Articles: analgesia.
-
The adequate use of opioids in the treatment of chronic cancer pain requires sound knowledge of selection criteria for the various opioids, the routes of administration, dosages, dosing schemes and possible side effects. Drug selection depends on the intensity of pain rather than on the specific pathophysiology. Mild to moderate pain can often be treated effectively by so-called "weak" opioids. ⋯ True dependence or psychological addiction rarely occurs in patients with chronic cancer pain. In most cases, progression of the underlying disease associated with increasing tissue damage and increasing pain is found. Fear of dependence and addiction often contributes to undertreatment of patients suffering from chronic cancer pain.
-
Review Comparative Study
[The pre-emptive analgesia in the treatment of postoperative pain].
The term "pre-emptive analgesia" implies the hypothesis that an analgesic treatment, given before nociceptive stimuli reach the Central Nervous System, could prevent or reduce the subsequent pain. The rational basis of this phenomenon, giving rise to much interest in the last years, comes from the finding that noxious stimuli cause wind-up and receptive fields expansion phenomena in the dorsal horn neurons of the spinal cord leading to hyperalgesia. ⋯ Conflicting results emerged from trials employing local anesthetics, opioids or associations of the three classes of drugs. Thus, the "pre-emptive analgesia" represents a very important phenomenon for the basic research, but further trials must investigate its clinical impact.
-
Review Comparative Study
[Intravenous patient-controlled analgesia (PCA) in the treatment of postoperative pain: rationale and clinical application].
The clinical use of the patient-controlled analgesia (PCA) represents a further improvement in the treatment of post-operative pain. In this way in success due to inadequate protocols, unpredictability of the drug absorption and variability of the response to one drug or to the same pain patterns between patients can be avoided. This technique allows the patient himself to control the pain without depending upon nurses or physicians for the administration of analgesic drugs. Although the PCA is in use since several years, there are still some unresolved problems which are considered in this paper.
-
Review Comparative Study
[Treatment of postoperative pain by balanced spinal analgesia].
Postoperative pain relief has the aim to provide patient subjective comfort, to inhibit neuroendocrine and metabolic responses to surgical injury and to enhance restoration of function by allowing the patient to breathe, cough, move more easily and to begin enteral nutrition. Opioid analgesics, independently from the route of administration, are unable to provide all this. In addition to spinal opioids other drugs, such as local anesthetics, alpha 2-agonists and cholinergic drugs, may produce an antinociceptive effect when administered by spinal route. ⋯ Furthermore, the combined use of opioids-local anesthetics proved to be effective also in abolishing postoperative incident pain and in inhibiting neuroendocrine and metabolic responses to surgical injury. Especially in high risk patients this is related to a better outcome. Finally, even if the synergism between cholinergic drugs with opioids or a2-agonists have been proved, at the moment their use in man by spinal route in the treatment of postoperative pain is not advisable.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Epidural diamorphine. A comparison of bolus and infusion administration in labour.
In a randomly allocated double blind study of 54 primigravidae, we examined the relative efficacy of the addition of diamorphine 3 mg to either an initial bolus or an infusion of bupivacaine. Both groups received an initial bolus of 10 ml of bupivacaine 0.25% followed by an infusion of bupivacaine 0.1% at 10 ml.h-1. Group 1 received diamorphine 3 mg in the bolus and group 2 received diamorphine 3 mg in the initial 100 ml of infusion solution. ⋯ Analgesia, assessed by visual analogue scores, was superior at 7h in group 2, but was similar at all other times. Sedation scores were significantly lower in group 2 for the first 3h and the incidence of nausea was significantly lower in group 2. The addition of diamorphine, whether as a bolus or added to an infusion of bupivacaine, results in similar quality of analgesia, but there is a reduction in side effects when diamorphine is administered in an infusion.