Articles: analgesics.
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In 34 cancer patients treated with chronic slow-release oral morphine, plasma and cerebrospinal fluid (CSF) minimum steady-state concentrations of morphine (M), morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) were determined by high-performance liquid chromatography (HPLC). Both plasma and CSF morphine, M3G and M6G, concentrations were linearly related to dose of morphine. At steady state, the mean +/- SEM CSF/plasma morphine concentration ratio was 0.8 +/- 0.1. ⋯ Pain relief, evaluated by a visual analogue scale (VAS), did not correlate with the CSF M3G concentrations or with the M3G/M ratio. Since CSF M6G concentrations were high, M6G could, however, contribute to pain relief. We conclude that after oral administration of slow-release morphine, there is a significant passage of the morphine glucuronide metabolites to the CSF and that the M3G and M6G metabolites in CSF are in the concentration range where they may have an influence on analgesia.
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Visceral pain is an important component of many clinical pain states. The perispinal administration of drug combinations rather than a single agent may reduce side effects while maximizing analgesic effectiveness. The purpose of this study was to examine the nature of interactions between an alpha 2-adrenergic agonist (clonidine) and a mu-opioid agonist (morphine), a delta-opioid agonist ([D-Pen2, D-Pen5] enkephalin [DPDPE]), or a kappa-opioid agonist (U50,488H). ⋯ Spinal combinations of alpha 2-adrenergic and mu- or delta- but not kappa-opioid agonists may be beneficial in the control of visceral pain.
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Randomized Controlled Trial Clinical Trial
Intramuscular ketorolac versus oral ibuprofen in acute musculoskeletal pain.
To evaluate the efficacy of IM ketorolac versus that of oral ibuprofen in acute musculoskeletal pain. ⋯ IM ketorolac and oral ibuprofen provide comparable analgesia in ED patients with acute musculoskeletal pain.
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Anaesth Intensive Care · Aug 1995
Randomized Controlled Trial Clinical TrialThe efficacy of adding a continuous intravenous morphine infusion to patient-controlled analgesia (PCA) in abdominal surgery.
The effect of adding a continuous infusion of morphine 1 mg/hr to patient-controlled intravenous analgesia was studied in a randomized double-blind trial. Ninety-six patients scheduled for abdominal surgery were enrolled; 38 received PCA and continuous infusion (PCA + C), 45 received PCA alone and 13 were excluded because of protocol violations. PCA was delivered via an ABBOTT 4200 pump with settings of morphine 1 mg bolus and five-minute lockout in both groups. ⋯ The PCA group delivered more PCA morphine during 0500-0800 hours and 0800-2200 hours on the first day only. There was no significant difference in the D/D ratio for any time period during the three days. Total morphine delivery was greater in the PCA + C group on the second and third postoperative days (P = 0.009 and P = 0.0001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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To provide an overview of access devices and infusion pumps available for pain management. ⋯ Nursing assessment is essential to develop an effective pain management regimen. Because patients are the best source of information about their pain, the nurse is in an excellent position to determine if the placement and use of an access device could be useful in controlling a patient's pain.