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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The past year's experience of the Pain and Regional Anesthesia Service at Hartford Hospital with neurolytic celiac plexus blockade for pancreatic cancer has been reviewed. The series includes eight patients with intractable pain from pancreatic cancer as well as two patients with pain from other abdominal malignancies. Nearly all patients noted good to excellent analgesia for up to 11 months. The only complication noted was one episode of mild, transient hypotension. Neurolytic celiac plexus blockade is a safe and effective means to relieve the terminal pain associated with not only pancreatic cancer but also other abdominal malignancies.
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PMID:Pain therapy for pancreatic carcinoma with neurolytic celiac plexus block. 247 51

Patient-controlled analgesia (PCA) represents a drug-delivery system in which patients self-administer predetermined doses of opiate analgesics. We have taken advantage of recent advances in pump technology and developed a system in which patients with severe pain received a continuous narcotic infusion, along with the capability of PCA bolus for breakthrough pain. All patients were experiencing chronic pain related to cancer and were unable to obtain adequate pain control with either intermittent parenteral, oral, or rectal narcotics. Sixty-nine percent of patients were treated in the home setting, and the majority received morphine sulfate subcutaneously (SQ). Admixture stability studies using high-pressure liquid chromatography (HPLC) showed that dexamethasone, metoclopramide, and haloperidol could be added to the morphine solutions and remain stable for 1 week at room temperature. Of 117 patients entered, 95% received excellent pain control, and side effects were rare, consisting of subcutaneous needle site infection and respiratory depression. Progressive pain due to either advancing disease or development of drug tolerance could be controlled by increasing opiate infusion rates. We conclude that (1) continuous infusion opiate with PCA bolus capability can be initiated and administered safely in the home setting; (2) patients with pain related to malignancy can be managed well with this system; and (3) pain control programs can be designed, implemented, and evaluated in the private practice setting.
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PMID:Patient-controlled analgesia for chronic cancer pain in the ambulatory setting: a report of 117 patients. 247 20

A prospective, randomized, double-blind trial was designed to compare the duration of analgesia produced by intravenous morphine and methadone. Patients with intractable cancer-related pain were studied for 5-6 days. One-eighth of the patient's daily opiate requirement was supplied as an i.v. infusion of either morphine or methadone over a period of 15 min. when initiated by the patient using a patient-controlled analgesia device. Dosing intervals, pain intensity assessments and toxicity were evaluated. Twenty-three patients were randomized; 18 were fully evaluable. Ten of the evaluable patients received morphine, 8 received methadone. Dosing intervals did not change over the 5 days for either group. The mean dosing interval for the last 10 doses was 3.9 +/- 0.85 h for patients receiving morphine and 3.9 +/- 1.6 h for patients receiving methadone (P = NS). One patient receiving morphine and one taking methadone required only 2-3 doses/day for pain control. Pain intensity and relief were similar for both groups. All patients had adequate analgesia as determined by at least a 50% difference in pain intensity at peak relief. The duration of pain relief when repeated intravenous doses of these analgesics were given was similar throughout the entire study period although morphine and methadone have different serum half-lives (3 vs. 25 h). Parenteral methadone does not offer a clinically significant increase in the duration of analgesia in patients with severe pain secondary to cancer.
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PMID:Does intravenous methadone provide longer lasting analgesia than intravenous morphine? A randomized, double-blind study. 225 Sep 26

Three patients operated for labial commissure cancer with cheek flap reconstruction are presented. In two cases general anaesthesia and in one local analgesia was used. There was no local recurrence, dehiscence, contracture or interference with function. This could be a method of choice for reconstruction of small lesions on labial commissure. The site of the incision lines fully comply with the aesthetic demands as they simulate the natural lines of the face.
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PMID:[Reconstruction of the labial commissure using a cheek flap]. 248 26

The long-term analgesic effects and the complications of epidural narcotic analgesia (ENA) were investigated in 40 cancer patients in whom systemic narcotic therapy failed to relieve pain or caused unacceptable side effects. In 32 patients, an externally fixated polyamide epidural catheter was used ("external group"), and in 8 patients, a polyurethane epidural catheter was tunneled and connected to a subcutaneous access port ("internal group"). The average duration of catheter treatment was 80.9 days (range 9-533 days). Twenty-five patients were treated as outpatients, and 15 remained hospitalized. Initially, all patients had significant or complete pain relief from 10 mg morphine/day, but the daily epidural morphine requirement showed a threefold increase during the first 3 weeks. During ENA, other methods of pain relief (radiotherapy, chemotherapy, surgery, epidural administration of local anesthetics, and nerve blocks) were necessary in 14 patients. Pharmacological side effects were of minor importance, with transient pruritus being the main subjective complaint. In the "external" group, 31 catheter replacements were necessary, mostly due to backflow of injected morphine outside the catheter. In two patients of the internal group, neurological complications occurred, but these disappeared spontaneously after removal of the system. They were presumably due to epidural fibrosis with compression of the spinal cord. Further technical improvements are necessary for the easier use and higher safety of the catheter technique.
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PMID:Epidural administration of morphine for control of cancer pain: long-term efficacy and complications. 252 Apr 8

The World Health Organization estimates that approximately 3.5 million people suffer daily from cancer pain. Approximately 30% to 40% of people with intermediate stages of cancer and 55% to 90% of patients with advanced or terminal disease have pain. A multidisciplinary effort is under way in Wisconsin to improve cancer pain management. In recognition of the state's initiative, the World Health Organization has designated Wisconsin a demonstration state for cancer pain management. Support for staffing is provided by the United States Public Health Service Interagency Committee on Pain and Analgesia. In December 1986, 65 people representing 50 health organizations met to develop a comprehensive plan of action to improve pain management in people with cancer. In this article the various statewide activities focused at improving cancer pain management are discussed.
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PMID:Cancer pain control: one state's experience. 256 72

The seriously ill or terminally ill child with cancer has received inadequate pain control in the past, partly due to physicians' and nurses' fears and misconceptions regarding the administration of effective pain medications to a child. Advances in assessment techniques in the infant and young child, as well as increasing use of pain assessment questionnaires and VAS in the older child, have mandated changes in administration of analgesia to children. It is the responsibility of the health-care team of provide adequate pain control to the ill child, using knowledgeable assessment and monitoring skills. The goal of therapy for the dying child is to maintain comfort and support the child and the family. Providing analgesia in the hospital or the home has proven safe and effective when administered either orally or parenterally, and comfort of the child is achieved.
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PMID:Pain control in the terminally ill child at home. 257 94

A review of 13 cases of second trimester termination at 20-24 weeks by dilation and evacuation after insertion of laminaria in women with critical illness is presented. The patients ranged in age from 17-41, parity from 0-5, and diagnoses covered a wide range, including hematologic, respiratory, vascular, gastrointestinal, cardiac systems, malignancies, autoimmune disorders and infections, as well as several with multiple problems, including intravenous drug use. Most were the result of late diagnosis or late presentation. Procedures were performed according to a standard protocol by 1 physician, from 1983- 1987, using iv meperidine and diazepam sedation and paracervical block, 12 after laminaria insertion. Amniotomy and evacuation with large ovum forceps were followed by oxytocin and sharp curettage. There were no complications in this series. The dilation and curettage method is preferable in such cases because the timing of the procedure can be planned for maximal use of facilities and staff, the patient is spared by unattended delivery, the length of the abortion process is minimal, and incidence of infection and retained placenta is lower. Need for lengthy analgesia and fluid monitoring is reduced, an advantage for many critically ill women. This approach is best done by a physician with specific experience, in a setting capable of managing severe complications.
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PMID:Late-second-trimester pregnancy termination with dilation and evacuation in critically ill women. 258 88

Intraoperative analgesia is the purview of anesthesiologists whereas postoperative pain is traditionally managed by surgeons. This series reports 19 months experience of anesthesiologists using epidural opiate analgesia (EOA) or patient-controlled analgesia (PCA) to treat postoperative pain in 302 patients following surgery for pelvic malignancy. For the 244 (81%) patients who received EOA, a lumbar epidural catheter was placed just prior to surgery, injected with local anesthetic for intraoperative analgesia, and injected with preservative-free morphine at appropriate intervals postoperatively to relieve pain. Fifty-eight patients (19%) used PCA which consisted of small self-administered boluses of intravenous narcotics. All patients were seen daily to ensure adequate analgesia and to treat side effects. Utilizing a 0-10 verbal rating scale (0 = no pain; 10 = worst pain imaginable), mean pain with EOA was 0.75 at rest and 2.6 with coughing. Mean pain ratings with PCA were 2.8 at rest and 5.0 during coughing. Side effects with EOA included nausea or vomiting (28%) and pruritus (20%). The only side effect of significance with PCA was nausea or vomiting (21%). All patients improved with treatment of side effects. Acceptance of these techniques is indicated by a steady increase in the number of gynecologic oncology surgical patients utilizing these modalities (50% at the outset to 87% currently).
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PMID:Postoperative pain management in gynecology oncology patients utilizing epidural opiate analgesia and patient-controlled analgesia. 259 69

Clophelinum (0.0014 +/- 0.00007 mg/kg, intravenously) as a component of multicomponent general anesthesia eliminated hemodynamic and endocrine reactions during major abdominal and thoracic surgery in cancer patients, reducing the dosage of calypsol and fentanyl. In the postoperative period clophelinum in combination with Baralgin ensures effective analgesia without the use of any narcotic analgesics.
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PMID:[Klofelin as a component of general anesthesia and a means of postoperative analgesia in cancer surgery]. 262 31


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