Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Acute Pain Service began at the Royal Adelaide Hospital in April 1989. Funding, education programmes, policies, procedures, protocols, techniques (particularly patient-controlled analgesia, epidural opioid analgesia and subcutaneous morphine therapy) and daily organisation of the service are described in this article, and the experience with the 1053 patients referred to the Service during the first year of operation is reported. The occurrence of major complications was small. Mild-to-moderate respiratory depression occurred in four (0.5%) of the 747 patients who received patient-controlled analgesia and in none of the 177 who received epidural opioids. Five patients receiving patient-controlled analgesia had persistent nausea/vomiting; 320 (35%) of all patients receiving patient-controlled analgesia or epidural opioids suffered nausea/vomiting that required no treatment or was alleviated by treatment with an antiemetic. Around 13% of patients reported mild-to-moderate itching. In our experience, the combination of appropriately trained nursing and medical staff, standardised orders and procedures, and proper supervision can lead to safe, more effective management of acute pain.
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PMID:An acute pain service in an Australian teaching hospital: the first year. 221 14

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (20 each having undergone abdominal or orthopedic operations). Whenever the patients required pain relief, piritramid demand doses of 2.0 mg were given via the hand-button of a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). Hourly maximum dose was set to 15 mg with a pump refractory time of 1 minute between valid demands. A continuous low-dose piritramid infusion (0.24 mg/h) was additionally administered in order to prevent catheter obstruction. Duration of the PCA period was 19.7 +/- 6.5 hours (mean +/- SD). During this time, 17.1 +/- 13.8 demands per patient were recorded resulting in mean individual piritramid consumptions of 30.4 +/- 28.1 micrograms/kg/h. Self-administration was characterized by considerable intra- and interindividual variability. Following abdominal surgery, slightly more piritramid was needed compared with orthopedic patients, although less pain relief was achieved in the former group. The same proved to be true for a comparison between the sexes, males requiring significantly more piritramide for less pain relief than females (p = 0.05). Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 73% of patients when compared with previously experienced conventional postoperative analgesia. Side effects (sweating, nausea, emesis) occurred in about 20% but were usually of minor intensity. No serious circulatory or respiratory problems were observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and for clinical pain research.
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PMID:Patient-controlled analgesia with piritramid for the treatment of postoperative pain. 288 42

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (each 20 having undergone abdominal or orthopaedic operations). Pentazocine bolusses of each 8 mg were available via a hand-button whenever the patients felt pain relief necessary, and delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). Hourly maximum dose was set to 60 mg with a pump refractory time of 1 min between valid demands. A continuous low-dose pentazocine infusion (1 mg/h) was additionally administered in order to prevent catheter obstruction. Duration of the PCA period was 20.3 +/- 5.9 h (mean, standard deviation). During this time, 20.0 +/- 12.7 demands per patient were recorded resulting in mean pentazocine consumption of 135.6 +/- 81.4 micrograms/kg/h. Self-administration was characterized by considerable intra- and interindividual variability. There were no statistically significant differences with regard of pentazocine consumption or pain relief between abdominal and orthopaedic patients, nor could any be demonstrated between the sexes. Similarly, no clear differences were found after various anaesthetic techniques (neuroleptanalgesia, halothane or spinal anaesthesia). Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 68% of patients when compared with previously experienced conventional postoperative analgesia. Side effects (nausea, emesis, sweating) occurred in about 10-18% but were usually of minor intensity. Circulatory or respiratory problems were not observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and clinical pain research.
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PMID:[Postoperative on-demand analgesia with pentazocine (Fortral)]. 409 11

Spontaneous intramural rupture or intramural haematoma of the oesophagus is a rare cause of acute pain in the chest and upper abdomen. Much less ominous than spontaneous complete rupture from which it must be distinguished, it seldom if ever necessitates operation. Five new cases are described and reviewed together with 15 collected from published reports. The dominant symptom of every case was severe and constant retrosternal or epigastric pain; concomitant dysphagia was mentioned in 11 cases. In seven the pain was preceded by or coincided with vomiting. The condition was related to other stresses in three and appeared to be truly spontaneous in 10. In approximately one-third of cases it started suddenly but more often it began as discomfort worsening rapidly. Fourteen patients vomited blood after experiencing pain but only four were given transfusions. In contradistinction to complete rupture, none had surgical emphysema and plain chest radiographs were unremarkable. All had abnormal gastrografin or barium swallows. Intramural haematomas with or without mucosal tears were seen in the 11 cases in which oesophagoscopy was performed. Fifteen patients made rapid and complete recoveries on conservative management. Of the four who did not respond satisfactorily, one had the oesophagus repaired, two had drainage of the mediastinum after failure to find the false lumen at thoracotomy, and one had only an abdominal exploration. The only death in the whole series occurred after a disastrous emergency exploration and subsequent total oesophagectomy.
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PMID:Spontaneous intramural rupture and intramural haematoma of the oesophagus. 697 33

Despite considerable progress achieved in the management of head and neck carcinomas (HNC) in the last decade, the prognosis of patients with advanced squamous cell HNC is still dismal. On the basis of the reported good activity of a new vinca alkaloid derivative, i.e., vinorelbine (VNR), we tested the combination of cisplatin and VNR in a series of patients with recurrent or previously untreated unresectable squamous cell HNC. Thirty-five patients with recurrent or previously untreated unresectable squamous cell HNC were treated with a combination of cisplatin 80 mg/m2 on day 1, plus vinorelbine 25 mg/m2 i.v. push on days 1 and 8. This cycle was repeated every 3 weeks. Analysis of response rates was carried out separately for previously untreated patients, and those with recurrent disease after surgery and/or radiotherapy. In the group of 20 patients with recurrent disease the overall response rate was 55% (95% CL 44-66%), with 3 patients (15%) showing a complete response with a mean duration of 6.2+ months and 8 patients showing a partial response with a mean duration of 8.6+ months. In the group of patients with previously untreated unresectable disease, 13 patients (87%, 95% CL 78-96%) had a major objective response with a complete response rate of 27%. This regimen was quite well tolerated, with meyelosuppression and vomiting being the most frequent toxicities. The occurrence of an acute pain syndrome following vinorelbine administration in 4 patients is noteworthy. In conclusion, this combination is active in advanced squamous cell head and neck carcinoma. However, although it may be recommended in recurrent carcinoma, the complete response rate achieved in previously untreated patients is lower than that reported with other more intensive regimens.
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PMID:Vinorelbine plus cisplatin in recurrent or previously untreated unresectable squamous cell carcinoma of the head and neck. 762 68

As more extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee and shoulder reconstruction, hysterectomy) are being performed on an outpatient basis, the availability of sophisticated postoperative analgesic regimens are necessary to optimize the benefits of day-case surgery for both the patient and the health care provider. However, outcome studies are needed to evaluate the effects of these newer therapeutic approaches with respect to postoperative side effects, cost and important recovery variables. Recent studies suggest that factors other than pain per se must be controlled in order to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anaesthetic technique can influence the analgesic requirements and the likelihood of emesis in the early postoperative period. Although opioid analgesics will continue to play an important role, the adjunctive use of both local anaesthetic agents and NSAIDs will probably assume an even greater role in the future. Use of drug combinations (e.g., opioids with local anaesthetics, alpha2 agonists and/or NSAIDs) may provide for improved analgesia with fewer opioid-related side effects than narcotic analgesics alone. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after day-case surgery in the future. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress free" anaesthesia with minimal postoperative discomfort is now possible for most patients undergoing ambulatory surgical procedures. The aim of any analgesic technique should not only be to lower the pain scores but also to facilitate earlier mobilization and to reduce perioperative complications, in particular PONV. In future, clinicians should be able to effectively treat postoperative pain using a combination of "balanced," "preemptive," and "peripheral" analgesia techniques without producing emetic sequelae.
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PMID:Management of postoperative pain and emesis. 859 Apr 97

Intranasal butorphanol is an opioid agonist-antagonist that is effective for the treatment of acute pain. Common adverse effects associated with the agent are somnolence, dizziness, nausea, and vomiting; they are readily reversed with naloxone. A patient developed signs and symptoms consistent with apraxia after a single dose of intranasal butorphanol. She was mentally alert, but she was unable to move or speak despite normal muscle tone and reflex movements. When she attempted to speak she had no voluntary control. At the emergency room she was administered naloxone 2 mg intramuscularly, which resulted in complete reversal of the symptoms in a short time. No other published cases describe these findings with butorphanol. Health care professionals should be aware that patients who are prescribed intranasal butorphanol, even in typical doses, may be at risk for such a reaction. This is important because, unlike the injectable formulation, the intranasal product is primarily used in the outpatient setting.
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PMID:Intranasal butorphanol-induced apraxia reversed by naloxone. 888 97

Pain is the main reason prompting patients to consult their physicians. In acute conditions, pain has a very particular significance as a warning sign, enabling the physician to attempt a diagnosis. Nevertheless, its detrimental effect upon the individual (even in the case of acute pain) and its cost to society are now widely acknowledged. There can be no doubt about the physical component of pain, but the psychological and social aspects should not be ignored, particularly in the case of chronic pain. There is no single therapeutic approach to pain and, more often than not, successful treatment comprises a combination of several. Pharmacological treatments are undeniably the most common approach. In clinical practice, recent advances have been based upon an improved understanding of 'old' substances such as morphine and, at the same time, research continues in the hope of finding the 'ideal' analgesic-effective in most situations but without adverse effects: this appears to be a somewhat utopian arm at present, considering the number of different causes of pain. An improved understanding of the physiological mechanisms of pain has led, within the field of clinical practice, to several methods of differentiating pain. These depend on whether or not pain responds to morphine, or on the type of pain: pain due to an excess of nociception, pain resulting from deafferentation (caused by damage to nerve pathways) in the central or peripheral nervous system and psychogenic (idiopathic) pain. Likewise, there are several different ways of classifying analgesic treatments: according to the intensity of pain, as with use of the WHO ladder (which is based on the notion of steps) for the treatment of cancer pain; according to the presumed physiopathological mechanism and, in particular, the response to morphine, and according to the presumed central or peripheral mechanism of the drugs. In reality, peripherally acting drugs can also have a central mechanism of action, just as drugs known to have a central mechanism of action can also have peripheral activity. As a result, several therapeutic classes have been identified. Firstly NSAIDs, which act by inhibiting the enzymes that synthesise prostaglandins, cyclooxygenases (COX-1, COX-2), but which also act upon lipo-oxygenases: Their efficacy is interesting, although somewhat limited by both their ceiling effect and the frequent adverse gastrointestinal reactions they produce. Specific inhibitors of COX-2 could well reduce the risk of adverse effects. Opioids constitute the first-line treatment for pain, particularly severe pain. There are several classifications for these drugs. Firstly, weak opioids (such as codeine) and strong opioids (such as morphine) are differentiated. Secondly, a distinction is made between pure agonists (such as morphine), partial agonists (such as buprenorphine), agonist-antagonists (such as nalbuphine) and antagonists (such as naloxone). Finally, agents are distinguished on the basis of their chemical structure (synthetic, semi-synthetic or natural derivatives). These molecules act upon different receptors (mu, delta, kappa, sigma) and, although peripheral mechanisms have been described, their activity occurs mainly at spinal and supraspinal levels. They provide a potent analgesic effect but are also responsible for various adverse effects-nausea, vomiting, sedation, constipation and respiratory depression-which seriously limit their use. As long as the indication is appropriate, these drugs should not be withheld because of fear of dependence or abuse. It has been observed that other adjuvant therapeutic approaches, generally used to treat conditions other than pain, provide pain relief in certain situations. These include corticosteroids, which are-widely used in rheumatology and oncology, and antidepressants, which are frequently used to treat chronic pain, especially that with a neuropathic component. Anti-epileptics are also used, particularly for excrutiating
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PMID:[Review of current pharmacologic treatment of pain]. 919 Mar 20

An open prospective and longitudinal study was carried out including 102 female patients whose pain was due to gyneco-obstetric surgery. The average age was 31.5 years and the average weight was 67 kg. The tramadol hydrochloride was administered as a single 100 mg dose p.o. or i.m., when moderate to intense pain was present. At the beginning of the trial, 96.1% of the patients presented moderate to very intense pain. At the end of the period of the trial, 74% reported none or mild pain. The analgesia began after an average of 17 minutes i.m. and 28 minutes p.o. The identified adverse effects were: nausea 1%, vomiting 5% and somnolence 8%. In accordance with the obtained results, we conclude that tramadol chlorhydrate is a good alternative for the treatment of moderate-to-severe acute pain of obstetric and gynecological origin.
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PMID:[Tramadol chlorhydrate in the management of gyneco-obstetric pain]. 928 Jul 42

We audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). Two patients required naloxone injection and none had long-term sequelae. Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 micrograms.ml-1 infusion occurred in four patients (1.2%), all with a sensory block higher than T5. They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.
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PMID:An audit of the safety of an acute pain service. 940 64


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