Articles: pain.
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Postgraduate medicine · Jun 1983
Comparative StudyNarcotics for acute postoperative pain. Is intramuscular administration passé?
Intramuscular (IM) injection of narcotic has been the mainstay of postoperative analgesia. However, problems inherent in IM administration--pulmonary dysfunction and inadequate pain control due to variable peak levels of drug concentration and variable absorption rate--have resulted in continuing efforts to find a more desirable method of administration. Intravenous (IV) infusion on a continuous or self-administered intermittent basis controls pain more effectively than IM injection. ⋯ Some investigators are studying injection of narcotic into the epidural or subarachnoid space of the spine as a means of providing postoperative analgesia. This method provides an unusually intense, prolonged, and segmental analgesic action, as well as greater improvement in respiratory dynamics than with IV infusion. Although the advantages of the IV and spinal methods seem to outweigh the disadvantages, further research is needed before they can be recommended as alternatives to the standard IM method used to control postoperative pain.
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This paper discusses the aetiology, incidence and severity of post-operative pain including factors that influence post-operative pain. Current concepts and the need for effective control of post-operative pain are discussed. A review of the various methods available for post-operative pain management is presented with special reference to practice in a developing country.
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Oral morphine sulphate is the strong narcotic of choice at most hospices. Administered in simple aqueous solution (e.g. 10 mg in 10 ml). No advantage in giving as "Brompton Cocktail." Usual starting dose 10 mg every 4 h. ⋯ Write out regimen in detail with times to be taken, names of drugs and amounts to be taken. Warn patient of possibility of initial drowsiness. Arrange for close liaison and follow up.