Journal articles on the topic 'Analgesics Administration'
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Sekulovski, M., B. Simonska, G. Mutafov, V. Alexandrov, and L. Spassov. "Bilateral ultrasound-guided abdominal peripheral block in tap plane, tap - block." Trakia Journal of Sciences 18, no. 4 (2020): 344–49. http://dx.doi.org/10.15547/tjs.2020.04.009.
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INTRODUCTION: Bilateral ultrasound-guided peripheral block (TAP - block) in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle – TAP plane, is a regional anesthesia technique by infiltration of a local anesthetic, provides analgesia for operations involving the anterior abdominal wall. The analgesic effectiveness of the block decreases the consumption of opioid analgesics and non-steroidal anti-inflammatory drugs. AIM: In this study, we evaluated the intraoperative analgesic efficacy of bilateral TAP - block and the consumption of opioid analgesics in patients undergoing bilateral laparoscopic inguinal hernia repair. METHODS: The study was conducted with 35 patients, who were randomized into two groups. In the control group (group I), there are patients who received general anesthesia (GA), and experimental group (group II), were patients who have received general anesthesia and a bilateral tap block (GA + TAP). RESULTS: Patients with TAP-block (group II) have significantly lower fentanyl consumption compared to group I. CONCLUSION: Multimodal approach for the simultaneous administration of general anesthesia with a TAP block provides effective intraoperative analgesia and significantly reduces the perioperative consumption of opioid analgesics.
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Bayalieva, Aynagul Zh, and J. N. Yankovich. "BIOAVAILABILITY AND EFFICACY OF OPIOID USE WITH EPIDURAL BLOCKADE." Regional Anesthesia and Acute Pain Management 12, no. 2 (June 15, 2018): 76–81. http://dx.doi.org/10.18821/1993-6508-2018-12-2-76-81.
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The article is devoted to the questions of epidural analgesia with the use of opioid analgesics. The work analyzes the clinical effectiveness of epidural use of opioids, lists possible complications and cautions of this method of anesthesia. Bioavailability of morphine and fentanyl for the spinal cord with epidural administration allows to achieve analgesic effects at a certain block level more effectively than with systemic administration. However, the side effects of opioids in the form of respiratory depression are also found with epidural administration (3%), so patient safety monitoring is necessary.
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Whitley, Gregory Adam, and Richard Pilbery. "Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review." British Paramedic Journal 4, no. 3 (December 1, 2019): 24–34. http://dx.doi.org/10.29045/14784726.2019.12.4.3.24.
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Introduction: Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review is to critically evaluate the pre-hospital literature, exploring the safety and efficacy of intranasal (IN) analgesics for children suffering pain.Methods: We performed a rapid evidence review, searching from inception to 17 December 2018, CINAHL, MEDLINE and Google Scholar. We included studies of children < 18 years suffering pain who were administered any IN analgesic in the pre-hospital setting. Our outcomes were effective pain management, defined as a pain score reduction of ≥ 2 out of 10, safety and rates of analgesia administration. Screening and risk of bias assessments were performed in duplicate. We performed a narrative synthesis.Results: From 310 articles screened, 23 received a full-text review resulting in 10 articles included. No interventional studies were found. Most papers reported on the use of intranasal fentanyl (INF) (n = 8) with one reporting IN ketamine and the other IN S-ketamine. Narrative synthesis showed that INF appeared safe and effective at reducing pain; however, its ability to increase analgesia administration rates was unclear. The effectiveness, safety and ability of IN ketamine and S-ketamine to increase analgesia administration rates were unclear. There was no evidence for IN diamorphine for children in this setting.Conclusion: Interventional studies are needed to determine with a higher confidence the effectiveness and safety of IN analgesics (fentanyl, ketamine, S-ketamine, diamorphine) for children in the pre-hospital setting.
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Kircher, Janeva, Amy L. Drendel, Amanda S. Newton, Sukhdeep Dulai, Ben Vandermeer, and Samina Ali. "Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation." CJEM 16, no. 06 (November 2014): 449–57. http://dx.doi.org/10.1017/s1481803500003468.
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ABSTRACTObjective:Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children’s MSK pain, both in the ED and postdischarge.Methods:We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care.Results:A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes.Conclusions:Documentation of the assessment and management of children’s pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ‘‘door to analgesia’’ time for children in pain.
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Kumar, Govindaraj Padmanabha, Chew Shu-Lyn, Goi Ee Win, Lee Win Sie, Nur Fatin Khaleeda binti Lakman, and Nazmul Haque. "Comparison between preoperative and post-operative administration of paracetamol, ibuprofen and mefenamic acid for post-extraction pain control." Biomedical Research and Therapy 7, no. 5 (May 25, 2020): 3794–98. http://dx.doi.org/10.15419/bmrat.v7i5.606.
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Pain is a common aftereffect following a dental treatment, especially extractions. Hence, the main aim of the study was to compare the effect of pre-operative and post-operative analgesic usage on post-operative pain management following dental treatment. Moreover, the efficacies of three types of painkillers (Paracetamol, Ibuprofen and Mefenamic Acid) in pain relief were also evaluated. Volunteers (n = 120) who were undergoing extraction participated in this study and were randomly divided into two groups. One group consisting of 60 participants were given pre- and post-operative analgesics while another group (n = 60) received post-operative analgesics only. A visual scale was used to record pain from zero to 56 hours post-operatively at 8-hour intervals. The results showed that patients who were taking analgesics pre-operatively experienced significantly (p = 0.0045) less pain compared to those who had taken post-operative analgesics only However, a lower cumulative number of moderate and severe experiences of post-extraction pain was recorded for the pre- and post-operative analgesic treatment groups as compared to the postoperative only analgesic treatment group; no significant differences were observed. Moreover, no significant differences were observed among the analgesics used in this study as well. On the basis of these results, we conclude that preoperative analgesic usage has a positive impact on postextraction acute pain management.
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Smith, Howard. "Peripherally-Acting Opioids." Pain Physician 2s;11, no. 3;2s (March 14, 2008): S121—S132. http://dx.doi.org/10.36076/ppj.2008/11/s121.
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Opioids are broad-spectrum analgesics with potent pain-relieving qualities but also with potential adverse effects related to both short-term and long-term therapy. Researchers have attempted to alter existing opioid analgesics, utilize different routes/ formulations, or combine opioid analgesics with other compounds in efforts to improve analgesia while minimizing adverse effects. Exogenous opioids, administered in efforts to achieve analgesia, work by mimicking the actions of endogenous opioids. Endogenous opioids and their receptors are located in the brain (supraspinal areas), spinal cord, and periphery. Although opioids and opioid receptors in the brain and spinal cord have received much attention over many years, peripheral endogenous opioid analgesic systems have only been extensively studied during the past decade. It has been known since 1990 that following injection into the rodent hindpaw, d-Ala2 , N-Me-Phe4 , Gly5 -ol-enkephalin (DAMGO) [a muopioid receptor agonist] probably exerts its antinociceptive effects locally, since the doses administered are too low to have an effect in the central nervous system (CNS). This notion has been supported by the observation that the quaternary compound morphine methyliodide, which does not as readily cross the bloodbrain barrier and enter the CNS, produced antinociception following intradermal administration into the hindpaw, but not when the same dose was administered systemically (subcutaneously at a distant site). With a growing appreciation of peripheral endogenous opioids, peripheral endogenous opioid receptors, and peripheral endogenous opioid analgesic systems, investigators began growing hopeful that it may be possible to achieve adequate analgesics while avoiding unwanted central untoward adverse effects (e.g. respiratory depression, somnolence, addiction). Peripherally-acting opioids, which capitalize on peripheral endogenous opioid analgesic systems, may be one potential future strategy which may be utilized in efforts to achieve potent analgesia with minimal side effects. Key words: Pain, opioids, immune cells, peripherally-acting opioids (PAO), leukocytes, inflammatory pain, peripheral analgesia
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Vincent Y.T. Cheung. "Pain experience during first trimester medical termination of pregnancy: Clinical observation from a cohort of Asian women." World Journal of Advanced Research and Reviews 13, no. 3 (March 30, 2022): 022–24. http://dx.doi.org/10.30574/wjarr.2022.13.3.0199.
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Objective: Optimal pain management during medical termination of pregnancy (TOP) remains unclear. This study aimed to suggest practical points to help minimize the intensity of pain of women during first trimester medical TOP. Methods: A retrospective observational study which reviewed the pain experience and the need for analgesics of 44 Asian women, who underwent first trimester medical TOP. Results: Nulliparous women had higher pain scores and more likely to need analgesics than multiparous women. Most women requested analgesics between 87.8 and 154.4 min (95% confidence interval) after misoprostol administration. Conclusions: Prophylactic analgesics should be provided to all nulliparous women undergoing first trimester medical TOP; and if paracetamol is the analgesic of choice, it should be given one hour after vaginal misoprostol administration to optimize pain relief.
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Bernadeth, Bernadeth, Ezra Oktaliansah, and Indriasari Indriasari. "Efektivitas Analgesik Pascaoperasi pada Pasien Pediatrik di Ruang Pemulihan Rumah Sakit Dr. Hasan Sadikin Bandung Periode Juni–November 2018." Jurnal Anestesi Perioperatif 7, no. 1 (April 30, 2019): 68–84. http://dx.doi.org/10.15851/jap.v7n1.15647.
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Nyeri merupakan pengalaman sensorik dan emosional yang tidak menyenangkan. Penyebab utama nyeri akut pada anak adalah prosedur pembedahan, trauma, dan penyakit akut. Penilaian nyeri merupakan bagian penting dari manajemen nyeri. Penelitian ini bertujuan mengetahui efektivitas analgesik pascaoperasi pada pasien pediatrik di ruang pemulihan RSUP Dr. Hasan Sadikin Bandung periode Juni-November 2018. Penelitian menggunakan metode deskriptif observasional prospektif terhadap 471 pasien pediatrik pascaoperasi di ruang pemulihan. Subjek penelitian dikelompokkan berdasar atas jenis operasi yang menyebabkan nyeri ringan, sedang, dan berat. Jenis analgesik pascaoperasi yang diberikan dan penilaian nyeri selama di ruang pemulihan dicatat untuk melihat efektivitas analgesik pascaoperasi tersebut. Dari hasil penelitian efektivitas analgesik pascaoperasi pada jenis operasi nyeri ringan sebanyak 181 pasien (99,5%), jenis operasi nyeri sedang sebanyak 231 pasien (98,7%), dan pada jenis operasi nyeri berat sebanyak 53 pasien (96,4%). Simpulan penelitian ini adalah efektivitas analgesik pascaoperasi pada pasien pediatrik di RSUP Dr. Hasan Sadikin Bandung masih kurang efektif karena belum memenuhi target rumah sakit 100% bebas nyeri dan pemberian analgesik juga belum efisien karena masih banyak terdapat ketidaksesuaian antara pilihan analgesik dan derajat nyeri.Effectiveness of Post-Operative Analgesia on Pediatric Patients in the recovery room of Dr. Hasan Sadikin General Hospital Bandung from June to November 2018Pain is an unpleasant sensory and emotional experience. Pain assessment is an important part of pain management. The main causes of acute pain in children are surgical procedures, trauma, and acute diseases. This study aimed to study the effectuIveness of postoperative analgesics in pediatric patients in the recovery room of Dr. Hasan Sadikin General Hospital Bandung from June to November 2018. This was a prospective observational descriptive study on 471 postoperative pediatric patients in recovery rooms. The research subjects were grouped based on the type of surgery pain, i.e. mild, moderate, and severe. The type of postoperative analgesics given and assessment of pain during the stay in the recovery room were recorded to see the effectiveness of the postoperative analgesic drug. From the results of the study it was identified that the of postoperative analgesics was effective for 181 patients (99.5%) in the mild pain surgery group, for 231 patients (98.7%) in the moderate pain surgery, and for 53 patients (96.4%) in severe pain surgery. It is concluded that the postoperative analgesics provided to pediatric patients at Dr. Hasan Sadikin General Hospital Bandung is still less effective because it has not met the target of 100% pain free set by the hospital and that analgesic administration is also not efficient because there are still many discrepancies in analgesic choices and the degree of pain.
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Tahereh Mohammadi, Elham Sharafi, Atieh Sadeghniiat-Haghighi, Farzan Vahedifard, Arghavan Shafiee-Aghdam, and Mohammad Arbabi. "Opioid for in-hospital admitted patient analgesics; which demographics and psychiatric profiles need more pain drugs?" World Journal of Biology Pharmacy and Health Sciences 11, no. 1 (July 30, 2022): 038–49. http://dx.doi.org/10.30574/wjbphs.2022.11.1.0090.
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Introduction: The prevalence of substance use disorders is higher in patients receiving opioid analgesics, and pain management in these patients is more challenging. This study aimed to investigate the pattern of analgesic drug administration and evaluate the associated factors. Method: The cross-sectional study was performed on 230 patients admitted to General Hospital ( internal medicine, surgery, and cancer wards). Result: The most used analgesic drug was morphine (59.4%), and a mean dose of 27 mg, then pethidine and methadone. Most pain control methods were intravenous (68.1%) and PRN pattern (61.1%). Using analgesics in patients who do not have risk factors for drug abuse, or addiction, can be considered safe. In our subjects, 95.6% of analgesic users did not become addicted or had any misuse. Discussion and Conclusion: For effective and low-risk treatment of these patients, there is a need for clinical skills, knowledge of opioid administration, assessment, and risk management of substance abuse and addiction. In patients with substance abuse, analgesics should be prescribed in a particular setting, under supervision, and with careful monitoring. Structured and planned administration of opioid agonists (such as methadone or buprenorphine) seems appropriate according to a structured schedule. These plans are recommended: · Increasing the awareness of clinicians about prescribing narcotic analgesics. · Prescribing narcotic analgesics with a regular pattern against PRN. · Evaluating patients for a history of substance abuse. · Closely monitoring them, and if necessary. · Counseling. Identifying high-risk groups such as women, youth, and psychiatric patients are also recommended, and performing early interventions.
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Saraghi, Mana, and Elliot V. Hersh. "Three Newly Approved Analgesics: An Update." Anesthesia Progress 60, no. 4 (December 1, 2013): 178–87. http://dx.doi.org/10.2344/0003-3006-60.4.178.
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Abstract Since 2008, three new analgesic entities, tapentadol immediate release (Nucynta) diclofenac potassium soft gelatin capsules (Zipsor), and bupivacaine liposome injectable suspension (EXPAREL) were granted US Food and Drug Administration (FDA) approval to treat acute pain. Tapentadol immediate-release is a both a mu-opioid agonist and a norepinephrine reuptake inhibitor, and is indicated for the treatment of moderate to severe pain. Diclofenac potassium soft gelatin capsules are a novel formulation of diclofenac potassium, which is a nonsteroidal anti-inflammatory drug (NSAID), and its putative mechanism of action is through inhibition of cyclooxygenase enzymes. This novel formulation of diclofenac allows for improved absorption at lower doses. Liposomal bupivacaine is a new formulation of bupivacaine intended for single-dose infiltration at the surgical site for postoperative analgesia. Bupivacaine is slowly released from this liposomal vehicle and can provide prolonged analgesia at the surgical site. By utilizing NSAIDs and local anesthetics to decrease the transmission of afferent pain signals, less opioid analgesics are needed to achieve analgesia. Since drug-related adverse events are frequently dose related, lower doses from different drug classes may be employed to reduce the incidence of adverse effects, while producing synergistic analgesia as part of a multimodal analgesic approach to acute pain.
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Nwanganga, Melinda, Jean Cadet, and Jochebed Ade-Oshifogun. "Effects of Pediatric Emergence Delirium Education on Analgesic Administration by PACU Nurses: A Pilot Study." International Journal of Studies in Nursing 5, no. 1 (March 9, 2020): 58. http://dx.doi.org/10.20849/ijsn.v5i1.720.
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Background: Emergence delirium (ED) is a behavioral disturbance as a result of general anesthesia that commonly occurs in pediatric patients. Adverse effects of ED lead to a complicated recovery from anesthesia leading to the increased use of sedatives and analgesics. Due to the multiple ramifications of ED, PACU nurses need to provide appropriate care to promote a safe recovery process from anesthesia while avoiding unnecessary use of analgesics. The Pediatric Assessment Emergence Delirium (PAED) tool has been successfully utilized in recognizing ED in PACU. Purpose: The purpose of this evidence-based practice project was to educate PACU nurses about the use of the PAED tool, and explore the post-education effect on the nurses’ use of analgesics in the immediate post-op period. Method: This project utilized a pre- and post- interventional study design. Twenty-eight charts of pediatric post-op patients were screened pre-intervention for analgesic use. An educational session on ED and instruction on the use of the PAED tool were provided to PACU nurses. After six weeks, 24 charts were reviewed for analgesic administration. The results of pre and post analgesic use were compared by using Fisher’s exact test of independence. Results: Findings revealed an overall non-significant decrease in analgesic use from 21% (n=6) to 17% (n=4) between pre-intervention and post-intervention groups (x2 = 0.189, p = .47), though a decrease in the use of stadol was observed from 11% (n=3) to 0%. Conclusion: ED education with PAED use has the potential to influence PACU nurses’ usage of analgesics. Follow up studies with larger sample sizes are needed to explore such an influence further.
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Stokes, E. L., P. A. Flecknell, and C. A. Richardson. "Reported analgesic and anaesthetic administration to rodents undergoing experimental surgical procedures." Laboratory Animals 43, no. 2 (April 2009): 149–54. http://dx.doi.org/10.1258/la.2008.008020.
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A structured literature review was carried out to assess recent trends in the administration of analgesics and anaesthetics to laboratory rats and mice undergoing surgical procedures. The ScienceDirect database was used to systematically identify studies published in peer-reviewed journals over two periods (2000–2001 and 2005–2006), 86 studies from each time period were included in the review. The total number of animals that underwent surgery, species used, type of procedure, anaesthetic regimen and analgesic administration were noted for each study. There was an increase in the reported administration of systemic analgesics from 10% in 2000–2001 to 20% in 2005–2006. Buprenorphine was the most commonly reported analgesic in both periods (2000–2001: 78%, 2005–2006: 35%) and reporting the use of non-steroidal anti-inflammatory drugs increased from 11% to 53%. There was also a change in reported anaesthetic practices, notably a decrease in the use of pentobarbital and an increase in the use of isoflurane and ketamine/xylazine. Although reported administration of analgesics has increased and there has been some refinement in the selection of anaesthetic agents used, the findings of this review suggest that there is still significant scope for improvement with respect to the perioperative care of laboratory rodents.
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Xu, Jiajie J., Sarah E. Thurston, Tyler J. Robinson, June F. Escara-Wilke, Stephanie Daignault-Newton, Tara L. Martin, Evan T. Keller, and Jill M. Keller. "Effects of Analgesics on Tumor Growth in Mouse Models of Prostate Cancer Bone Metastasis." Journal of the American Association for Laboratory Animal Science 60, no. 3 (May 1, 2021): 341–48. http://dx.doi.org/10.30802/aalas-jaalas-20-000060.
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Murine models of tumor development often require invasive procedures for tumor implantation, potentially causing pain or distress. However, analgesics are often withheld during implantation because of concerns that they may adversely affect tumor development. Previous studies examining the effects of analgesics on the development and metastasis of various tumor lines show that the effect of analgesics depends on the tumor line and analgesic used. A blanket statement that analgesics affect the general growth of tumors is not adequate scientific justification for withholding pain relief, and pilot studies or references are recommended for each specific tumor cell line and treatment combination. In this study, we evaluated the effects of 2 commonly used analgesics on tumor growth in 2 models of prostate cancer (PCa) bone metastasis. We hypothesized that a one-time injection of analgesics at the time of intratibial injection of tumor cells would not significantly impact tumor growth. Either C57BL/6 or SCID mice were injected subcutaneously with an analgesic (carprofen [5 mg/kg], or buprenorphine [0.1 mg/kg]) or vehicle (0.1 mL of saline) at the time of intratibial injection with a PCa cell line (RM1 or PC3, n = 10 to 11 per group). Tumor growth (measured by determination of tumor burden and the extent of bone involvement) and welfare (measured by nociception, locomotion, and weight) were monitored for 2 to 4 wk. Neither carprofen or buprenorphine administration consistently affected tumor growth or indices of animal welfare as compared with the saline control for either cell line. This study adds to the growing body of literature demonstrating that analgesia can be compatible with scientific objectives, and that a decision to withhold analgesics must be scientifically justified and evaluated on a model-specific basis.
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Zia, A., R. MacDonald, S. Moore, J. Ducharme, and C. Vaillancourt. "MP34: Assessment of pain management during transport of intubated patients in a prehospital setting." CJEM 19, S1 (May 2017): S76—S77. http://dx.doi.org/10.1017/cem.2017.200.
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Introduction: While methods have been developed to assess pain and provide analgesia to hospitalized intubated patients, little is known about current EMS practices in providing similar care during air and land medical transports. Therefore, we sought to determine if opioid analgesia is provided to intubated patients during transportation in out-of-hospital setting. Methods: We conducted a health record review examining electronic records of intubated patients transported by Ornge in 2015. Ornge is the exclusive provider of air and land transport of critically ill patients in Ontario, Canada with over 18,000 transports per year. We identified cases using Ornge’s database and selected intubated patients meeting inclusion criteria. A standardized data extraction form was piloted and used by a single trained data extractor. The primary outcome was frequency of administration and dose adequacy of an opioid analgesic. Secondary outcomes included: choice of analgesics used (fentanyl, hydromorphone or morphine), adverse events, and impact of age, sex, or reason for transfer on pain management. We present descriptive statistics. Results: Our strategy identified 500 potential cases, of which 448 met our inclusion criteria. Among those 448 patients, 154 (34.4%) were females, 328 (73.4%) received analgesia and 211 (64.3%) received more than one dose during transport (median frequency of 2 doses, IQR=1 to 3). The average transport time was 148 minutes and repeated dosing (>1 repeat dose) occurred primarily (45.5%) in transports of over 180 minutes. Fentanyl was the most commonly used analgesic (97.6%) and most commonly used dose was 50 micrograms (51.8%). Adverse events occurred in 8 (2.5%) patients with 5 patients having new hypotension (MAP <65 mm Hg). There was no significant difference in administration of analgesia based on patient’s age or sex (68.8% of females and 75.3% of male patients received analgesia). Interestingly, 30.8% of patients repatriated to originating-hospital received analgesia compared to 72.3% of patients receiving analgesia for all other reasons for transfers. Conclusion: More than 73% of intubated patients transported by Ornge received an opioid analgesic, most commonly fentanyl. We found no clinically relevant difference in the administration of analgesics based on age, sex or reason for transfer other than home repatriation.
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P., Shanmukananda, Shwetha H., Veena D. R., and Poorvi M. "A cross sectional questionnaire based study on self medication practice of analgesics among MBBS students at Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka." International Journal of Basic & Clinical Pharmacology 9, no. 4 (March 24, 2020): 633. http://dx.doi.org/10.18203/2319-2003.ijbcp20201190.
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Background: Self medication with analgesics is prevalent worldwide due to easy procurement of over the counter drugs. Present study was done to assess knowledge, attitude, practice and perception of self medication of analgesics among MBBS students at Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka.Methods: A cross-sectional study was conducted on 5th term MBBS students of Dr. B. R. Ambedkar Medical College, Bengaluru in November 2019. A pre-designed validated questionnaire was used to collect information on knowledge, attitude, practice and perception of self medication of analgesics. Data was analysed using descriptive statistics.Results: 83.3 % of 5th term MBBS students practiced self medication with analgesics. Majority of students had some knowledge on self medication with analgesics. Common reason for using analgesic self medication was headache (59.7%) and nonsteroidal antiinflammatory drugs (90%) were commonly used analgesics. Analgesics were used for quick relief (73.3%) and source of information was from medical textbooks (61.6%). Students stopped taking analgesics after symptoms disappeared (75%). Students agreed that self medication is acceptable for medical students (63.3%) and medical license is required for better administration of drugs (51.3%).Conclusions: This study has found that self medication with analgesics was common among undergraduate medical students for minor illness. It is necessary to create awareness and educate students regarding dangers of analgesic self medication.
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Paull, D. R., I. G. Colditz, C. Lee, S. J. Atkinson, and A. D. Fisher. "Effectiveness of non-steroidal anti-inflammatory drugs and epidural anaesthesia in reducing the pain and stress responses to a surgical husbandry procedure (mulesing) in sheep." Australian Journal of Experimental Agriculture 48, no. 7 (2008): 1034. http://dx.doi.org/10.1071/ea08050.
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In this study, we examined the potential of several widely used non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesics to reduce pain and stress in sheep after surgery. Because mulesing involves a greater degree of tissue trauma than other surgical husbandry procedures such as castration or tail-docking, it provides a more rigorous and conservative test to identify potentially useful analgesic strategies in sheep. Merino lambs (5 weeks of age) were randomised into eight treatment groups: (1) carprofen; (2) flunixin; (3) ketoprofen; (4) buprenorphine; (5) xylazine; (6) lignocaine epidural; (7) saline control; (8) sham control. The NSAIDs were administered 1.5 h before mulesing, buprenorphine 0.75 h and xylazine and lignocaine 0.25 h before mulesing. Pain- and discomfort-related behaviours were recorded for 12 h after mulesing, and plasma cortisol concentrations were measured before mulesing and 0.5, 6, 12, 24 and 48 h after mulesing. The results indicated that no single analgesic treatment provided satisfactory analgesia during both the surgical mulesing procedure and the ensuing period of pain associated with the inflammatory phase. However, there were indications that two NSAIDs (carprofen and flunixin) showed good potential as analgesics during the inflammatory phase. A combination of short- and long-acting analgesics may be needed to provide more complete pain relief. In conclusion, the administration of some NSAIDs offers the potential for good analgesia in sheep for the inflammatory phase following the tissue trauma of surgical husbandry procedures. Other analgesic options need to be considered if the acute stress response to the procedure is to be reduced.
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Robles, Ivelisse, Andreia G. Arruda, Emma Nixon, Elizabeth Johnstone, Brooklyn Wagner, Lily Edwards-Callaway, Ronald Baynes, Johann Coetzee, and Monique Pairis-Garcia. "Producer and Veterinarian Perspectives towards Pain Management Practices in the US Cattle Industry." Animals 11, no. 1 (January 16, 2021): 209. http://dx.doi.org/10.3390/ani11010209.
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Producers and veterinarians are considered responsible for improving animal welfare, as they are responsible for implementing practices that directly impact the animal’s well-being. Most husbandry procedures performed in cattle do not include pain mitigation, and understanding challenges faced by these stakeholders to use analgesics is key in improving on-farm pain management strategies. Therefore, the objectives of this study were to explore producer and veterinarian perspectives on pain management practices by (1) exploring inquires received by Food Animal Residue Avoidance Databank (FARAD) regarding analgesic use in cattle and (2) using a survey instrument to identify factors that impact pain management implementation in the US cattle industry. Albeit analgesia use increased in the past ten years for some producers and the majority of veterinarians, administering analgesics for pain management on US cattle farms remains a challenge. From a producer perspective, drug cost, availability and logistics for administration. From a veterinarian perspective, lack of Food and Drug Administration (FDA) products hinders the support of on-farm protocols requiring extra-label drug use. Future steps to improve analgesic use on-farm include identifying and approving drugs that demonstrate efficacy for managing pain in cattle and disseminating educational resources to support stakeholders in both the implementation and drug withdrawal process.
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Naraharisetti, Suresh Babu, Salma Srour, Yun Xu, David J. Lee, Sharon H. Hertz, and Chandrahas Sahajwalla. "Effects of Food on Bioavailability of Analgesics; Resulting Dosage and Administration Recommendations." Pain Medicine 21, no. 11 (April 10, 2020): 2877–92. http://dx.doi.org/10.1093/pm/pnaa046.
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Abstract Objectives To evaluate currently approved analgesics, that is, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and serotonin and norepinephrine reuptake inhibitors (SNRIs) used as analgesics, for 1) differences in pharmacokinetic parameters under fed vs fasting conditions and 2) factors involved in dosage recommendations in relation to food. Design Systematic review. Results Food effect on the rate, extent of absorption, or shape of concentration–time profile can alter the onset of action, duration of action, or tolerability of a medication. Based on 79 analgesic products reviewed, food effect dosage recommendations depend on whether an analgesic will be dosed on a regular interval around-the-clock vs on an as-needed basis, the shape of concentration–time profile, steady-state concentrations, the type of meals used in the pharmacokinetic study, and drug administration with regard to food in clinical trials. Overall, most opioids do not have food restriction and are taken without regard to food, with the exception of OPANA products and XTAMPZA ER. For many NSAIDs, food does not affect absorption characteristics, with the exception of ZORVOLEX and CELEBREX. Although NSAIDs are commonly to be taken without regard to food, prescribers recommend administering them with food to reduce their propensity for gastrointestinal adverse events. A larger percentage of anticonvulsants and SNRIs used as analgesics are taken with food to improve their tolerability. Of all analgesic products, seven NSAIDs and six opioids lack food effect information, maybe due to their approval before Food and Drug Administration food effect guidance. Conclusions Overall, because food effects could alter the onset and/or duration of pain relief, analgesic medication should be used as per labeled recommendations for proper pain management.
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Raušer, Petr, and Tomáš Fichtel. "Early Analgesic Efficacy of Morphine, Butorphanol, Lidocaine, Bupivacaine or Carprofen After Periodontal Treatment in Dogs." Journal of Veterinary Dentistry 37, no. 4 (December 2020): 184–91. http://dx.doi.org/10.1177/0898756420986926.
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The early effectiveness of 5 analgesics was investigated after periodontal treatment. Dogs were assigned to 6 groups (n = 14 each). A prospective, randomized and blinded clinical study was performed. Before anesthesia was induced, butorphanol, morphine, carprofen and saline were administered. After induction, a maxillary and mandibular block was performed with lidocaine or bupivacaine. Painful periodontal therapies were performed. Two hours after the administration of analgesics and after anesthesia reversal, pain was scored using the Visual Analog Scale for pain (VAS) and the modified University of Melbourne Pain Score (UMPS). Blood glucose and cortisol levels were measured prior to analgesic administration and again 2 hours later. Rescue analgesia was provided when the VAS exceeded 50 mm or the UMPS exceeded 14 points. Rescue analgesia was required in one patient in the morphine group and one in the carprofen group. The VAS values were significantly lower in the butorphanol group compared to those of the saline group and in the bupivacaine group vs. those in the saline and lidocaine groups. Significantly lower UMPS values were obtained in the bupivacaine group compared to those in the saline, butorphanol and lidocaine groups and in the carprofen group vs. those in the saline and lidocaine groups. Significantly higher serum cortisol values were found in the lidocaine group compared to those in the saline, bupivacaine and carprofen groups. Administration of carprofen or the use of nerve blocks with bupivacaine improved analgesia after periodontal treatment more than did butorphanol, morphine or nerve blocks using lidocaine.
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Kulmatycki, Kenneth M., and Fakhreddin Jamali. "Drug Disease Interactions: Role of Inflammatory Mediators in Pain and Variability in Analgesic Drug Response." Journal of Pharmacy & Pharmaceutical Sciences 10, no. 4 (January 1, 2008): 554. http://dx.doi.org/10.18433/j36p47.
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Pain has both physical and emotional components. Physical noxious stimuli activate peripheral sensory neurons that, in turn, relay signals to the spinal and supraspinal nuclei. Subsequently, these signals activate areas within the brain associated with pain. Despite considerable knowledge in this area, analgesics may provide pain complete relief in only one out of five patients. Failure to manage pain may be due to a lack of understanding of the neurobiological processing of pain. Factors such as anticipation, anxiety and pain history play roles in the perception of pain. Non-neuronal cells such as those of the immune system influence perception and modulation of pain by the nervous system. In post-dental surgery patients, the severity of the pain and the relief following administration of anti-inflammatory analgesics has been linked to the time course of inflammatory mediators. Similarly, the relief of post-operative pain after abdominal surgery is also associated with a reduction in expression of pro-inflammatory mediators. Administration of anti-cytokines to sciatica patients and subsequent pain relief further emphasizes the role of pro-inflammatory mediators in modulation of pain. Increased expression of inflammatory mediators may also alter response to analgesia. For example, rheumatoid patients with temporal mandibular joint disease with increased expression of interleukins prior to treatment demonstrate inadequate pain relief after administration of anti-TNF-?. In addition, pain or its trauma impairs absorption of oral analgesics causing therapeutic failure. Improved analgesic pharmacotherapy may require a better understanding of the involvement of the inflammatory pathways.
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Fish, David, Fiona Bell, Clare O’Connell, Alison Walker, Laura Evans, and Shammi Ramlakhan. "PP40 Pre-hospital and emergency department analgesia for paediatric trauma – a survey of UK trauma centres and ambulance services supports consideration of alternatives such as ketamine." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A16.3—A17. http://dx.doi.org/10.1136/emermed-2021-999.40.
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BackgroundStudies have found that pre-hospital and emergency department (ED) analgesia for children is sub-optimal. In the pre-hospital setting, barriers include limited parenteral routes, education or clinical experience and practice legislation restricting the use of opioids by paramedics. Ketamine is safe and effective with multiple administration routes. It is not bound by the controlled drugs limitations in the pre-hospital setting, and is familiar to pre-hospital and ED practitioners.MethodsQuestionnaires were sent to all UK Ambulance Service Medical Directors and Paediatric Major Trauma Centres to establish current use of parenteral analgesics, and acceptability of alternatives in pre-hospital care such as ketamine. Descriptive analysis was undertaken.ResultsIntranasal opiates were the first line parenteral analgesics in injured children in all EDs. Frequent shortages of IN diamorphine resulted in more variability of second line choices, with 40% opting for another opioid. 96% of EDs would support the use of ketamine by pre-hospital clinicians, although concerns regarding inappropriate (IV) use and use by technician crews were raised. Most ED clinicians were unaware of the limited analgesic choices available to paramedics, with many suggesting alternative opiates as well as ketamine.All ambulance service directors recognised the need for alternative analgesics being made available. Without legislative changes, inhaled/IN agents or oral opiates were the only current options. All services were supportive of research to explore the use of ketamine by paramedics for injured children.ConclusionsThere is support for the addition of IN ketamine into paramedics’ repertoire of analgesics and recognition of potential benefit. However, there is a lack of experience and evidence around its use, thus warranting research to consider the impact on analgesic timeliness, adequacy and effectiveness. An analgesia ‘system of care’ which integrates pre- and in-hospital practice would be facilitated by the use of medicines effective in managing pain and familiar to practitioners in both settings.
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Sayyed, Hayam G., Naglaa K. Idriss, Marwa A. Gaber, Sherif Sayed, and Rasha Ahmed. "Physiological Responses and Gene Expression in Ultrasound-Guided Supraclavicular Brachial Plexus Block: a Comparative Study." Cellular Physiology and Biochemistry 46, no. 6 (2018): 2412–20. http://dx.doi.org/10.1159/000489647.
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Background/Aims: Ultrasound-guided supraclavicular brachial plexus block (BPB) has come into wider use as a regional anesthetic during upper limb operations. This study assessed the neurological and hemodynamic changes and gene expression after co-administration of midazolam or neostigmine with bupivacaine during supraclavicular BPB. Methods: The study involved 90 adults divided into three groups: control (bupivacaine), midazolam (bupivacaine plus midazolam), and neostigmine (bupivacaine plus neostigmine). Blood samples were taken and interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) mRNA levels were measured by real-time PCR, and oxidative stress markers were identified. In addition to the hemodynamic variables, the onset and duration of sensory and motor blockades, duration of analgesia, pain scores, time of first request for an analgesic, and amounts of analgesics ingested were evaluated. Results: Compared with the control and neostigmine groups, the midazolam group experienced longer sensory and motor blockades, prolonged analgesia, lower pain scores at 12 h and 24 h, and lower need for postoperative analgesics. Moreover, the midazolam group exhibited lower oxidative stress markers with a higher fold change in IL-6 and TNF-α mRNA levels. Conclusion: Midazolam co-administered with bupivacaine provided better analgesic quality than did neostigmine with bupivacaine. This might be due to its superior antioxidant and anti-inflammatory effects.
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Milakovic, B., M. Dostanic, and S. Ivanovic. "Strategies for postoperative pain relief in neurosurgical intensive care unit." Acta chirurgica Iugoslavica 51, no. 4 (2004): 93–100. http://dx.doi.org/10.2298/aci0404093m.
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Despite advances in neurosurgical and neuroanesthesiological practice, postoperative pain continues to be under treated. There are many modalities that may provide safe and effective postoperative analgesia. We discuss mainly systemic (e.g. opioids, nonsteroidal antiinflammatory agents) analgesic options. They still remain the most widely used method for providing pain relief in acute surgical situations. The exact choice or combination of analgesics utilized for a particular patient will depend on the riskbenefit profile and patient preferences. Especially is crucial to promptly involve the analgesics when an opioidtolerant patient requires aggressive pain treatment. But, opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Combinations of drugs acting on different mechanisms of nociceptive modulation will decrease the incidence of adverse effects and offer additive and/or sinergistic effects. Analgesic concentrations of ketamine infusions remain a valuable addition to opioid administration. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and improve postoperative distress. Neuromuscular blocking agents (NMB) in the intensive care unit (ICU) patient facilitate intubation and ventilatory support, decrease oxygen consumption, facilitate bedside procedures and diagnostics, and potentially decrease intracranial pressure. Ideally, analgesics, sedatives and/or muscle relaxants should be combined into a multimodal approach to facilitate patient recovery after surgery. Although a great deal is known about specific drugs and dosage requirements, further research is needed that clearly examines optimal scheduling regimens if we are to maximize patient care. The most important rule of pain management is that pain is what the patient says it is.
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Slack, Jeanne F., and Margaret Faut-Callahan. "Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care." AACN Advanced Critical Care 2, no. 4 (November 1, 1991): 729–40. http://dx.doi.org/10.4037/15597768-1991-4013.
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Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care
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Zaslansky, DSc, Ruth, Elon Eisenberg, MD, Bezalel Peskin, MD, Elliot Sprecher, PhD, Daniel N. Reis, MD, Chaim Zinman, MD, and Silviu Brill, MD. "Early administration of oral morphine to orthopedic patients after surgery." Journal of Opioid Management 2, no. 2 (March 1, 2006): 88. http://dx.doi.org/10.5055/jom.2006.0014.
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Current pain treatment guidelines advise against providing analgesics for postoperative pain using intramuscular injections, as this generally provides poor pain relief. However, this route remains the most prevalent treatment method. Intravenous or epidural patient-controlled-analgesia methods reduce pain effectively but are expensive, labor intensive, and available to only a limited number of patients. We propose administering the analgesics using oral analgesics and have developed a simple protocol for treating postoperative pain by use of oral morphine. After a variety of orthopedic surgeries, patients were given “around-the-clock,” oral, immediate-release morphine. Efficacy of the treatment (pain scores and adverse effects) was assessed 24 ± 2 hours after surgery. Data were collected prospectively from 95 patients, who received an average of 61 ± 30 (SD) mg morphine. Average pain scores were 2.4/10 (± 1.4) at rest and 4.0/10 (± 1.4) during movement in bed. Nausea and vomiting, the most common adverse effects, were reported by 22 (23 percent) patients. Naloxone was not administered to any of the patients. Oral morphine given in the early postoperative time to patients after a variety of orthopedic surgeries was effective and safe.
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Pchelintsev, M. V. "Pain syndrome in oncology. Possibilities of dexketoprofen administration." Meditsinskiy sovet = Medical Council, no. 9 (July 30, 2020): 146–54. http://dx.doi.org/10.21518/2079-701x-2020-9-146-154.
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Pain is an important problem in oncology patients. Depending on its intensity, for pain treatment, analgesics of different pharmacological classes are used. According to WHO recommendations, for nociceptive pain treatment in oncology patients, non-steroidal antiinflammatory drugs (NSAIDs), mild and potent opioids are the essential medications. If in pain formation along with the nociceptive pain component, a neuropathic one is present, antiepilepsy drugs, tricyclic antidepressants, local anesthetics are added. Apart from these medicines, adjuvants are used. These agents potentiate the analgesic endpoint of NSAIDs and opioids, correct their adverse effects. Often, intensive pain development is driven by bone metastases, which form in oncologic processes of different primary localization. Herewith, patients could suffer from constant as well as from paroxysmal, “breakthrough” pain. The efficacy of NSAIDs in oncology patients is due not only to analgesic effect but also to their action on inflammatory processes in areas of tumor formation and growth as well as in metastatic foci. Dexketoprofen trometamol is an effective and safe NSAID, a water-soluble salt of a dexketoprofen dextrorotatory stereoisomer. The preparation has a good lipid and water solubility. Thus, dexketoprofen trometamol can rapidly absorb, create therapeutic concentrations in blood serum, and penetrate through brain-blood barrier. It produces a significant and fast analgesic action in different diseases, which is related both to central analgesic mechanisms and to anti-inflammatory effect in peripheral tissues. Dexketoprofen trometamol efficacy is proven in bone pain related to oncological disease. The availability of intravenous solution and the prompt action at oral administration allow using the medicine for “breakthrough” pain. The medication significantly potentiates the action of mild and potent opioids at combined therapy, which allows to use opioid analgesics in lower doses.
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Furumoto, Kayo, Kumi Ogita, Tomomi Kamisaka, Asami Kawasumi, Koushi Takata, Noritaka Maeta, Takamasa Itoi, Masakatsu Nohara, Kaori Saeki, and Teppei Kanda. "Effects of Multimodal Analgesic Protocol, with Buprenorphine and Meloxicam, on Mice Well-Being: A Dose Finding Study." Animals 11, no. 12 (November 30, 2021): 3420. http://dx.doi.org/10.3390/ani11123420.
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The anesthetic or analgesic agent of choice, route and frequency of anesthetic or analgesic administration, and stressors induce distress during the perioperative period. We evaluated a multimodal analgesic protocol using buprenorphine and meloxicam on the well-being of mice. Twenty-four Slc:ICR male mice were divided into control, anesthesia + analgesia, and surgery + anesthesia + analgesia groups. Tap water (orally: PO) and water for injection (subcutaneous: SC) were administered to the control group. Buprenorphine was administered twice (SC, 0.1 mg/kg/8 h) and meloxicam was administered thrice (PO, 5 mg/kg/24 h) to the anesthesia + analgesia and surgery + anesthesia + analgesia groups. The mice were subjected to laparotomy and assessed for several parameters. Even in absence of surgical pain, the anesthesia + analgesia group presented the same negative effects as the surgery + anesthesia + analgesia group. This multimodal analgesic protocol for mice was expected to have an analgesic effect on pain associated with laparotomy but was not sufficient to prevent food intake and weight decrease. This does not negate the need to administer analgesics, but suggests the need to focus on and care not only about the approach to relieve pain associated with surgery, but also other types of distresses to minimize negative side effects that may interfere with postoperative recovery in mice.
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Mathews, Leya Meriam. "Management of pain using transdermal patches." Asian Journal of Pharmaceutical and Clinical Research 9, no. 6 (November 1, 2016): 32. http://dx.doi.org/10.22159/ajpcr.2016.v9i6.13775.
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Transdermal delivery is a non-invasive route of drug administration through the skin surface that can deliver the drug at a predetermined rate across the dermis to achieve a local or systemic effect. It is potentially used as an alternative to oral route of drugs and hypodermic injections. Analgesics are mostly used for various diseases as most of them are associated with severe or mild pain .The use of analgesics as a pain relief patch is now being used commonly. A transdermal analgesic or pain relief patch is a medicated adhesive patch used to relieve minor to severe pain. Currently, the patches are available for many Opioids , Non opioids analgesics. Local anesthetics and antianginal drugs. The drugs include Fentanyl, Buprenorphine ketoprofen, diclofenacepolamine , piroxicam , Capsaicin ,Nitroglycerine and Lignocaine . They are available as both matrix and reservoir patches. This review explores the various drugs used to manage pain and their route of administration in terms of frequency, complications and effects
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Wampole, Chelsea R., and Kathryn E. Smith. "Beyond Opioids for Pain Management in Adult Critically Ill Patients." Journal of Pharmacy Practice 32, no. 3 (March 7, 2019): 256–70. http://dx.doi.org/10.1177/0897190019834479.
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Critically ill patients commonly experience pain, and the provision of analgesia is an essential component of intensive care unit (ICU) care. Opioids are the mainstay of pain management in the ICU but are limited by their adverse effects, risk of addiction and abuse, and recent drug shortages of injectable formulations. A multimodal analgesia approach, utilizing nonopioid analgesics as adjuncts to opioid therapy, is recommended since they may modulate the pain response and reduce opioid requirements by acting on multiple pain mediators. Nonopioid analgesics discussed in detail in this article are acetaminophen, α-2 receptor agonists, gabapentinoids, ketamine, lidocaine, and nonsteroidal anti-inflammatory drugs. This literature review describes the clinical pharmacology, supportive ICU and relevant non-ICU data, and practical considerations associated with the administration of nonopioid analgesics in critically ill adult patients.
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Rosen, HF, and MM Calio. "An epidural analgesia program: balancing risks and benefits." Critical Care Nurse 10, no. 8 (September 1, 1990): 32–41. http://dx.doi.org/10.4037/ccn1990.10.8.32.
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An alternative to parenteral narcotic management is the administration of analgesics into the epidural space. The recognition and prevention of complications or side effects of epidural analgesia are prime concerns in planning nursing care for these patients.
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Notartomaso, Serena, Nico Antenucci, Francesca Liberatore, Giada Mascio, Stefano Vito Boccadamo Pompili, Joan Font, Mariarosaria Scioli, et al. "Light-Induced Activation of a Specific Type-5 Metabotropic Glutamate Receptor Antagonist in the Ventrobasal Thalamus Causes Analgesia in a Mouse Model of Breakthrough Cancer Pain." International Journal of Molecular Sciences 23, no. 14 (July 20, 2022): 8018. http://dx.doi.org/10.3390/ijms23148018.
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Breakthrough cancer pain (BTcP) refers to a sudden and transient exacerbation of pain, which develops in patients treated with opioid analgesics. Fast-onset analgesia is required for the treatment of BTcP. Light-activated drugs offer a novel potential strategy for the rapid control of pain without the typical adverse effects of systemic analgesic drugs. mGlu5 metabotropic glutamate receptor antagonists display potent analgesic activity, and light-induced activation of one of these compounds (JF-NP-26) in the thalamus was found to induce analgesia in models of inflammatory and neuropathic pain. We used an established mouse model of BTcP based on the injection of cancer cells into the femur, followed, 16 days later, by systemic administration of morphine. BTcP was induced by injection of endothelin-1 (ET-1) into the tumor, 20 min after morphine administration. Mice were implanted with optic fibers delivering light in the visible spectrum (405 nm) in the thalamus or prelimbic cortex to locally activate systemically injected JF-NP-26. Light delivery in the thalamus caused rapid and substantial analgesia, and this effect was specific because light delivery in the prelimbic cortex did not relieve BTcP. This finding lays the groundwork for the use of optopharmacology in the treatment of BTcP.
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Eidelman, Anthony, Traci White, and Robert A. Swarm. "Interventional Therapies for Cancer Pain Management: Important Adjuvants to Systemic Analgesics." Journal of the National Comprehensive Cancer Network 5, no. 8 (September 2007): 851–58. http://dx.doi.org/10.6004/jnccn.2007.0075.
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Optimized use of systemic analgesics fails to adequately control pain in some patients with cancer. Commonly used analgesics, including opioids, nonopioids (acetaminophen and non-steroidal anti-inflammatory drugs), and adjuvant analgesics (anticonvulsants and antidepressants), have limited analgesic efficacy, and their use is often associated with adverse effects. Without adequate pain control, patients with cancer not only experience the anguish of poorly controlled pain but also have greatly diminished quality of life and may even have reduced life expectancy. Interventional pain therapies are a diverse set of procedural techniques for controlling pain that may be useful when systemic analgesics fail to provide adequate control of cancer pain or when the adverse effects of systemic analgesics cannot be managed reasonably. Commonly used interventional therapies for cancer pain include neurolytic neural blockade, spinal administration of analgesics, and vertebroplasty. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies are important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control.
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Dmytriiev, Dmytro, A. Andriiets, E. Andriiets, V. Bankivsky, and S. Yatsenko. "Management of pain treatment in the early postoperative period. Practice of using ketorolac. A clinical case." Pain medicine 5, no. 3 (November 4, 2020): 18–26. http://dx.doi.org/10.31636/pmjua.v5i3.3.
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The current strategy of rational perioperative analgesia involves reducing the use of opioid analgesics and preventing associated side effects. Today it is known that the use of opioid analgesics can further lead to the development of hyperalgesia. Opioid-induced hyperalgesia is an adaptive response of the body in response to exogenous administration of opioids, the mechanisms of development of which are associated with the activation of the central glutamatergic system and the release of spinal dinorphins. In contrast, gabapentin, NSAIDs, and ketamine have opioid-preserving properties, reducing the number of opioid-associated side effects. Hyperalgesia is a condition that underlies the formation of chronic pain and develops regardless of the degree of postoperative wound repair.
For the treatment of pain in the postoperative period, the main group of treatment agents are opioid analgesics, which are prescribed to 60% of patients. However, with severe pain, there is a need for opioids in doses that exceed the standard recommended. It is known that the tactics of increasing the dose of opioid analgesics leads to an increase in the frequency of adverse reactions: severe sedation, respiratory depression, nausea, vomiting, intestinal paresis, dysfunction of the biliary and urinary systems, hallucinations. In order to reduce side effects, the doctor reduces the dose of opioids, which is accompanied by inadequate analgesia.
Given the above, clinicians prescribe additional drugs of other drug groups that can enhance the analgesic effect of opioids. An important aspect is the ability to reduce the dose of opioids.
Our data and data of other authors. Until recently, NSAIDs were rarely used in intensive care units, mainly in mild to moderate pain.
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Maxam-Moore, VA, DJ Wilkie, and SL Woods. "Analgesics for cardiac surgery patients in critical care: describing current practice." American Journal of Critical Care 3, no. 1 (January 1, 1994): 31–39. http://dx.doi.org/10.4037/ajcc1994.3.1.31.
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BACKGROUND: In the last 10 years, the American Association of Critical-Care Nurses has twice ranked pain management as a priority issue for research and practice. Recent research findings suggest that undermedication of patients continues both in and out of critical care. Postoperative cardiac surgery patients have reported detailed recollections of pain experiences while in critical care, yet little is known about management of postoperative cardiac surgery pain. OBJECTIVE: The purpose of this study was to describe current practice related to analgesic prescription and administration for postoperative cardiac surgery patients in critical care. METHODS: Medical records of 80 adults undergoing cardiac surgery in two hospitals were randomly selected for review. Data pertaining to pain medications prescribed and doses administered for the day of surgery, first and second postoperative days were recorded for 66 eligible subjects. RESULTS: All but one patient had a prescription for intravenous morphine, hourly as needed. In addition, all patients had prescriptions for one or more oral analgesics as needed. Gender and age effects were noted for analgesic prescriptions. The average total amount of intravenous morphine given over the 3 days was 13.9 +/- 13.5 mg in an average of 4 +/- 3.7 doses. The average total number of acetaminophen with oxycodone tablets given over the 3 days was 5.8 +/- 5.4 tablets in an average of 3.6 +/- 3.0 doses. Age and hospital effects were noted in the administration of analgesics. CONCLUSIONS: The finding of small and infrequent analgesic doses is consistent with other studies conducted in and out of critical care. Important inconsistencies, or variations in practice, exist in both the prescription and administration of analgesics for postoperative cardiac surgery patients in the critical care setting.
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Surowicz, Dawid, Dominik Gałuszka, Agnieszka Martyka, Karolina Penar, Krystian Wolanin, and Angelika Poznańska. "TREAT MENT OF PAIN DURING EMERGENCY MEDICA L SERVICES." Emergency Medical Service 7, no. 2 (2020): 135–45. http://dx.doi.org/10.36740/emems202002110.
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Introduction: Pain, while undertaking medical rescue operations, is a common complication of injuries or a symptom of disease entities of internal medicine. Equipping emergency medical teams with painkillers from various groups, gives broad opportunities to fight pain at the pre-hospital stage. The manner of using medicines is regulated by law in the form of an executive regulation to the Act on State Emergency Medical Services, which specifies the type and route of their administration. When undertaking analgesic treatment, one should be aware of the contraindications to the use of individual medications, possible complications of their use, and methods of combining analgesics and co-analgesics as part of multimodal analgesia. The consequence of using medicines may be their impact on the work of the circulatory and respiratory systems, hence it is necessary to observe the patient’s cardiopulmonary stability during medical emergency operations at the call site, during transport and in the Hospital Emergency Department. The aim: This article aims to systematize the knowledge of painkillers available to the paramedic and methods of assessing pain intensity according to the following scales: numerical, verbal, visual-analog and picture for pediatric patients with whom it is possible to make logical contact. Conclusions: 1. Basic emergency teams are equipped with drugs from the following groups: nonsteroidal anti-inflammatory drugs, non-opioid analgesics and opioid analgesics. Thanks to them, it is possible to effectively and noticeably reduce pain at the stage of providing medical emergency services. 2. Despite properly undertaken pain therapy with available means and methods, it may not be possible to completely eliminate pain and clearly determine its etiology at the pre-hospital stage. 3. Available scales allow proper assessment of pain intensity in both pediatric and adult patients. 4. In complex cases, pain should not go away, it is necessary to use multimodal analgesia by combining analgesics of different groups, or to include in analgesic therapy co-analgesics, which, due to the weakening of the impact of a potential cause of pain, may determine the effectiveness of therapy. 5. Establishing the etiology of pain due to the numerous potential pathologies that cause it requires careful assessment of the patient at the stage of providing medical emergency services and the implementation of a full and properly conducted physical examination.
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Spetea, Mariana, and Helmut Schmidhammer. "Recent Chemical and Pharmacological Developments on 14-Oxygenated-N-methylmorphinan-6-ones." Molecules 26, no. 18 (September 18, 2021): 5677. http://dx.doi.org/10.3390/molecules26185677.
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Adequate pain management, particularly chronic pain, remains a major challenge associated with modern-day medicine. Current pharmacotherapy offers unsatisfactory long-term solutions due to serious side effects related to the chronic administration of analgesic drugs. Morphine and structurally related derivatives (e.g., oxycodone, oxymorphone, buprenorphine) are highly effective opioid analgesics, mediating their effects via the activation of opioid receptors, with the mu-opioid receptor subtype as the primary molecular target. However, they also cause addiction and overdose deaths, which has led to a global opioid crisis in the last decades. Therefore, research efforts are needed to overcome the limitations of present pain therapies with the aim to improve treatment efficacy and to reduce complications. This review presents recent chemical and pharmacological advances on 14-oxygenated-N-methylmorphinan-6-ones, in the search of safer pain therapeutics. We focus on drug design strategies and structure–activity relationships on specific modifications in positions 5, 6, 14 and 17 on the morphinan skeleton, with the goal of aiding the discovery of opioid analgesics with more favorable pharmacological properties, potent analgesia and fewer undesirable effects. Targeted molecular modifications on the morphinan scaffold can afford novel opioids as bi- or multifunctional ligands targeting multiple opioid receptors, as attractive alternatives to mu-opioid receptor selective analgesics.
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Boer, C., A. N. Treebus, W. W. A. Zuurmond, and J. J. De Lange. "Compliance in administration of prescribed analgesics." Anaesthesia 52, no. 12 (December 1997): 1177–81. http://dx.doi.org/10.1111/j.1365-2044.1997.243-az0378.x.
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Pasero, Chris. "Perioperative Rectal Administration of Nonopioid Analgesics." Journal of PeriAnesthesia Nursing 25, no. 1 (February 2010): 5–6. http://dx.doi.org/10.1016/j.jopan.2010.01.005.
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Foster, R. L., and N. O. Hester. "Administration of analgesics for children's pain." Pain 41 (January 1990): S27. http://dx.doi.org/10.1016/0304-3959(90)92192-s.
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SYMEON, IRENE, ALEXIA POLISSIDIS, EVANGELOS BALAFAS, MARIANNA STASINOPOULOU, PAVLOS ALEXAKOS, CHRYSA VOYIATZAKI, and NIKOLAOS KOSTOMITSOPOULOS. "Evaluation of the effects of tramadol on analgesic response and locomotor activity on two different strains of laboratory mice." Journal of the Hellenic Veterinary Medical Society 68, no. 1 (January 29, 2018): 89. http://dx.doi.org/10.12681/jhvms.15567.
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Analgesia of laboratory animals consists an important component in experimental studies where painful stimuli or procedures may take place. When choosing analgesics, the severity of pain along with the response to medication is among the factors that determine the choice of agent. Tramadol is a known synthetic opioid analgesic used to treat main acute or chronic pain including perioperative pain. The purpose of this study was to evaluate the analgesic response as well as the effect on locomotor activity in two different strains of mice after the intraperitoneal (i.p.) administration of tramadol. Subjects were 11-13 week-old male C57BL/6J (n=39) and BALB/cJ (n=38) mice, randomly assigned to receive either saline, tramadol 10 mg/kg or tramadol 40 mg/kg. Analgesia was measured using the hot-plate test, 30 or 60 minutes after drug administration while the open field test was used in order to assess locomotor activity. Both strains exhibited a significant increase of hot-plate latencies after administration of tramadol 40 mg/kg while the same dose induced significantly greater analgesia in BALB/cJ as compared with the C57BL/6J mice. BALB/cJ mice presented a dose-dependent decrease in locomotor activity following tramadol administration whereas C57BL/6J mice receiving 40 mg/kg tramadol showed hyperactivity. In conclusion, the lower dose of tramadol (10 mg/kg) has insufficient antinociceptive effects on acute thermal pain for both strains. The highest dose of tramadol used in this study (40 mg/kg) was greater than the one required for BALB/cJ mice, as they were under sedation for at least 60 minutes after drug administration. The same dose of tramadol appeared to be effective on C57BL/6J tramamice as latency times on the hot plate were significantly increased. Despite this fact, it is not a suitable choice as an analgesic, especially postoperatively, as it causes hyperactivity to this strain. Special concern should be given to the fact that tramadol’s analgesic and behavioral effects depend not only on its dosage, but also on the strain in which it is administered.
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Drapkin, J., S. Motov, A. Likourezos, T. Beals, R. Monfort, C. Fromm, and J. Marshall. "P035: Continuous intravenous low-dose ketamine infusion for managing pain in the emergency department." CJEM 20, S1 (May 2018): S69. http://dx.doi.org/10.1017/cem.2018.233.
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Introduction: To describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). Methods: Retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over 6 years (2010-2016). Primary data analyses included dosing and duration of infusion, rates of pre- and post-infusion analgesic administration, and final diagnoses. Secondary data included pre- and post-infusion pain scores and rates of side effects. Results: 104 patients were enrolled in the study. Average dosing of ketamine infusion was 11.26 mg/hr, the mean duration of infusion was 135.87 minutes with 38% increase in patients not requiring post-infusion analgesia. The average decrease in pain score was 5.04. There were 12 reported adverse effects with nausea being the most prevalent. Conclusion: Continuous intravenous SDK infusion has a role in controlling pain of various etiologies in the ED with a potential to reduce need for co-analgesics or rescue analgesic administration. There is a need for more robust, prospective, randomized trials that will further evaluate the analgesic efficacy and safety of this modality across wide range of pain syndromes and different age groups in the ED.
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Franck, Linda Sturla. "Issues Regarding the Use of Analgesia and Sedation in Critically Ill Neonates." AACN Advanced Critical Care 2, no. 4 (November 1, 1991): 709–19. http://dx.doi.org/10.4037/15597768-1991-4011.
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Attitudes and beliefs of physicians and nurses have shifted during the past decade, resulting in more frequent administration of analgesics and sedatives to neonates. However, nurses caring for critically ill newborns have difficulty in determining appropriate interventions because of the lack of clear and complete knowledge related to the use of analgesia and sedation in this patient population. This chapter presents current information on six key issues related to the use of analgesia and sedation in neonates. An algorithm for determining appropriate intervention for neonates with pain, distress, or agitation is proposed to provide a more systematic approach to the use of analgesics and sedatives
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Cheung, Chi Wai. "Analgesic Efficacy and Adverse Effects of Meperidine in Managing Postoperative or Labor Pain: A Narrative Review of Randomized Controlled Trials." Pain Physician 2;23, no. 4;2 (April 14, 2020): 175–201. http://dx.doi.org/10.36076/ppj.2020/23/175.
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Background: Meperidine, a synthetic opioid, has a rapid onset and short duration of action. Mounting evidence has challenged meperidine’s analgesic benefits, and concerns have been raised about its safety profile. Despite recommendations to restrict the prescription of meperidine, the drug remains frequently used. Objectives: The aim of this study was to evaluate the evidence regarding the efficacy and safety of meperidine for acute postoperative and labor pain. Study Design: This was a narrative review of the analgesic efficacy and side effects of meperidine compared to other analgesic drugs for acute postoperative and labor pain in adults. Setting: Randomized controlled trials that compared the analgesic efficacy and side effect profile of meperidine versus another analgesic drug in adult patients were evaluated. Methods: A systemized search of randomized controlled trials studying meperidine for acute postoperative or labor pain in the adult patient population from PubMed, Medline, and EMBASE was performed. Included studies reported on different routes of meperidine administration including intramuscular, intravenous, and patient-controlled analgesia in various surgical procedures such as abdominal surgery, Cesarean section, gynecological surgery, orthopedic surgery, cardiothoracic surgery, as well as for labor analgesia. Meperidine’s analgesic efficacy and safety profile were compared to other opioids (morphine, tramadol, fentanyl, buprenorphine, nalbuphine, and pentazocine), nonsteroidal anti-inflammatory drugs (ketorolac, diclofenac, and indomethacin), dipyrone, ketamine, and bupivacaine. Results: A total of 62 randomized controlled trials published between 1972 and 2018 were reviewed. Meperidine had a similar or inferior analgesic efficacy compared to other analgesics for acute postoperative or labor pain. Meperidine was associated with more sedation and respiratory depression. Limitations: The sample sizes of many clinical studies were small, and therefore probably insufficiently powered to detect differences in uncommon side effects, such as central nervous system toxicity. In addition, some of the included clinical studies were old. Conclusion: Considering the availability of other effective analgesics with potentially fewer side effects, the use of meperidine for acute postoperative or labor pain should not be recommended. Key words: Acute postoperative pain, adverse effects, labor analgesia, meperidine, pethidine
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Tewari, Abhinav, and Ajit Kumar Singh. "Comparative evaluation of caudal tramadol and fentanyl when mixed with bupivacaine in paediatric age group." International Journal of Research in Medical Sciences 8, no. 4 (March 26, 2020): 1445. http://dx.doi.org/10.18203/2320-6012.ijrms20201340.
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Background: A caudal block is commonly performed block for postoperative analgesia pediatric surgeries. Duration can be enhanced by addition drugs like fentanyl, tramadol, clonidine midazolam etc to local anesthetics helps in decreasing the requirement of postoperative analgesics. This study was conducted to assess the analgesic efficacy of tramadol or fentanyl when mixed with bupivacaine in pediatric patients for surgeries below the umbilicus.Methods: Fifty children of ASA I and ASA status, between 2 to 12 years of age, of both sexes underwent elective surgeries below umbilicus were selected and randomly divided into groups of 25 each. One Group, T (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with tramadol 1mg/ kg and other Group F (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with Inj fentanyl 1μg/kg. Assessment of analgesia and any side effects after caudal injection to the first administration of analgesia were recorded for both the groups in next 24 hours following objective pain scores. Duration of analgesia and requirement of additional rescue analgesics was noted.Results: The Mean duration of analgesia recorded longer in Group T (18.26±6.1 hours) as compared to Group F (10.0+/- 2.68 hrs.) and no significant haemodynamic changes or adverse effect noted between 2 groups.Conclusions: Addition of tramadol, 1mg/kg to bupivacaine 0.25% for caudal anesthesia in children undergoing surgeries below umbilicus, enhances and prolongs postoperative analgesia compared to caudal fentanyl 1μg/kg and bupivacaine 0.25% alone.
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Bernabe-Garcia, Mariela, Mardia López-Alarcon, Alfredo Salgado-Sosa, Raul Villegas-Silva, Jorge Maldonado-Hernandez, Maricela Rodríguez-Cruz, Rodolfo Rivas-Ruiz, et al. "Enteral Docosahexaenoic Acid Reduces Analgesic Administration in Neonates Undergoing Cardiovascular Surgery." Annals of Nutrition and Metabolism 69, no. 2 (2016): 150–60. http://dx.doi.org/10.1159/000452227.
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Background: Neonates undergoing surgery require analgesic medication to ameliorate acute pain. These medications produce negative side effects. Docosahexaenoic acid (DHA) has an antinociceptive effect in animals, but this has not been evaluated in human neonates. We evaluated the DHA effect on cumulative dose and duration of analgesics administered to neonates undergoing cardiovascular surgery. Methods: A secondary analysis was performed with data from a clinical trial, in which enteral DHA was administered perioperatively compared with sunflower oil (SO). Present study assessed the antinociceptive effect of DHA by measuring the cumulative dose and duration of analgesics administered during postoperative stay in a neonatal intensive care unit. Multivariate linear regression models were performed. Results: Seventeen neonates received DHA and 18 received SO in the control group. Compared with the control group, the DHA group received lower cumulative dose (14.6 ± 2.2 vs. 25.2 ± 4.8 μg/kg, p = 0.029) and shorter duration of buprenorphine (2 days (1-8) vs. 4.5 days (1-12); p = 0.053). After adjusting for confounders, the DHA group received significantly lesser buprenorphine (β = -27 μg/kg, p = 0.028; R2 model = 0.90) for shorter duration (β = -9 days, p = 0.003; R2 model = 0.94). No differences in fentanyl or ketorolac were detected. Conclusions: Buprenorphine administration was reduced in neonates who received DHA, suggesting that DHA likely has analgesic effects.
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Dawane, Jayshree, Kalyani Khade, Yamini Ingale, and Vijaya Pandit. "EVALUATION OF USE OF ANALGESICS IN PAIN MANAGEMENT AMONG SURGEONS IN A TERTIARY CARE HOSPITAL." Asian Journal of Pharmaceutical and Clinical Research 11, no. 11 (November 7, 2018): 124. http://dx.doi.org/10.22159/ajpcr.2018.v11i11.27489.
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Objective: The objective of this study is to evaluate pain and to assess if analgesic prescriptions are according to the World Health Organization guidelines. Methods: The study was conducted in the Department of Surgery in a tertiary care hospital. Patients with age >18 years, of either sex, admitted to surgery ward were included in the study. Pain assessment was done using a visual analog scale and McGill questionnaire. Information obtained from case paper sheets was recorded, such as name of analgesics, the generic name of prescribed analgesics, dosage, route of administration, frequency, number of analgesics per prescription, and non-pharmacological techniques. Data generated from the questionnaire were entered into an Excel sheet, and percentages were calculated. Results: A total of eight different analgesics were prescribed in the study group. Paracetamol was the maximally prescribed drug (40%). In 48% of cases, antacids were given along with analgesics. A majority of analgesics were prescribed in generic names (52%). No drug was prescribed to almost 18% cases even though the pain intensity was of mild-to-moderate intensity. Conclusion: Commonly prescribed drugs were paracetamol + tramadol. Prescription pattern of analgesics is partially deviating from standard guidelines. Generic names were written in the majority of prescriptions, which is in accordance with standard prescription writing.
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Zanvettor, Alex, Wolfgang Lederer, Bernhard Glodny, Andreas P. Chemelli, and Franz J. Wiedermann. "Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts." Open Medicine 15, no. 1 (August 28, 2020): 815–21. http://dx.doi.org/10.1515/med-2020-0220.
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AbstractProcedural sedation and analgesia (PSA) is important during painful dilatation and stenting in patients undergoing percutaneous trans-hepatic biliary drainage (PTBD). A prospective, nonblinded randomized clinical trial was performed comparing different analgesic regimens with regard to the patient’s comfort. Patients were randomly assigned to two treatment groups in a parallel study, receiving either remifentanil or combined midazolam, piritramide, and S-ketamine. The primary study endpoint was pain intensity before, during, and after the intervention using the numerical rating scale (0, no pain; 10, maximum pain). The secondary study endpoint was the satisfaction of the interventional radiologist. Fifty patients underwent PTBD of whom 19 (38.0%) underwent additional stenting. During intervention, the two groups did not differ significantly. After the intervention, the need for auxiliary opioids was higher (12.5% vs 7.7%; p = 0.571) and nausea/vomiting was more frequently observed (33.4% vs 3.8%; p = 0.007) in patients with remifentanil than in patients with PSA. Overall, 45 patients (90.0%) needed additional administration of non-opioid analgesics during postinterventional observation. Remifentanil and combined midazolam, piritramide, and S-ketamine obtained adequate analgesic effects during PTBD. After the intervention, medications with antiemetics and long-acting analgesics were more frequently administered in patients treated with remifentanil (EudraCT No. 2006-003285-34; institutional funding).
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Ozdemir, Ercan. "The pathophysiological role of serotonin receptor systems in opioid analgesia and tolerance." International Journal of Basic & Clinical Pharmacology 6, no. 2 (January 28, 2017): 217. http://dx.doi.org/10.18203/2319-2003.ijbcp20170312.
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Continuous treatment with opioid analgesics, such as morphine, leads to the development of ant nociceptive tolerance in patients. Although a lot of information about antinociceptive, the pathophysiological mechanisms of tolerance to opioid analgesia are not yet completely understood. Proposed mechanisms for opioid analgesic tolerance comprise down-regulation of opioid receptors, reduction of sensitivity G-proteins, altered intracellular signalling pathway including nitric oxide, adenyl cyclase, and protein kinase C. Numerous physiological and behavioural studies have shown an interaction of the serotonergic system and opioid antinociception. The serotonin (5-HT) receptor system is a necessary component of the spinal and midbrain pain modulation circuit mediating opioid analgesia. Various types of serotonin receptors demonstrate different effects on morphine analgesia. Systemic administration of opioids rise 5-HT levels in the spinal cord dorsal horn and contribute to opioid analgesia in the normal state but reduce that in neuropathic pain via spinal 5-HT3 receptors. Spinal and supraspinal serotonergic neurons may also play a pathophysiological role in the development of morphine analgesic tolerance. Serotonin receptor subtypes show different effects on opioid tolerance. This review paper focus on the current understanding of the role of serotonin receptor systems in opioid analgesia and tolerance.
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Putri, Herdiani Sulistyo, Elizeus Hanindito, and Herdy Sulistyono. "Ketamine Versus Tramadol Effectiveness as Postoperative Oral Analgesics on Pediatric Patients Age 5-10 Years in Elective Surgery at Dr. Soetomo Hospital Surabaya." Indonesian Journal of Anesthesiology and Reanimation 2, no. 2 (July 29, 2020): 1. http://dx.doi.org/10.20473/ijar.v2i22020.1-9.
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Introduction: The use of ketamine and tramadol as postoperative analgesics for pediatric are still relatively rare, especially orally administrated. As an analgesic, ketamine blocks the NMDA receptor, the main excitatory transmitter in CNS; whereas tramadol blocks serotonin and norepinephrine uptake, thus preventing pain transmission on the spinal cord. Objective: The aim of this study is to compare the effectiveness of oral ketamine and oral tramadol as analgesics for postoperative acute pain in children. Method: A double-blind randomized clinical trial was conducted at Dr. Soetomo Hospital. The hospital ethical committee had approved this study. The subject includes thirty children aged 5-10 years old who fulfilled the inclusion criteria. They were divided into either ketamine groups or the tramadol group, in which each group consisting of fifteen patients. The regimen dosage that been given was 2mg/kg tramadol and ketamine as postoperative oral analgesics in the form of simple syrup. The FLACC table was used to evaluate pain score before and after administration of drugs (30-minutes, 1-hour, 2-hours, 3-hours, 4-hours, and at discharge from the recovery room). Result and Discussion: Based on the quantitative parameter of the FLACC (scale 0-10), there was a significant difference (p<0.05) between the first-hour postoperative administration and patient discharge from the recovery room. The patient of ketamine group had far lower FLACC value compared to the tramadol group. Rescue analgesics in the form of intravenous fentanyl were given to one patient (6.7%) in the ketamine group and four patients (26.7%) in the tramadol group. Conclusion: Ketamine proved to be a better and more effective postoperative oral analgesic compared to tramadol in this study.
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Putri, Herdiani Sulistyo, Elizeus Hanindito, and Herdy Sulistyono. "Ketamine Versus Tramadol Effectiveness as Postoperative Oral Analgesics on Pediatric Patients Age 5-10 Years in Elective Surgery at Dr. Soetomo Hospital Surabaya." Indonesian Journal of Anesthesiology and Reanimation 2, no. 2 (July 29, 2020): 38. http://dx.doi.org/10.20473/ijar.v2i22020.38-46.
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Introduction: The use of ketamine and tramadol as postoperative analgesics for pediatric are still relatively rare, especially orally administrated. As an analgesic, ketamine blocks the NMDA receptor, the main excitatory transmitter in CNS; whereas tramadol blocks serotonin and norepinephrine uptake, thus preventing pain transmission on the spinal cord. Objective: The aim of this study is to compare the effectiveness of oral ketamine and oral tramadol as analgesics for postoperative acute pain in children. Method: A double-blind randomized clinical trial was conducted at Dr. Soetomo Hospital. The hospital ethical committee had approved this study. The subject includes thirty children aged 5-10 years old who fulfilled the inclusion criteria. They were divided into either ketamine groups or the tramadol group, in which each group consisting of fifteen patients. The regimen dosage that been given was 2mg/kg tramadol and ketamine as postoperative oral analgesics in the form of simple syrup. The FLACC table was used to evaluate pain score before and after administration of drugs (30-minutes, 1-hour, 2-hours, 3-hours, 4-hours, and at discharge from the recovery room). Result and Discussion: Based on the quantitative parameter of the FLACC (scale 0-10), there was a significant difference (p<0.05) between the first-hour postoperative administration and patient discharge from the recovery room. The patient of ketamine group had far lower FLACC value compared to the tramadol group. Rescue analgesics in the form of intravenous fentanyl were given to one patient (6.7%) in the ketamine group and four patients (26.7%) in the tramadol group. Conclusion: Ketamine proved to be a better and more effective postoperative oral analgesic compared to tramadol in this study.