Articles: analgesics.
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Ketorolac tromethamine (Toradol, Syntex Laboratories Inc, Palo Alto, CA) is a new nonsteroidal anti-inflammatory drug widely used in emergency departments and during the postoperative period because of its potent analgesic effects and lack of central nervous system activities. We present three new cases of acute renal failure and hyperkalemia secondary to ketorolac. ⋯ In all patients, acute renal failure developed after a moderate dose of ketorolac was administered for the management of postsurgical pain. Acute renal failure and hyperkalemia were transient, and improved after discontinuation of ketorolac treatment.
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Int J Obstet Anesth · Oct 1994
Parturients' assessment of water blocks, pethidine, nitrous oxide, paracervical and epidural blocks in labour.
This prospective study evaluated the extent to which the analgesic procedures available resulted in efficient pain relief in 833 Finnish parturients. Their pain ratings were recorded according to their own assessment of pain intensity during labour before and after pain management and according to their total pain experience recalled on the third day after delivery. Only regional blocks significantly diminished pain scores during labour and a striking decrease in pain level (P < 0.0001) was maintained until the second stage by epidural analgesia (EDA) alone. ⋯ After delivery 60% of parturients in this group recalled labour pain as being very severe or intolerable. This was partly due to delays in receiving epidural blockade and partly due to the parturient's reticence in requesting analgesia. Pain relief was rated as excellent or good by 94% of the EDA group but by only 50% of the remaining patients.
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Of the currently available mu agonist drugs, the following are relatively contraindicated: 1. Methadone--unpredictable duration of action [5]. 2. Pethidine--unwanted central effects, metabolised to an active metabolite and too short acting. 3. ⋯ Morphine remains the drug of choice for chronic pain when administered in a sustained release preparation. MS Contin, a slow release oral formulation of morphine, is available and has a predictable duration of action lasting from 8-12 h, while improved formulations are about to be released in the near future in some countries. Prescribers need to take into account the relatively poor oral bioavailability of morphine when calculating the daily morphine dose.
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The analgesic effect of indomethacin was investigated by using the visceral pain model in rabbits. After intravenous administration of indomethacin (2 mg/kg), the maximum increase of the visceral pain threshold was 0.42 +/- 0.31 mA (P < 0.05). The analgesic effect lasted 40 min. ⋯ The results imply that prostaglandins of the central nervous system could induce hyperalgesia. Indomethacin injected centrally and peripherally has an analgesic effect on visceral pain. This analgesic effect is mediated by alpha-adrenoceptors. beta-Endorphin does not participate in the analgesic action of indomethacin.
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Analgesic activities of Randia siamensis CRAIB (R. siamensis) extract and pseudoginsenoside-RP1, a constituent of the extract, were examined in the writhing test, hot plate test and Randall-Selitto test. Oral administration of R. siamensis extract dose-dependently decreased the number of writhings and stretchings induced by 0.6% acetic acid in the writhing test in mice. Moreover, in the Randall-Selitto test in rats, the extract raised the nociceptive threshold of the carrageenan-inflamed but not of non-inflamed paw. ⋯ The R. siamensis extract did not affect hexobarbital-induced sleep or spontaneous motor activity in mice, suggesting that it has no sedative effect. Pseudoginsenoside-RP1 produced similar effects to the R. siamensis extract, but its effective doses in the analgesic tests were lower than those with the extract. These results suggest that R. siamensis extract produces anti-nociceptive actions similar to those of a peripherally acting analgesic drug aspirin, and that pseudoginsenoside-RP1 may partly contribute, but is not the main contributor, to the antinociceptive action of the extract.