Der Schmerz
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Patients operated because of lumbar disc herniations (104 patients) were included in a randomized double-blind study analyzing the influence of dexamethasone versus placebo on postoperative drug requirements and the pain score on the visual analogue scale. High doses of dexamethasone had been administered: 40 mg i.v. on the night before the operation; 8 mg intraoperatively topical perineural application; 8 mg i.v. in the evening of the day of operation; 2x8 mg i.m. on days 1 and 2 postoperatively; 2x4 mg i.m. on days 3 and 4; 4 mg po on day 5 and 6 postoperatively. A significant decrease in the requirement for analgesics was found in the drug-treated group, particularly male patients, and also an impressive reduction in the lumbar pain score. In conclusion, there was good alleviation of sciatic pain in the dexamethasone-treated group of females during the 1st week after operation, but we found no evidence that the agent tested had an influence on the clinical outcome 1 month following the operation.
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Systemic application of analgesics is still the most frequently used method of postoperative relief of pain. However, neither intermittent intramuscular nor intermittent intravenous application can provide the patient with a continuous level of analgesia. Lipid-soluble analgesics or those with polar binding that are rapidly metabolized demonstrate an rapid effectiveness. ⋯ After an initial bolus injection, the continuous infusion of an analgesic is guaranteed and may be completed by the patient with several bolus injections. PCA requires careful monitoring. We suggest that a special analgesia team to take care of the patient in special analgesia units might be appropriate in the future.
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Clinical pain syndromes affecting the locomotor apparatus can become apparent not only in the form of nociceptive pain in the skeleto-mechanical system, but also as neurogenic pain emanating from lesions in the peripheral nerves or nerve roots or as referred pain resulting from disorders of visceral organs. The anatomical structure and basic innervation can contribute to the various characteristics of such deep pain. Within the spinal cord, visceral and somatic afferent fibres converge on nociceptive pathways, resulting in a uniform clinical pain syndrome. ⋯ There is no doubt that these drugs can help a great deal. However, they have only a symptomatic effect without any influence on the origin or course of the disease. Therefore, a critical evaluation of their benefits and risks is required before treatment with such drugs is instituted.