Articles: analgesia.
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The concept of multiple opioid receptors reconciles a large body of clinical and pharmacological data. Recent studies have shown that there are also multiple opioid binding sites. It would appear that there is considerable variability between species in both the specificity and selectivity of opioid receptors. ⋯ Already subspecies of mu, kappa, and sigma receptors are being postulated. Both pharmacological and neurochemical methods may reveal even more. Some of the newer kappa agonists differ in their pharmacology from the prototypic kappa agonist ethylketazocine.
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Results of peridural morphine analgesia in 122 patients after operation were analysed. The duration of analgesia was established to be longer in this case and to improve the course of the postoperative period. Side effects of morphine (nausea, vomiting, skin itch) were noted in 6% of the cases.
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Br Med J (Clin Res Ed) · Nov 1983
Randomized Controlled Trial Comparative Study Clinical TrialComparative trial of rectal indomethacin and cryoanalgesia for control of early postthoracotomy pain.
A randomised double blind trial was carried out over the first two days after thoracotomy to compare the analgesic effects of rectal indomethacin 100 mg administered eight hourly, cryoanalgesia, and a combination of both of these with the effects of conventional intramuscular opiate analgesia. Pain scores were significantly reduced with both rectal indomethacin alone and cryoanalgesia alone; these treatments had an additive effect when used in combination. Pain on movement was significantly increased, and indomethacin was more effective in reducing this than cryoanalgesia. ⋯ It is concluded that rectal indomethacin, in this dosage, can provide good, safe analgesia after thoracotomy with minimum administrative difficulty. When used as an adjunct to cryoanalgesia it has an additive effect. There are many potential uses for this drug in other branches of surgery.
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Opiates such as morphine have a direct spinal effect, acting at special receptor sites in the dorsal horn. When morphine is administered epidurally, it diffuses to the cord substance, producing analgesia of improved quality after a dose of 2 to 4 mg. ⋯ Significant side effects are uncommon, but pronounced respiratory depression can occur late and careful observation is necessary. The first instance of paraplegia in association with epidural morphine anesthesia has been reported herein.