Articles: analgesics.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ketorolac and morphine as adjuvants during pediatric surgery.
The intraoperative use of opioid analgesics decreases the volatile anesthetic requirement and provides for pain relief in the early postoperative period. In a randomized double-blind, placebo-controlled study involving 95 ASA physical status 1 or 2 children (ages 5-15 yr) undergoing general anesthesia for elective operations, we compared postoperative analgesia following the intraoperative intravenous (iv) administration of ketorolac, a nonsteroidal antiinflammatory drug or morphine, an opioid analgesic. After induction of general anesthesia and before the start of the surgical procedure, children received equal volumes of saline, morphine (0.1 mg.kg-1, iv) or ketorolac (0.9 mg.kg-1, iv). ⋯ The placebo group had a significantly higher VAS and OPS score and required earlier and more frequent analgesic therapy in the PACU compared to the two analgesic groups. Patients receiving ketorolac had less postoperative emesis than those receiving morphine. We conclude that ketorolac (0.9 mg.kg-1) is an effective alternative to morphine (0.1 mg.kg-1) as an iv adjuvant during general anesthesia, and in the dose used in this study, is associated with less postoperative nausea and vomiting in children.
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Most pain in cancer should be easily relieved because it responds in a predictable way to opioid analgesic drugs. Some pains do not respond so well but can usually be ameliorated by the judicious use of adjuvant analgesics, non-drug measures, and the active involvement of the multidisciplinary team.
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Non-opioide analgesics have different pharmacological effects and different profiles of their risks. The life-threatening side effects i.e. agranulocytosis after administration of Dipyrone (Metamizol) are rare, but the must be known and cautions must be considered. On the other hand information must be given about the severe side effects following the not-recommended use i.e. end-stage renal disease after misuse of non-opioid analgesics, because these diseases are preventable.
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To determine why and how sedatives and analgesics are ordered and administered during the withholding and withdrawal of life support from critically ill patients. ⋯ Large doses of sedatives and analgesics were ordered primarily to relieve pain and suffering during the withholding and withdrawal of life support, and death was not hastened by drug administration.
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To review current and potential analgesic techniques in day surgery, with particular regard to their pharmacology. ⋯ Combination analgesia therapy is the best approach for postoperative analgesia for day surgery. The usefulness of preoperative blockade of the pain sensation which limits activation of the central pain pathway and decreases analgesic requirements, is also emphasised. Examples of measures for relief of mild, moderate and severe pain are given.