Articles: opioid-analgesics.
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Comparative Study
Profiles of opioid analgesia in humans after intravenous bolus administration: alfentanil, fentanyl and morphine compared on experimental pain.
This report examines the relationship of plasma drug concentration to analgesic effect following bolus doses of alfentanil, fentanyl and morphine and assesses individual differences in analgesic response among volunteers. We predicted that the 3 opioids would yield disparate analgesic profiles because their physicochemical and pharmacokinetic characteristics differ. Ten healthy volunteers received intravenous bolus doses of either alfentanil, fentanyl, morphine or normal saline on different days. ⋯ Fentanyl exhibited a marked hysteresis. We observed noteworthy individual differences in analgesic response with all 3 drugs but these differences were greatest for morphine and least for alfentanil. Inter- and intrasubject variability in analgesic response across drugs is related to the physicochemical properties of the drugs tested.
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Morphine and other strong opioids are very often needed for the treatment of severe pain. In the FRG the prescription of these analgesics is limited by law, especially for outpatients. Special prescriptions are needed for opioid medication. ⋯ Insufficient treatment of outpatients suffering from severe pain is obvious. The complex regulations in the FRG concerning the prescription of strong opioids are the main reason for insufficient treatment. It is necessary to liberalize these regulations in order to treat severe pain better.
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Review Randomized Controlled Trial Clinical Trial
Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men.
Postoperative use of as-needed intramuscular narcotics is potentially hazardous in frail elderly patients. Patient-controlled analgesia (PCA) allows patients to self-administer small boluses of narcotic, allowing better dose titration, enhanced responsiveness to variability in narcotic requirements, and reduction in serum narcotic level fluctuation. Although theoretically useful, this method has not bee well studied in the elderly or medically ill. ⋯ Patients who had previously received intramuscular injections reported that PCA was easier to use and provided better analgesia. Serum morphine levels showed significantly less variability on postoperative day 1 with PCA, compared with intramuscular injections. We conclude that PCA is an improved method of postoperative analgesia in high-risk elderly men with normal mental status, compared with as-needed intramuscular injections.