Articles: opioid-analgesics.
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A short survey about the different methods available for producing postoperative analgesia is given, the goal being to make it clear to the clinician that there are quite a number of techniques to be used although the everyday clinical practice often sticks to simple and not too effective methods of pain treatment following surgery. Initially presenting short informations about the neurophysiology of pain and the pathogenesis and causes of postoperative pain two main groups of producing analgesia are then discussed. Thefirst group deals with the systemic use of analgesics be it nonnarcotic analgesic antipyretics or narcotic analgesics (opioids). ⋯ They present clear advantages over the local anesthetic methods as there are the long lasting analgesia and the selective blockade of pain not touching motor and sympathetic nerve fibers. A delayed respiratory depression however might be a serious danger showing an incidence of 0,3% in the epidural and some 10% in the subarachnoid route. Aiming to inform the clinician once again about the vast field of possibilities available to make the postoperative course painfree it is hoped that this important task in the postoperative period will be handled with more consequence and effectivity in the future.
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A nationwide follow-up survey was undertaken to study the use of extradural and intrathecal opioids in the management of pain, to estimate the incidence of delayed ventilatory depression and to study post-injection surveillance routines. A questionnaire was sent to all 93 anaesthetic departments in Sweden; 96% responded. The major indication for using extradural opioids was the treatment of postoperative, traumatic and cancer pain. ⋯ Risk factors for delayed ventilatory depression are discussed. Administration of extradural morphine for postoperative pain relief in patients undergoing major surgery is considered a high benefit-low risk technique by most Swedish anaesthetists. The results of the present nationwide survey suggests that, following extradural morphine, surveillance of patients for more than 12 h appears unnecessary.