Articles: analgesia.
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Helvetica chirurgica acta · Jun 1989
[Epidural administration of morphine by a completely implantable device (Port-a-Cath)].
The analgesia for patients suffering from incurable tumors is a major problem. The parenteral administration of opioids causes disagreable side effects. The development of completely implantable devices which permit the epidural administration of morphine offers higher quality analgesia with less side effects. Being easy to use, these devices allow cancer patients to remain at home, whereas otherwise they would need to be hospitalized for effective treatment of pain.
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Despite widespread use of a parenterally administered mixture of meperidine, promethazine, and chlorpromazine (Demerol, Phenergan, and Thorazine, DPT), there has been no systematic evaluation of its efficacy and complications in emergency department patients. We reviewed the medical records of all patients less than 16 years old who received DPT in our ED during the 24-month period ending December 31, 1987. Of 487 patients who received DPT, the maximum dose was 50/25/25 mg, respectively. ⋯ An abnormal initial mental status examination or an underlying neurologic abnormality was significantly associated with complications (P less than .05). DPT appears to be a safe and relatively effective sedative for selected pediatric ED patients when administered as a ratio of 2:1:1 mg/kg, respectively. Complications are increased in patients with acute or underlying neurologic abnormalities.
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A transdermal formulation of fentanyl (TTS-fentanyl, Alza Corp., Palo Alto, CA) was evaluated in 13 surgical patients after an abdominal operation. An intraoperative dose of fentanyl (100-200 micrograms i.v.) was administered at the same time as the TTS-fentanyl systems (50-125 micrograms/h) were applied to the antero-lateral chest wall. The TTS-fentanyl systems remained in situ for 24 h and were then removed and a second lot of systems were applied to the contra-lateral chest wall. ⋯ These effects were due to the combined effects of a sustained blood fentanyl concentration and the intermittent supplementary pethidine doses. Side effects due to the topical formulation were transient and included erythema (8 patients) and a minor rash (2 patients) in the area occluded by the systems. The TTS-fentanyl systems provided a significant contribution to postoperative pain control but, at the TTS dose rates used, supplementary doses of pethidine were required by all patients probably to control 'incident' pain.