Articles: analgesia.
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The surgical experience is often characterized by fear, stress, and pain. Whenever an individual has to confront a painful or stressful event such as surgery, the individual's opportunity to control some aspect of the situation may actually influence the degree of pain experienced. ⋯ Regression analyses controlling for age and type of opioid revealed that the psychological measures were important predictors of pain and PCA use. Patients with higher anxiety levels and less social support had higher postoperative pain and made more frequent PCA demands.
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Nursing care of the patient receiving spinal opioids for pain control is reviewed in a comprehensive manner. Selection of patients, nursing management and patient outcomes are discussed. Three pain control techniques are described: epidural opioid injection for cancer pain, epidural opioid infusion for acute postoperative pain, and single dose spinal opioids for postcesarean section pain. Monitoring and pharmacologic aspects common to all three forms of spinal opioid treatment are given, and specific nursing interventions for each therapy are delineated.
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Spinal opioids have dramatically changed the way acute, obstetrical and pain of malignant origin is managed. The development of various implantable narcotic delivery systems has complemented and facilitated the growth of this treatment modality. By interfacing appropriate patient selection with the unique advantages and disadvantages of each of the six types of implantable narcotic delivery systems, improved results both in terms of pain relief and patient satisfaction can be achieved.
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Spinal opioids have dramatically influenced the way intractable pain of malignant origin is managed. To provide optimal pain relief, spinal opioids must be used in the context of a comprehensive cancer pain management treatment plan. ⋯ During therapy, side effects must be anticipated and treated aggressively to assure patient comfort and safety. Although the chronic administration of opioids and other drugs into the epidural or subarachnoid space is in its infancy, advances in the pharmacology of spinal drugs and the development of new delivery system technology will probably expand the options available for the relief of cancer pain.
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The outpatient management of spinal opioids presents multiple challenges to the home infusion pharmacist. These include compounding, Schedule II prescription control, dispensing for long-term infusion or injection, reimbursement, and the management of opioids in the home. Although spinal opioids such as meperidine, fentanyl, and methadone have been used to control intractable pain, preservative-free morphine is the preferred opioid for epidural and intrathecal injection. ⋯ Spinal opioids can be administered intermittently, by continuous infusion, or patient-controlled analgesia pump. Extensive clinical experience indicates that the home administration of spinal opioids is safe and effective. There is a need for additional research on stability, storage and use of various opioids administered in the home environment.