Articles: opioid-analgesics.
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Postoperative pain arises largely from distension and sectioning of nerve fibers, which generate a short-lasting but enormous afferent impulse barrage. This causes a long-lasting enlargement of receptive fields and an increase in excitability of dorsal horn neurons sending their axons up to the brain. ⋯ Prostaglandins in the spinal cord facilitate the synaptic transmission from nociceptive afferents. Nonsteroidal anti-inflammatory drugs (NSAIDs) produce relief from postoperative pain by blocking the formation of prostaglandins in the spinal cord, thus abolishing the facilitatory effect of these compounds.
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The description of multiple classes of opioid receptors has had a major impact on our understanding of the mechanisms of analgesia. Three major classes of opioid receptors have been defined: mu, kappa, and delta. The mu receptors have been further subclassified into two distinct subtypes (mu 1 and mu 2), as have the delta receptors (delta 1 and delta 2). ⋯ In addition to their ability to act independently, the various systems also interact synergistically with each other. Thus, the relief of pain involves the complex interaction of at least six receptor systems. This review discusses the implications of opiate receptor multiplicity on the control of pain.
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Spinal administration of morphine and other opiates has been used in clinical practice since many years, particularly in the outpatient management of cancer pain patients. The rationale and the safety of chronic spinal opiate administration is well established and not questioned anymore. However, the indications to use these therapies remain unclear, essentially because no controlled studies have ever shown the advantages of these treatments. ⋯ This raises technological and financial issues, as well as management problems related to the home care system. The choices that have to be made should include the home physician, the home care nursing team as well as the hospital based pain management team. This short overview will deal with some of these aspects.
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Knee Surg Sports Traumatol Arthrosc · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialIs intra-articular pethidine an alternative to local anaesthetics in arthroscopy? A double-blind study comparing prilocaine with pethidine.
We investigated the per- and postoperative pain-reducing effect of pethidine given intra-articularly (i. art.). Thirty patients subjected to knee joint arthroscopy, diagnostic and surgical procedures, were randomly assigned to one of three groups. Group A consisted of ten patients who received 250 mg prilocaine + 200 micrograms adrenaline (i. art.) in a volume of 50 ml, group B of ten patients who received 200 mg pethidine (i. art.) in 50 ml saline, and group C of ten patients who received 200 mg pethidine + 200 micrograms adrenaline (i. art.) in 50 ml saline. ⋯ Calculating the total sum of pain scores, patients receiving pethidine (group B) reported significantly less pain both at rest and during movement than those receiving prilocaine (group A). Furthermore, patients in group B used significantly less analgesics than those in group A. Adrenaline did not potentiate the effect of pethidine.(ABSTRACT TRUNCATED AT 250 WORDS)