Der Schmerz
-
It has been demonstrated that intranasal opioid titration has a rapid onset of action and can provide satisfactory management of postoperative pain [10, 12, 14]. In these studies the intranasal titration was carried out by the investigator. Self-administration of an opioid intranasally by patients requires a spray bottle with safety precautions of an equivalent standard to those offered by an intravenous PCA device. We describe a device for patient-controlled intranasal analgesia (PCINA) that meets these safety requirements. ⋯ We conclude that the PCINA device presented fulfils the PCA device safety requirements. The bolus volume delivered by the device is precise and follows the manufacturer's specifications for flow rate and bolus volume. Initial.
-
Outcome studies of lumbar disc surgery document a success rate ranging between 49% and 90%, according to the evaluation criteria used. The aim of the present study was to investigate the prognostic value of pain history and of sociodemographic, psychodiagnostic and medical factors for the long-term outcome after lumbar disc surgery. ⋯ Anamnestic information on the pain history and psychological factors have prognostic value for the outcome after lumbar disc surgery. If there is no absolute medical indication for disc surgery, we suggest reconsidering the treatment planned for patients with the risk factors specified.
-
A consecutive series of 100 microneurosurgical revision operations on lumbar discs has been evaluated in a prospective and randomized clinical trial analyzing the influence of dexamethasone on postoperative clinical outcome. ⋯ After revision operations on lumbar discs, corticosteroids are a helpful adjuvant drug for relief of lumbar or radicular pain, but they do not significantly improve the final clinical outcome.
-
Adjuvant analgesics are drugs that are not primarily used as analgesics but can produce analgesia in certain types of pain. Adjuvant analgesics can be administered together with non-opioid and opioid analgesics on each step of the WHO analgesic ladder. They should be given when an additional or specific indication exists, but should not be used as a substitute for a thorough treatment with opioids and nonopioids. ⋯ Biphosphonates (etidronate, clodronate, pamidronate derivates) also produce analgesic effects in patients with bone metastases. However, differences among the various compounds have not been clearly evaluated yet. Potent and specific radioisotopes are still under development and the use of calcitonin in bone pain is considered controversial.