specially in the brachial plexus produce a prolonged analgesia status in the post operative period but also and mostly in the chronic pain. The more liposoluble opioids like fentanyl and buprenorphine are the more effective.
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In pediatric intensive care, analgesia and sedation has become increasingly important for newborns as well as prematures in recent years. However, its importance is frequently not well recognized and sedation is confounded with analgesia. In our intensive-care unit (ICU), fentanyl and midazolam have proved to be useful. ⋯ During the concomitant administration of midazolam and fentanyl, significantly less midazolam was needed to achieve appropriate analog-sedation. Prior to the administration of analgesics and sedatives, care should be taken to ensure that circulatory conditions are stable and that there is no hypovolemia, and the drugs must be given slowly during several minutes. Especially in a pediatric ICU, light and noise should be diminished and contact between the parents and the child should be encouraged, even when the child is undergoing mechanical ventilation.
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The patterns of recovery of patients who received seven different analgesic and sedative treatments were investigated with regard to the time at which the subjects awoke. For observations of the neurologic status, we developed a special score. ⋯ Piritramid/promethazine, pethidine/flunitrazepam, pethidine/promethazine and tramadol/methohexital required more time for awakening. On the basis of these results, we prefer to use the combination of fentanyl/midazolam, alfentanil/midazolam and ketamine/flunitrazepam to judge all patients' neurologic scores.