Articles: analgesics.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Different opioids in patients at cardiovascular risk. Comparison of central and peripheral hemodynamic adverse effects].
Efficient analgesia may be the major objective in the cardiovascular risk patient following myocardial infarction, acute occlusion of peripheral vessels, or dissection/perforation of major abdominal vessels. It was the purpose of the study to investigate the haemodynamic and respiratory side effects of eight different opioids in 57 circulatory risk patients prior to major vascular surgery. METHODS. ⋯ CONCLUSIONS. For interpretation of the results, factors such as respiratory depression, histamine release, secretion of endogenous catecholamines, and hypoxia-induced pulmonary vasoconstriction have to be discussed. Tramadol, an opioid with moderate potency, seems to offer some advantages due to its minor cardiovascular and respiratory side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketorolac vs meperidine for the management of pain in the emergency department.
To compare the pain relief, sedation, and common side effect profiles of ketorolac tromethamine and meperidine for the management of acute pain in the emergency department (ED). ⋯ When used to treat patients who had acute pain states, 60 mg of IM ketorolac produced analgesia similar to that produced by 100 mg of IM meperidine; however, the ketorolac produced fewer subjective side effects and less sedation than did the meperidine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of TENS on pain, medications, and pulmonary function following coronary artery bypass graft surgery.
The efficacy of transcutaneous electrical nerve stimulation (TENS) as an adjunct to narcotic medications for the management of postoperative pain was assessed in a prospective, randomized, controlled study of patients following coronary artery bypass graft (CABG) surgery with the right or left internal thoracic artery (ITA). Forty-five male patients (mean age, 57 +/- 6 years) were randomly assigned to (1) TENS, (2) placebo TENS, or (3) control treatments (n = 15 each), following extubation and during the 24- to 72-h postoperative period. ⋯ All six criterion measures were characterized by significant changes over time for the entire group (n = 45; time main effect; p < 0.01), as follows: pain and medication intake were similar on days 1 and 2, but were significantly less on day 3, and pulmonary functions were significantly lower than preoperatively on day 1, decreased further on day 2, and despite an improvement on day 3, remained significantly lower than preoperative values (p < 0.01). This study suggests that the addition of TENS, applied continuously during the immediate postoperative period following CABG with ITA, may not be advantageous in pain management or the prevention of pulmonary dysfunction.
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Drug Alcohol Depend · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialOpiate detoxification of methadone maintenance patients using lefetamine, clonidine and buprenorphine.
Thirty-nine methadone maintenance patients were included in a 9-day, double blind, randomized, inpatient detoxification trial. Methadone was tapered to 10 mg/day and then patients were assigned to one of these 3 protocols: clonidine (0.3-0.9 mg/day), lefetamine (60-240 mg/day), buprenorphine (0.15-0.9 mg/day). ⋯ Clonidine was more effective than lefetamine in suppressing withdrawal in the first 3 days of treatment (day 3: F = 4.10 df = 2, 30 P < 0.05), and this trend was apparent on the objective and psychological items. In addition to evaluations of the efficacy of the single drugs used, the study showed that tapering methadone to low doses before entering the pharmacologically assisted discontinuation phase was clinically acceptable in detoxification from long-term methadone treatment.
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Randomized Controlled Trial Clinical Trial
Multimodal analgesia before thoracic surgery does not reduce postoperative pain.
Several reports have suggested that preoperative nociceptive block may reduce postoperative pain, analgesic requirements, or both, beyond the anticipated duration of action of the analgesic agents. We have investigated, in a double-blind, placebo-controlled study, pre-emptive analgesia and the respiratory effects of preoperative administration of a multimodal antinociceptive regimen. Thirty patients undergoing thoracotomy were allocated randomly to two groups. ⋯ There were no differences between the groups in postoperative VAS scores (at rest or after movement), PaCO2 values or postoperative spirometry. However, pain thresholds to pressure applied at the side of the chest contralateral to the site of incision decreased significantly from preoperative values on days 1 and 2 after surgery in both groups. The results of this study do not support the preoperative use of this combined regimen for post-thoracotomy pain.