Articles: analgesia.
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Noxious stimulation-induced sensitization of the central nervous system has been proposed as a key element in the development of subsequent protracted pain. Accordingly, the authors used the formalin model of pain to test the hypothesis that general anesthesia can produce preemptive analgesia and thereby interfere with noxious stimulation-induced central sensitization. ⋯ Nitrous oxide induces dose-dependent preemptive analgesia in this model that is reversed partially by naloxone, thus suggesting the involvement of endogenous opioids in this action. In contrast, halothane has no preemptive analgesic properties and even antagonizes the analgesic effect of nitrous oxide. Hence, the hypnotic potency of an anesthetic is a poor indication of its preemptive analgesic potential.
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The use of ketamine anaesthesia is described for the transport from home to hospital of patients in severe pain secondary to malignant disease. The technique is simple and highly effective and introduces a new role for anaesthetists and pain relief specialists.
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Anaesth Intensive Care · Feb 1994
Randomized Controlled Trial Clinical TrialIntramuscular ketorolac for postoperative analgesia following laparoscopic sterilisation.
The analgesic effect of intramuscular ketorolac was assessed by double blind study in forty women presenting for day-case laparoscopic sterilisation. The patients were randomly allocated to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of general anaesthesia. There was no statistically significant difference between the groups in pain scores, opioid requirements or incidence of nausea and vomiting in the postoperative period. In view of the potential side-effects of ketorolac, and the apparent lack of efficacy when used prophylactically, the routine use of the drug in this group of patients cannot be recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative extradural analgesia in children: comparison of morphine with fentanyl.
We have compared the efficacy and side effects of extradural morphine with extradural fentanyl for postoperative pain relief. Thirty children (ages 1-16 yr) were allocated randomly to receive, after extradural administration of 0.5% bupivacaine 0.75 ml kg-1 and before surgical incision, extradural morphine 0.75 microgram kg-1 (group M), with an additional dose administered 24 h later or extradural fentanyl 2 micrograms kg-1 (group F) followed by a continuous extradural infusion (during 48 h). There was no major complication (respiratory depression). ⋯ Pruritus, nausea and vomiting were less common with extradural fentanyl (20% vs 53%, P < 0.05 and 0% vs 33%, P < 0.05) than with morphine. Urinary retention occurred with equal frequency (25%) in the two groups. After a bolus of 2 micrograms kg-1, continuous extradural infusion of fentanyl 5 micrograms kg-1 day-1 provided analgesia comparable to that from a daily bolus of extradural morphine 0.75 mg kg-1 and produced fewer side effects.