Articles: analgesia.
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Review Case Reports
[Epidural analgesia for postoperative pain in infants and children].
Until recently it was thought that children do not suffer as much from postoperative pain as adults. Coupled with the fear of administering systemic opiates to young children, this meant that babies were often left "to cry it out." Lately it has been acknowledged that children and even babies not only feel pain, but similar to adults, suffer from the physiologic consequences of the untreated stress response. It has also been shown that preventing this response improves the postoperative period in babies after undergoing cardiac surgery. ⋯ We use epidural analgesia in children who undergo major thoracic, abdominal, pelvic and major lower limb surgery, and are expected to suffer significant postoperative pain for more than 24 hours. We have not encountered any major complications or inadvertent dural punctures. We judiciously monitor these children, especially their respiratory function, as long as they receive epidural narcotics.
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Case Reports Clinical Trial
Respiratory depression: an adverse outcome during patient controlled analgesia therapy.
Patient-controlled analgesia (PCA) is one of the more popular means of controlling postoperative pain. However, there is very little in the literature concerning the adverse outcome of respiratory depression in PCA. ⋯ The respiratory depressions were associated with drug interactions, continuous narcotic infusion, nurse- or physician-controlled analgesia and inappropriate use of PCA by patients. This report identified the common precipitating factors in PCA-associated respiratory depression and its prevention.
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Long-term administration of morphine for the treatment of chronic pain produces constipation; this requires the use of laxatives, which impair water absorption and upset the electrolyte balance. Morphine-induced constipation is mainly due to inhibition of the propulsive movement of the gastrointestinal tract combined with spastic contraction of smooth circular muscles as a result of drug binding to opioid receptors in the tract. Since papaverine lacks affinity for opioid receptors but relaxes smooth muscle, it seemed possible that oral papaverine might be capable of diminishing constipation without impairing the analgesia achieved with morphine. ⋯ Since in former experiments on nociceptive activity evoked in thalamus neurones it has been found that the ED(50) of i. v. morphine is 0.05 mg/kg, it is very likely that the presystemic elimination of orally administered morphine is very high and, in addition, that the efficiency of its active metabolite, morphine-6-glucuronide, is rather poor. When morphine 2.5 mg/kg was given together with papaverine 0.5 mg/kg, and morphine 5 mg/kg was administered in combination with papaverine 2 mg/kg, there was no significant reduction in the depressant effect of morphine on nociceptive activity evoked in thalamus neurons (Figs. 6, 7). The results suggest that papaverine given by the oral route may reduce morphine-induced constipation without impairment of the analgesic action of morphine in patients suffering from pain.