Articles: pain.
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Spinal opiate receptor tolerance is the major limitation of continuous intraspinal narcotic analgesia delivered by implanted reservoir pump. Six intractable pain patients receiving continuous epidural morphine were given trials of low dose bupivicaine HCL in order to assess the effects on implanted reservoir function, analgesia, and safety. Daily infusion of 2.6-18.8 mg bupivicaine HCL had no consistent effect on flow rates. ⋯ No sympathectomy was appreciated at these doses. The future of continuous intraspinal analgesia might require further advances in implantable infusion pump technology to allow manipulation of both daily infusion doses and multiple intraspinal analgesics. Further study is needed to assess the safety and effectiveness of higher continuous intraspinal bupivicaine doses for chronic pain relief.
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Br J Clin Pharmacol · Oct 1982
Randomized Controlled Trial Clinical TrialCodeine added to paracetamol induced adverse effects but did not increase analgesia.
1 In a double-blind crossover study identical oral surgical procedures were performed on two separate occasions in 24 outpatients. 2 At one operation they were given tablets containing paracetamol + codeine phosphate (400 mg + 30 mg), and at the other plain paracetamol (400 mg). The day of operation 2 tablets were taken 3, 6 and 9 h after surgery, the following two days 1 tablet four times daily. 3 Several measurements/assessments were recorded for a paired comparison of the postoperative courses. 4 No increase In the analgesic effect could be demonstrated by addition of codeine to paracetamol. 5 On the day of operation 18 patients reported adverse effects like nausea, dizziness and drowsiness with paracetamol + codeine, while only 3 patients experienced side effects with paracetamol alone (P less than 0.001). 6 Measurements revealed almost identical swelling after the two operations. 7 Compared with results obtained in previous studies, the present findings indicate that paracetamol may exert anti-inflammatory activity and reduce postoperative swelling, even when given 3 h after surgery. 8 On the day of operation and the following two days 20 patients preferred the treatment with plain paracetamol, while only 4 favoured paracetamol + codeine (P less than 0.001).