Articles: analgesia.
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Comparative Study
Epidural, intrathecal, and patient-controlled analgesic use in a university medical center.
To determine the number and profile of surgical patients receiving epidural, intrathecal, and patient-controlled analgesia. ⋯ Specialized forms of analgesia are becoming increasingly common. Our audit defined the number of patients receiving such therapies according to type of surgery. Collection of such information by other institutions should allow for targeted evaluations of cost-effectiveness (e.g., drug use evaluations).
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1. The opioid type of swim-stress induced antinociception (SIA) is mediated via mu-sites in preweanling rats and predominantly by delta-sites in postweanling animals. We have studied the effect of delay of weaning on the receptor transition of this behaviour in the developing rat. 2. ⋯ In 30 day old non-weaned rats, naltrindole (5 mg kg-1) abolished the swim SIA. 6. In conclusion, transition from mu to delta-receptor control of swim SIA in rat pups can be delayed by between 5 and 10 days by delay of weaning. The environmental stimulus of weaning can activate opioid receptor subtype operation of biological responses in the developing animal.
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Pain management has emerged as a priority patient care issue, especially in the oncology setting. For most patients with advanced cancer, pain is a major symptom. Cancer pain can be acute, chronic, or a combination. ⋯ Recommendations are offered for organization of services, reliance on primary nurses, and involvement of the multidisciplinary team. Safety concerns and other patient-related issues are highlighted. Based on Memorial Hospital experience, the authors conclude that an acute pain service has an important role in meeting the needs of patients with cancer.
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The 10 months after the introduction of the first acute pain relief service (APRS) in southern Africa is described. Seven hundred patients were treated with morphine by means of patient-controlled analgesia (PCA), administered to patients after major surgery or extensive burns via the intravenous (IV) or subcutaneous (SC) route. The efficacy, safety and resource implications were assessed. ⋯ A total of 86,861 mg morphine was used during this period with rare morbidity and no mortality. Only 1 patient experienced sedation and respiratory depression. The benefits of an APRS with PCA to patients and medical staff alike are discussed.
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Cutaneous O2 and CO2 pressures were monitored for 16 h in 55 female patients recovering from major gynaecological surgery performed under neurolept anaesthesia. Postoperative pain was managed either with an antipyretic analgesic (i.m. or i.v. metamizol up to 2.5 g/4 h; group NLA) or with i.v. patient-controlled analgesia using fentanyl (demand dose 34 micrograms, infusion rate 4 micrograms/h, hourly maximum dose 0.25 mg, lock-out time 1 min; group NLA/PCA). In addition, 11 patients received a single i.v. bolus injection of 150 mg amiphenazole, a respiratory stimulant, at the beginning of PCA treatment (group NLA/PCA/AMI). Data were collected and stored by a personal computer, using the TCM3 system with a combination electrode for simultaneous measurement of cutaneous oxygen and carbon dioxide partial pressures (TINA, Radiometer) at 30-s intervals. The overall observation period was four times 240 min; patients from the NLA group who required additional opioids were excluded from the analysis. Means and standard deviations were calculated for individual data and data pooled for 15- or 60-min intervals. Groups were compared by means of the chi-square test, Student's t-test or analysis of variance (level of significance, P < or = 0.05). ⋯ The present study confirmed that spontaneous respiration in the early postoperative period can be monitored non-invasively by measuring cutaneous partial pressures of carbon dioxide and, less precisely owing to wide individual variations, oxygen. It showed that spontaneous respiration is less effective immediately after termination of surgery under neurolept anaesthesia and recovers slowly over the next 4 h. During the first observation period, ventilation was no worse with i.v. PCA using fentanyl than with conventional pain management using the antipyretic analgesic metamizol, confirming the hypothesis that opioid-induced respiratory depression occurs only at overdosage (which is not a problem with individualized dose titration using PCA). Since all patients in the NLA group required additional opioids after the first observation period and had to be excluded from further analysis, it cannot be decided from the present data whether late hypercapnia was due to PCA or to residual effects of surgery and anaesthesia. The respiratory stimulant amiphenazole (150 mg i.v.) was not helpful in improving ventilation; there was no indication of analgesic effects or interactions of amiphenazole.