Articles: analgesia.
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Intrathecal narcotics are a relatively recent addition to the list of analgesic options that are available for the management of labor pain. Pain during the first stage of labor is related to repetitive uterine contractions and resultant cervical dilatation, while pain during the second stage is due to stretching of the perineum. ⋯ The drugs most often used for intrathecal administration include sufentanil, fentanyl, meperidine and morphine. Use of intrathecal narcotics does not significantly affect the natural progression of labor, and no adverse fetal outcomes have been reported.
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Preemptive analgesia has recently been the subject of much discussion in the literature including a recent editorial which describes some of the difficulties surrounding the subject. The concept of preemptive analgesia is frequently misunderstood by anesthesia providers especially relative to the use of regional anesthesia. This confusion hampers anesthetists in their practice when they seek to provide optimal pain care for their patients, and especially when regional block is not an option in their particular practice or is inappropriate either for the individual patient or for the surgery being undertaken. This article attempts to differentiate preemptive analgesia from regional anesthetic blockade, and discusses other interventions which may also play a role in producing some measure of preemptive effect.
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J. Vet. Pharmacol. Ther. · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of preoperative morphine and buprenorphine for postoperative analgesia for arthrotomy in dogs.
The aim of this study was to compare morphine with the partial agonist, buprenorphine, for postoperative analgesic effects, when administered preoperatively for elective arthrotomy in dogs. Fifty two dogs were anaesthetized for stifle, elbow, or hock arthrotomy. The dogs were premedicated 30 min prior to induction of anaesthesia with 0.03 mg/kg acepromazine intramuscularly, and either 0.3 mg/kg morphine or 0.01 mg/kg buprenorphine intramuscularly (allocated randomly). ⋯ Pain scores did not differ significantly (morphine group median postoperative score from 30 to 40 mm, buprenophine group median postoperative score from 36 to 43 mm) and analgesia was considered adequate in the majority of cases (score less than 40 mm). Morphine produced significantly more sedation at 0.5 h after anaesthesia only. It was concluded that both opioids are equally suitable analgesics for postoperative analgesia for the elective arthrotomy in dogs.
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Recent evidence has documented the deleterious physiologic effects of pain and the beneficial results of effective postoperative analgesia. As outlined in this article, a three-step approach is recommended depending on the severity of pain. ⋯ All three choices may significantly impact on the efficacy of analgesia. While we continue to use primarily intravenous opioids to treat moderate and severe pain in the hospital setting, future formulations and developments may allow for the increased use of non-parenteral routes.