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

Swaziland is a kingdom with 800,000 inhabitants bordering on Mozambique and South Africa with about 50% of the population under 15 years of age. The experience of a nurse in a small clinic in the course of several years is recounted. Swaziland ranks 3rd in the world in alcohol abuse which often leads to wounds requiring suturing. Penicillin is given prophylactically with a paracetamol preparation for analgesia. As a rule, every injured person will get a .5 ml tetanus injection for prophylaxis. The most serious conditions of polyclinic patients are hepatitis, bilharzia, diarrhea, pellagra, pneumonia, and malnutrition. A great number of patients have sexually transmitted diseases, and the rate of AIDS infection is not known. According to 1 study 60-80% of the population in reproductive age will die of AIDS in the course of a 5-year period. The majority of people are impervious to counseling about their sexual behavior in spite of educational programs on the radio, in schools, and in work places. Condoms are not popular, since they are not considered manly. Pregnant women receive iron and multivitamin tablets in the course of pregnancy. Many pregnant women are anemic, and 70% give birth at home, the rest in a hospital or clinic. During delivery they get no analgesia, and there are few complications. The average weight of the newborn is 3.5 kg, although none of the women are under 150 cm. A little after birth all children are vaccinated with bacillus Calmette-Guerin (BCG) and polio, later with diphtheria-pertussis-tetanus (DPT) and measles.
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PMID:[Nursing under a different sky. Swaziland]. 146 29

Analgesia and sedation with the associated reduction of undesired vegetative reactions are important components in the therapeutic regimen of intensive care patients. None of the sedative drugs available can fulfil every one of the criteria expected of an "ideal" sedative. Four commonly used drug combinations have been established as standards: 1. opioid and neuroleptic, 2. opioid and benzodiazepine, 3. ketamine and benzodiazepine, and 4. opioid and propofol. In everyday use one must take not only the specific side-effects of a drug into consideration but also its pharmacokinetic properties. These are often markedly altered in critically ill patients who have impaired functions of vital organs. The pharmacokinetics of a drug is affected by disturbed renal or hepatic function, interactions with other drugs, altered protein binding and the induction or inhibition of metabolic enzymes. The best method of drug administration is by motor-driven pump, with which large fluctuations of the dosage can be avoided. Constant ratios of drug combinations are not recommended, since the pharmacokinetics of each drug is affected to a different degree in the critically ill patient. Withdrawal symptoms, can occur for example after prolonged administration of benzodiazepines, can often be avoided by slowly reducing the dose or by switching to a short-acting substance. In some patients (e.g. those with a history of alcohol abuse) a massive increase of the drug dose is not indicated when the effect is not adequate. Instead, an entirely different substance should be employed and the administration of less frequently used drugs should be considered. Despite detailed knowledge of the altered pharmacokinetics in critically ill patients, the drugs should be dosed as dictated by the situation, true to the anaesthesiologists' adage: "Dosage according to effect!"
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PMID:[Analgesia and sedation in intensive care patients]. 148 80

Buprenorphine is a mixed opioid agonist/antagonist which appears to produce less physical dependence and respiratory depression than typical mu-agonist opioids. These effects suggest its use for analgesia for drug abusers. However, buprenorphine may precipitate withdrawal from other opioids. The present case illustrates the utility of buprenorphine and describes a method to transfer a patient from a mu-agonist to buprenorphine without precipitating withdrawal or interrupting analgesia.
Am J Drug Alcohol Abuse 1991
PMID:Buprenorphine for pain relief in a patient with drug abuse. 174 7

The purpose of this study was to determine whether sensitivity to nitrous oxide analgesia was altered by chronic ethanol exposure. Control mice exposed to 25%, 50%, and 75% nitrous oxide in oxygen demonstrated a concentration-related analgesic effect, as measured by the acetic acid abdominal constriction test. Other mice previously exposed to ethanol vapors for 72 h exhibited a significantly reduced sensitivity to nitrous oxide analgesia. The dose-response curve of the chronic ethanol-exposed group was shifted to the right of that of the control mice. These findings suggest the possibility that subjects with a history of alcohol abuse might have reduced responsiveness to nitrous oxide in a clinical setting.
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PMID:Influence of chronic ethanol exposure on nitrous oxide analgesia in mice. 221 13

The literature on the interaction of ethanol and stress is reviewed. Stress has amethystic properties in both experimental animals and human subjects when analgesia or various behavioral parameters were evaluated. In addition studies have shown that ethanol counteracts some effects of stress in non-alcoholic subjects. Improvement in performance and in the effective state of humans and reversal of some behavioral and pathological concomitants of stress in experimental animals have been reported. Although there is indication that ethanol improves the affective state in humans, reduction of anxiety has not been a universal finding. Recent studies have pointed out a number of variables (the drinking environment, cognitive set, mood and personality of subjects, prior experience with ethanol, sex, dose and type of beverage) which can significantly alter the effects of alcohol in human subjects. These may account for the variability in results in the literature. Although some studies have shown that alcohol ingestion increases under stressful conditions, others have failed to do so in both experimental animals and in humans. In alcoholics ethanol ingestion, in general, does not appear to relieve anxiety. In fact anxiety usually increases with time during a drinking binge. Therefore more research needs to be done to assess the validity of the anxiety-reducing theory for alcohol abuse. Possible mechanisms for the interaction of stress and alcohol are discussed.
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PMID:The interaction of alcohol and stress. A review. 611 46

Three cases of extradural abscess with delayed presentation after extradural analgesia have been reported previously. The present report describes a patient with alcohol abuse who was treated for 5 days with extradural injections of bupivacaine for pain from multiple rib fractures. The first symptoms of an extradural abscess developed approximately 11 days after removal of the extradural catheter, and definite diagnosis was delayed a further 7 days.
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PMID:Delayed presentation of an extradural abscess in a patient with alcohol abuse. 847 85

The metabolic effects of continuous intravenous (IV) application of the alpha 2 agonist clonidine were evaluated by assessment of nitrogen economy and postaggression endocrine patterns. Twenty-four patients undergoing abdominothoracic esophageal cancer resection were studied. Thirteen of these patients with alcohol abuse were treated postoperatively with IV clonidine for prevention of alcohol withdrawal syndrome. Eleven patients who were not treated with clonidine served as controls. All patients were treated in a standardized manner in regard to surgical technique, balanced anesthesia, and postoperative intensive care treatment, including thoracic epidural analgesia with bupivacaine and fentanyl. Isonitrogenous and isocaloric nutrition was comparable in all patients. A significantly improved cumulated 6-day nitrogen balance was found in clonidine-treated patients (-1.5 +/- 4.9 g nitrogen) compared to the control group (-17.6 +/- 4.2 g nitrogen) (P < 0.05). The main reason for improved nitrogen economy may be clonidine-induced growth hormone (GH) release. The pattern of insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) concentrations could support this hypothesis.
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PMID:Postoperative alpha 2-adrenergic stimulation attenuates protein catabolism. 889 12

Alcoholic pancreatitis is a major complication of alcohol abuse. Until recently, it was generally accepted that alcoholic pancreatitis was a chronic disease from the outset. However, evidence is now emerging in support of the 'necrosis-fibrosis' hypothesis that alcoholic pancreatitis begins as an acute process and that repeated episodes of acute injury lead to the changes of chronic pancreatitis (acinar atrophy and fibrosis) resulting in exocrine and endocrine dysfunction. The treatment of acute pancreatitis follows the regimen of bed rest, nasogastric suction, analgesia and intravenous support. The role of additional therapeutic measures such as prophylactic antibiotics, antioxidants and enteral nutrition in severe cases has not yet been precisely defined. The treatment of chronic pancreatitis involves attention to its three cardinal features: pain, maldigestion and diabetes. With respect to the pathogenesis of alcoholic pancreatitis, the focus of research over the past 30 years has shifted from the sphincter of Oddi and ductular abnormalities to the acinar cell itself. It has now been established that the acinar cell is capable of metabolizing alcohol and that direct toxic effects of alcohol and/or its metabolites on acinar cells may predispose the gland to injury in the presence of an appropriate trigger factor. A significant recent development relates to the characterization of pancreatic stellate cells, increasingly implicated in alcoholic pancreatic fibrosis. This chapter summarizes the natural history, clinical features, current trends in treatment as well as recent advances in our understanding of the pathogenesis of alcoholic pancreatitis.
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PMID:Alcohol-induced pancreatic injury. 1282 57

Naltrexone implants are used as an abstinence therapy for patients with opioid, amphetamine and alcohol abuse. This study was designed to assess the implications of this therapy in patients presenting for anaesthesia for removal of these implants. We conducted a retrospective case-note review of 37 patients undergoing removal of naltrexone implants in the period 2001 to 2008 at Sir Charles Gairdner Hospital. Indications for removal included infection at the insertion site, naltrexone intolerance or the requirement for effective opioid analgesia. Thirty-two patients had surgery under general anaesthesia, four under local anaesthesia and one under spinal anaesthesia. The perioperative opioid requirement varied from 0 to 100 mg of intravenous morphine equivalents (median 11.7 mg, mean 20.7 mg). The only factor that was associated with a higher perioperative opioid requirement was whether the implant was infected or not. Forty-four percent of patients having a general anaesthetic complained of moderate to severe pain postoperatively, and 64% of these patients had a prolonged stay in the post-anaesthesia care unit. We did not observe any instances of postoperative complications due to increased opioid sensitivity after removal of naltrexone implants. The majority of patients were discharged home by the first postoperative day. Anaesthesia for the removal of naltrexone implants was associated with a wide range of opioid analgesia requirements and a high incidence of pain postoperatively. Concern regarding increasing opioid sensitivity after removal of implants does not seem to preclude use of generous opioid analgesia in this group of patients.
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PMID:Adverse events in the removal of naltrexone implants. 2197 Jan 35

A notable minority of patients experience persistent postsurgical pain and some of these patients consequently have prolonged exposure to opioids. Risk factors for prolonged opioid use after surgery include preoperative opioid use, anxiety, substance abuse, and alcohol abuse. The window to intervene and potentially prevent persistent opioid use after surgery is short and may best be accomplished by both surgeon and anesthesiologist working together. Anesthesiologists in particular are well positioned in the perioperative surgical home model to affect multiple aspects of the perioperative experience, including tailoring intraoperative medications and providing consultation for possible discharge analgesic regimens that can help minimize opioid use. Multimodal analgesia protocols reduce opioid consumption and thereby reduce exposure to opioids and theoretically the risk of persistent use. Regional anesthesia and analgesia techniques also reduce opioid consumption. Although many patients will recover without difficulty, the small minority who do not should receive customized care which may involve multiple office visits or consultation of a pain specialist. Enhanced recovery pathways are useful in optimizing outcomes after surgery.
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PMID:Managing Prolonged Pain After Surgery: Examining the Role of Opioids. 3019 82


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