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

Pharmacokinetic drug-drug interactions with codeine, dihydrocodeine, hydrocodone, oxycodone, and buprenorphine are reviewed in this column. These compounds have a very similar chemical structure to morphine. Unlike morphine, which is metabolized chiefly through conjugation reactions with uridine diphosphate glucuronosyl transferase (UGT) enzymes, these five drugs are metabolized both through oxidative reactions by the cytochrome P450 (CYP450) enzyme and conjugation by UGT enzymes. There is controversy as to whether codeine, dihydrocodeine, and hydrocodone are actually prodrugs requiring activation by the CYP450 2D6 enzyme or UGT enzymes. Oxycodone and buprenorphine, however, are clearly not prodrugs and are metabolized by the CYP450 2D6 and 3A4 enzymes, respectively. Knowledge of this metabolism assists in the understanding for the potential of drug-drug interactions with these drugs. This understanding is important so that clinicians can choose the proper dosages for analgesia and anticipate potential drug-drug interactions.
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PMID:Pharmacokinetic drug interactions of morphine, codeine, and their derivatives: theory and clinical reality, Part II. 1459 88

This article examines acute pain management practices for patients 65 years of age and older who were hospitalized during 1999 for hip fracture. Data were collected from the medical records of patients (N = 709) admitted to 12 hospitals in the Midwest and from questionnaires on pain practices completed by nurses (N = 172) caring for these patients. The major variables examined were (1). pharmacological and nonpharmacological treatments for acute pain in hospitalized elders, (2). nurses' perceived stage of adoption for avoiding meperidine use and for administering analgesics around-the-clock, and (3). nurses' perceived barriers to optimal treatment of acute pain in elders. Acetaminophen was the most frequently administered analgesic, but administered doses were far less than the maximum daily recommended dose. More than one third (39%) of the nurses reported that they always avoided the use of meperidine, and over half reporting avoiding its use sometimes. However, the majority of patients (56.8%) received at least one dose of meperidine, even though evidence suggests that other analgesic agents are more appropriate for treatment of acute pain in elders. Only 27% of patients received patient-controlled analgesia, and only 22.3% of patients received around-the-clock administration during the first 24 hours after admission of analgesics that had been ordered on a prn basis. The majority of nurses were aware that around-the-clock administration of analgesics was preferable, but only 33.7% were persuaded (believed) that this method should be used. Intramuscular injection was used for 52.2% of patients, even though this route is not recommended for older adults. The most frequently used nonpharmacological intervention was repositioning, followed by use of pressure relief devices and cold application. Nurses reported difficulty contacting physicians and difficulty communicating with them about type and/or dose of analgesics as the greatest barriers to pain management. Findings from this multi-site study show that active and focused "translation" interventions are needed to promote adoption of evidence-based acute pain management practices by health care providers.
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PMID:Acute pain treatment for older adults hospitalized with hip fracture: current nursing practices and perceived barriers. 1460 55

In this study 20 paediatric surgical patients were randomized to two groups after induction of general anaesthesia. Group 1 received 0.25% bupivacaine (2 mg/kg) and group 2 received 5% tramadol (2 mg/kg) both as a caudal block. Heart rate, mean arterial pressure, arterial oxygen saturation, respiratory rate and pain and sedation scores were recorded at 1, 2, 4, 6, 12 and 24 h post-operatively. Acetaminophen was administered rectally (20 mg/kg) if the pain score was > 3/10. The pain and sedation scores in group 2 were significantly lower compared with group 1. There were no significant differences in heart rate, mean arterial pressure, arterial oxygen saturation and respiratory rate between the two groups. In conclusion, caudal tramadol was superior to bupivacaine in analgesic efficacy and in reducing the need for additional analgesia during the post-operative period in paediatric patients.
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PMID:The effect of caudal bupivacaine versus tramadol in post-operative analgesia for paediatric patients. 1470 14

Paracetamol (acetaminophen) has been shown to be an effective analgesic for the treatment of moderate pain where it is chiefly indicated, as shown in placebo-controlled studies in the perioperative setting and other acute pain states. In addition, an opioid-sparing effect has been demonstrated. No clinically relevant adverse effects are usually apparent with recommended doses. Paracetamol is an effective component in 'multimodal analgesia' in combination with morphine, weak opioids and non-steroidal anti-inflammatory drugs. Although most studies involve the perioperative setting, similar results have been obtained in other acute pain states, such as acute musculoskeletal pain, migraine, etc. In conclusion, paracetamol has a favourable efficacy-tolerability profile and is therefore recommended as a basic, first-line analgesic in acute pain states and as a valuable component in multimodal analgesia.
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PMID:[Role of paracetamol in the acute pain management]. 1475 87

Paracetamol (acetaminophen) is well established as a leading non-prescription antipyretic analgesic drug. Future developments are likely to include new formulations to achieve rapid absorption for a fast onset of action, and prolonged absorption to extend the duration of action for regular long-term administration. Better dosage forms are also required for rectal administration. The availability of intravenous paracetamol has greatly extended the use of this drug as an adjunct to postoperative analgesia and for control of fever in the intensive care setting. Intravenous paracetamol is available in only a few countries at present, but it seems inevitable that it will be marketed much more widely in the future. The misuse of paracetamol as a fashionable agent for self-poisoning seems likely to continue, and liver failure may still occur in the small proportion of overdose patients who present too late for effective antidotal treatment with N-acetylcysteine. Much effort is being devoted to the study of the molecular mechanisms of paracetamol hepatotoxicity, and it is hoped that further advances may make it possible to prevent liver failure in all patients, irrespective of delays in presentation. At the same time, there is great interest in the mechanisms of the therapeutic actions of paracetamol and its effects on the different isoforms of cyclo-oxygenase. There will probably be important new findings in this area and these may lead to wider clinical use. Meantime, possible novel therapeutic applications for paracetamol include its use as an antioxidant to prevent atherosclerosis and cardiovascular disease by inhibiting the oxidation of low-density lipoproteins, and to prevent the formation of cataracts.
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PMID:[New perspectives on paracetamol]. 1475 91

Osteoarthritis is a common, chronic condition which requires an individualised management plan involving multiple kinds of treatment. Exercise programs and the Arthritis Self-Management Program reduce pain and disability associated with osteoarthritis. Paracetamol is the most appropriate first-line analgesic. Non-steroidal anti-inflammatory drugs may be used as second-line analgesia on an as-needed basis (including continuous use), but must be used with caution. Cyclo-oxygenase-2-specific inhibitors are used if there are risk factors for upper-gastrointestinal complications, but only after considering cardiovascular risk. Glucosamine sulfate is a safe and effective over-the-counter treatment. Intra-articular therapies are used when others have failed.
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PMID:Medical management of osteoarthritis of the knee and hip joints. 1498 44

Studies addressing pain management after pediatric spinal fusion surgery have focused on the use of patient-controlled or epidural analgesia during the immediate postoperative period. Controlled-release (CR) analgesics have been found to be safe and effective in adults. The purpose of this study was to describe the use of oxycodone-CR in pediatric patients after the immediate postoperative period. A retrospective chart review of 62 postoperative spinal fusion patients (10-19 years) was conducted. The mean initial oxycodone-CR dose was 1.24 mg/kg/day. The mean ratio of conversion from parenteral morphine equivalents to oxycodone-CR was 1:1. Mean pain scores decreased from 4.2/10 to 3.7/10 with the transition to oxycodone-CR. Common side effects included dizziness, constipation, and nausea. Oxycodone-CR was used for an average of 13.3 days, which included an average wean time of 6 days. Results of this study demonstrate safe and effective use of oxycodone-CR in the pediatric spinal fusion population.
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PMID:Controlled-release oxycodone for the management of pediatric postoperative pain. 1511 83

This study investigated whether intrathecal diamorphine affects gastric emptying following elective Caesarean section. Forty women were randomly allocated to receive either diamorphine 300 microg or 0.9% saline as part of a standard spinal anaesthetic. Gastric emptying was measured in the immediate postoperative period using paracetamol absorption. Paracetamol concentrations were measured by enzymatic assay method using a Beckman CX-7 automated analyser. The time to maximum concentration (Tmax) was statistically longer in the diamorphine group (control 41.8, SD 20.8 min; diamorphine 72.6 SD 41.9 min; p < 0.01). During the 2-h study period, mean morphine consumption via a patient controlled analgesia device was significantly higher in the control group (control 9.3, SD 3.6 mg; diamorphine 2.1, SD 2.1 mg; p < 0.01). We conclude that intrathecal diamorphine may contribute to the delay in gastric emptying that occurs immediately following elective spinal Caesarean section.
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PMID:The effects of intrathecal diamorphine on gastric emptying after elective Caesarean section. 1514 96

The purpose of the study is to evaluate both the efficacy of ring block of the penis with levobupivacaine in preventing intraoperative and postoperative pain associated with circumcision in children and the quality of the recovery. Thirty boys aged 3 - 12 years who underwent circumcision under general anaesthesia as day case patients were allocated randomly to receive either a subcutaneous ring block with levobupivacaine or intravenous fentanyl (2 microg/kg) and paracetamol (30 mg/kg) rectally, after induction of anesthesia but before surgery. The efficacy of intraoperative analgesia was estimated using the heart rate and alterations in blood pressure. The quality of the recovery was assessed based on the Aldrete Scoring System (First Value and Time of Maximum Value were recorded). Postoperative pain was estimated using a four degree scale by nurses in the Postanaesthesia Care Unit and over the next 24 hours by the parents. Paracetamol was given depending on the pain score and the time of first dose given was recorded. The quality of postoperative analgesia was based on the children's activity and mobilisation. The ring block group showed intraoperative cardiovascular stability and a faster and better recovery (p < 0.0005) while the postoperative analgesia tended to be longer and more adequate, although that no statistically significant difference was noted (p < 0.1).
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PMID:Intraoperative and postoperative analgesia with subcutaneous ring block of the penis with levobupivacaine for circumcision in children. 1521 12

Our objective in this study was to compare the analgesic effects of etoricoxib and oxycodone/acetaminophen in a postoperative dental pain model. Patients experiencing moderate to severe pain after extraction of two or more third molars were randomized to single doses of etoricoxib 120 mg (n = 100), oxycodone/acetaminophen 10/650 mg (n = 100), or placebo (n = 25). The primary end-point was total pain relief over 6 h. Other end-points included patient global assessment of response to therapy; onset, peak, and duration of effect; and rescue opioid analgesic use. Active treatments were statistically significantly superior to placebo for all efficacy measures. Total pain relief over 6 h for etoricoxib was significantly more than for oxycodone/acetaminophen (P < 0.001). Patient global assessment of response to therapy at 6 and 24 h was superior for etoricoxib. Both drugs achieved rapid onset, although the time was faster for oxycodone/acetaminophen by 5 min. The peak effect was similar for both drugs. Compared with oxycodone/acetaminophen patients, etoricoxib patients experienced a longer analgesic duration, had a smaller percentage requiring rescue opioids during 6 and 24 h, and required less rescue analgesia during 6 and 24 h. Oxycodone/acetaminophen treatment resulted in more frequent adverse events (AEs), drug-related AEs, nausea, and vomiting compared with etoricoxib treatment. In conclusion, etoricoxib 120 mg provided superior overall efficacy compared with oxycodone/acetaminophen 10/650 mg and was associated with significantly fewer AEs.
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PMID:The analgesic efficacy of etoricoxib compared with oxycodone/acetaminophen in an acute postoperative pain model: a randomized, double-blind clinical trial. 1533 15


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