Articles: opioid-analgesics.
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Anesteziol Reanimatol · Jul 1994
Review Comparative Study[Current principles of the clinical use of central-action analgesics].
The author analyzes the results of experimental and clinical studies of various central action analgesics used for total anesthesia, postoperative analgesia, and chronic pain relief in cancer patients. General shortcomings of all opioid analgesics were revealed: analgesias not always full-value because of different individual sensitivity to opioids, and side effects were often serious. The latest progress of the fundamental sciences in research of the mechanisms of pain and body responses related to pain helped improve the available and develop new more effective methods for total anesthesia and postoperative analgesia on the basis of opioid analgesics with the use of special nonopiate components compensating for the defects of opiate analgesia: clofelin, an adreno-positive agent; acelysin and contrykal, prostaglandin and kinin synthesis inhibitors. Synthetic opioids of the latest generation (buprenorphine, tramadol) were found preferable in the treatment of chronic pain in cancer vs. morphine and its analogs; an alternative scheme of drug therapy of chronic pain on the basis of these drugs is offered which is highly effective and causes the minimal side effects.
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Pain relief in children during the perioperative period can be provided by means of peripherally or centrally acting analgesics or of regional anaesthetic techniques. Narcotics or regional blockde are indicated when peripherally acting analgesics prove inadequate to abolish pain. Side effects of narcotics must be taken into account: opioids must not be administered unless continuous safety monitoring of the child's respiration is assured. ⋯ All advantages and drawbacks of the various techniques that might be appropriate must be considered: the technique involving the least risk and side effects is the anaesthetic technique with a broad margin of safety when applied by an anaesthesiologist who has experience with paediatric regional blocks include topical anaesthesia, local infiltration, peripheral nerve blocks (e.g. nervi dorsalis penis, plexus axillaris) and caudal epidural blockade. Caution must be exercised whenever narcotics are administered systemically or epidurally; side effects must not be underestimated, even under conditions of intensive care observation. The provision of effective pain relief is a rewarding task-and particularly in little children.
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Nociceptive stimuli are modulated at the dorsal horn of the spinal cord. This modulation is performed by various systems working independently complementarily, additively or supra-additively. Non-opioid analgesics relieve pain without a motor blockade. ⋯ Lysine acetylsalicylic acid (L-ASA) has been given intrathecally for the therapy of severe cancer pain and chronic back pain. In most patients good analgesia was observed up to 2 months after a single injection. If neurotoxity can be excluded, L-ASA may be an alternative in the therapy of cancer pain before neurodestructive therapy is done.
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A questionnaire was sent to the pharmacies of 88 Finish hospitals with surgical departments to inquire about the consumption of opioids during 1990. Another questionnaire was sent to 480 members of the Finnish Society of Anaesthesiologists to ask how they administer opioids to adult patients. Answers were received from 95% of hospitals and 67% of anaesthetists. ⋯ Epidural opioids were administered by 77% of anaesthetists and patient-controlled analgesia (PCA) technique mostly for intravenous administration by 19%. Only 10% of Finnish anaesthetists were actively involved in the management of chronic pain; the methods they use are discussed. The majority of anaesthetists were satisfied with the currently available opioids.