Articles: analgesics.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialA double-blind evaluation of ketorolac tromethamine versus acetaminophen in pediatric tonsillectomy: analgesia and bleeding.
The study was designed to compare intravenous ketorolac to rectal acetaminophen for analgesia and bleeding in pediatric patients undergoing tonsillectomy. We studied 50 patients, aged 2-15 yr undergoing tonsillectomy with or without adenoidectomy. In a randomized, prospective double-blind fashion, patients were assigned to receive either ketorolac (1 mg/kg) or rectal acetaminophen (35 mg/kg). ⋯ Significantly more measures to achieve hemostasis were required in the ketorolac group (P = 0.012). We conclude that ketorolac is no more effective than high-dose rectal acetaminophen for analgesia in the patient undergoing tonsillectomy. Hemostasis during tonsillectomy was significantly more difficult to achieve in patients receiving ketorolac.
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Urol. Clin. North Am. · Feb 1995
ReviewPostoperative pain management for pediatric urologic surgery.
The issues relating to postoperative pain management for pediatric urologic surgery have been discussed. Child development and the behavioral responses to pain have been reviewed, with emphasis on their relation to pain assessment in the pediatric patient. The benefits and limitations of various modalities for the treatment of postoperative pain have been reviewed, and their appropriate use for different urologic surgical procedures has been presented.
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These data suggest the presence of peripheral opioid receptors that are involved in the clinical perception of pain. This is a radical change in our traditional thinking of opioid pharmacology and pain management. Most clinicians have been taught that opioids work through the central nervous system. ⋯ Further data, specifically, additional dose-response data with varying amounts of morphine, additional studies in pain syndromes other than knee arthroscopy, and the development and pharmacology of orally active opioid compounds that do not cross the central nervous system, are necessary to confirm and expand the present findings. The possibility of providing opioid pain relief free of central nervous system adverse effects is an exciting prospect. Additional studies of topical opioid preparations also would be of interest.
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The reluctance of patients with cancer to report pain and to use analgesics hinders the management of their pain. In the United States, this reluctance is related to the patient's misconceptions regarding addiction and tolerance to analgesics and the desire to be a "good patient" who does not complain. Reports in the literature suggest that patients in Taiwan may have these same concerns and misconceptions. ⋯ The responses indicated that patients who were less educated were more likely to have concerns and that patients in general were most worried about tolerance. Patients who were inadequately medicated, as determined by an index of "adequate pain management" constructed for the study, had significantly higher levels of concerns. Open communication between health professionals and patients and educational programs about pain and about the concerns measured in this study could help overcome these concerns and misconceptions and improve pain management.