Articles: pain-management.
-
Expert Opin Investig Drugs · Jun 1999
Levobupivacaine: a new safer long acting local anaesthetic agent.
The choice of local anaesthetic is influenced by several factors; it must provide effective anaesthesia and analgesia for the duration of the procedure and meet the expectations for post-operative pain management. Of primary concern is patient safety. Bupivacaine, currently the most widely used long acting local anaesthetic agent in both surgery and obstetrics, generally has a good safety record but its use has resulted in fatal cardiotoxicity, usually after accidental intravascular injection. ⋯ Nevertheless, levobupivacaine has been shown to have less effect on myocardial contractility and QTc prolongation, early signs of cardiotoxicity, than bupivacaine in healthy subjects. In clinical use levobupivacaine has been shown to be equally efficacious as bupivacaine at comparable doses and concentrations, and has been found to produce similar anaesthetic characteristics (onset, duration and density of block). As levobupivacaine now becomes commercially available, the database available with which to make efficacy and safety comparisons with other local anaesthetics will increase, and the true value of this new long acting local anaesthetic should become even more apparent.
-
J Pain Symptom Manage · Jun 1999
Clinical TrialBarriers to better pain control in hospitalized patients.
Pain is often inadequately treated. To evaluate a common method of assessing pain and to identify some barriers to improving pain control, 50 hospitalized patients in pain, their nurses, and their physicians were interviewed about the pain experienced by the patients. The patients' "pain behavior" was assessed and literatures was reviewed to identify the risk for developing iatrogenic drug addiction in patients with no prior history of drug abuse. ⋯ Barriers to better pain control in acutely hospitalized patients include: (1) exaggerated fear of iatrogenic addiction, (2) an attitude among staff that patients exaggerate the intensity of their pain, (3) poor correlation between pain behavior and pain intensity that can mislead staff who rely on pain behavior to assess pain intensity, and (4) a lack of agreement between doctor and nurse in estimating the intensity of a patient's pain. A new way of thinking about patients in pain, assessing pain as either present or absent, is proposed for evaluation. If pain is present, one should attempt to ameliorate it in a manner consistent with the desire of the patient and the acceptability of adverse effects.
-
Anesthesia and analgesia · Jun 1999
The state of implantable pain therapies in the United States: a nationwide survey of academic teaching programs.
The purpose of this questionnaire survey was to provide an overview of anesthesiology pain fellowship programs in the United States with regard to implantation of spinal cord stimulators (SCS) and opioid infusion devices. Of the 95 programs solicited, 80% responded to questions pertaining to the prevalence of use and technical considerations of implantation. Of the responding programs, 87% report implanting SCS, and 84% report implanting neuraxial infusion pumps. All programs perform a stimulation or infusion trial before implantation, although the duration varied from a trial in the operating room at the time of implantation to 25 days. Of the programs, 83% implant cylindrical leads, and 17% implant flat leads via laminectomy for their nonrevision SCS implants. Morphine, bupivacaine, hydromorphone, and baclofen are the most commonly used drugs and are used in implanted pumps by >50% of respondents. The question of industry-sponsored pain fellow education in implantable techniques is addressed. ⋯ Of the pain teaching programs in the United States, 80% responded to a questionnaire eliciting information about the implantation of spinal cord-stimulating and opioid infusion devices. The range and diversity of responses imply a lack of agreement about implantation techniques, drugs, and protocols.
-
This article outlines the project entitled "Towards a Pain Free Hospital" which aims to make both citizens and health sector workers more aware of the problem of pain in hospitalised patients. The project is already under way in some countries and is being implemented in others. It has been introduced into the local Health Authority Hospital of Vicenza for the first time in Italy and will later be introduced into other Italian hospitals. The article deals with the various initiatives which make up the project and the methods used to involve those assisting the patient in pain.
-
La Revue du praticien · May 1999
Comparative Study[Pain at the end of life: assessment and management].
Pain assessment and management of pain at the end of life require a good knowledge of pain pathophysiology and of the connections between pain and facing death related suffering. Pain is a multidimensional experience. Only an interdisciplinary team is able to provide a compassionate care with a comprehensive approach.