Articles: analgesics.
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Anaesthesiol Reanim · Jan 1991
ReviewPain control with intrathecally and peridurally administered opioids and other drugs.
Sharp pain is conducted rapidly by myelinated delta A fibers and diffused pain slowly by nonmyelinated C fibers to pseudobipolar neurons in the posterior ganglion and from there to neurons located in the posterolateral horn of the spinal cord. From here on nociferous impulses are transmitted by excitatory peptides (e.g. substance P) or amino acids (e.g. glutamate, aspartate) through interconnecting neurons of the pain pathways, primarily on the contralateral side, to the brain stem and from there to the sensory cortex, where they are appreciated and acted upon. There are specific inhibitory receptors located on axon terminals, near to the release sites of the excitatory amino acids and peptides. ⋯ Several different approaches are being investigated for the production of selective spinal analgesia without side effects. They include: a. the use of more lipophilic, long-lasting opioids (e.g. lofentanil) which would be almost completely absorbed by the spinal cord and therefore would not reach the medullary centers; b. the development of opioids with specific affinity to kappa- and for delta- and little or no affinity to mu-receptors, primarily responsible for side effects; and c. combining lower doses of opioid agonists with alpha 2-adrenergic agonists (e.g. clonidine) or with somatostatin. It is conceivable that in the not-too-distant future, it will be possible to achieve through these measures, selective spinal analgesia without side effects.
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The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. ⋯ Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.
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Psychother Psychosom · Jan 1991
Influence of psychological and clinical factors on postoperative pain and narcotic consumption.
Demographic, psychological and clinical factors influencing postoperative pain and narcotic analgesic requirements in 162 patients undergoing elective operations under general anesthesia were studied. Eysencks Personality Questionnaire, Foulds Hostility Questionnaire, Zung's Anxiety-Depression (self-rating) Scales and the 43 Item Life Events Inventory by Holmes and Rahe were used. ⋯ Postoperative narcotic requirements increase with increased postoperative pain levels (p = 0.039) and preoccupation with pain postoperatively (p = 0.025), preoperative analgesic drug use (p = 0.017), abdominal surgery (p = 0.009) and longer stay at hospital preoperatively (p = 0.016). Also the department in which the patients were hospitalized influenced narcotic consumption.
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Int J Clin Pharmacol Res · Jan 1991
The importance of non-opioid analgesics for cancer pain relief according to the guidelines of the World Health Organization.
In a retrospective study of 1070 cancer patients being treated according to guidelines of the World Health Organization during a period of 55,285 days, the importance, efficacy and side-effects of non-opioid analgesics were evaluated. The non-opioids were given alone on 6917 days and in combination with weak opioids on 15,253 days, with strong opioids on 24,246 days and with spinal opioids on 1008 days. In evaluating efficacy and safety, it was not possible to differentiate adequately between the effects of non-opioids, opioids and adjuvant drugs, but it was demonstrated that an adequate combination of these drugs was effective and safe in the treatment of cancer pain.