RESUMEN
AIM: To develop an effective and safe analgesic regimen (by minimizing the proportion of narcotic analgesics) in hemophiliac patients in the perioperative period during high-trauma surgeries (total knee and hip replacements). SUBJECTS AND METHODS: The prospective study included 24 patients aged 22 to 57 years (median age 38 years) with severe congenital hemophilia A (n = 22) and B (n = 2), who had undergone knee (n = 18) or hip (n = 6) replacements in the Hematology Research Center, Russian Ministry of Health of the Russian Federation, in 2013. Two analgesic regimens (a) paracetamol with trimeperidine; b) paracetamol and ketamine with trimeperidine) were used. To assess pain intensity, the authors used scoring scales: a visual analogue scale (VAS) and a numeric rating scale (NRS). The effect of paracetamol on hemostasis was evaluated on the basis of thromboelastogram and coagulogram readings. Possible paracetamol hepatotoxicity was assessed analyzing liver enzymes. RESULTS: An interview has shown that 66% of the hemophiliac patients regularly take analgesics for chronic pain syndrome, among them 29% use narcotic analgesics. It is difficult to achieve perioperative analgesia in these patients. The dosage of narcotics can be decreased (that of trimeperidine on an average from 80 to 45 mg/day) in the early postoperative period if non-narcotic analgesics, such as paracetamol 4 g/day, are incorporated into the analgesic regimen. Paracetamol promotes pain relief to moderate and mild (not more than 40-50 VAS scores and 3-4 NRS scores), without affecting hemostasis (the thromboelastogram readings differed statistically insignificantly; the coagulation index was 0.6-1.6) and without having a hepatotoxic effect. CONCLUSION: The systemic use of analgesics in hemophiliac patients considerably makes postoperative analgesia difficult. The use of paracetamol with trimeperidine within the first 24 hours after high-trauma surgeries in hemophiliac patients (even if they have hepatitis C) is rather effective and safe.
Asunto(s)
Acetaminofén , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Coagulación Sanguínea/efectos de los fármacos , Hemofilia A , Dolor Postoperatorio , Promedol , Acetaminofén/administración & dosificación , Acetaminofén/efectos adversos , Adulto , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Pruebas de Coagulación Sanguínea/métodos , Enfermedades Óseas/cirugía , Monitoreo de Drogas , Quimioterapia Combinada/métodos , Femenino , Hemofilia A/sangre , Hemofilia A/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Dimensión del Dolor , Dolor Postoperatorio/complicaciones , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Cuidados Posoperatorios/métodos , Promedol/administración & dosificación , Promedol/efectos adversos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To develop effective and safe measures of postoperative multimodal analgesia (optimizing the use of narcotic analgesics) in surgical treatment of hematological patients with thrombocytopenia. DESIGN: A pilot and prospective comparative controlled study. METHODS: We studied 27 patients with acquired thrombocytopenia who underwent laparoscopic splenectomy. Three schemes of anesthesia were used: 1) Nefopam 20 mg/day + trimeperidin (n = 7); 2) Paracetamol 4 g/day + trimeperidin (n = 10); 3) paracetamol + trimeperidin + glucocorticosteroids (GC) (through treatment of the underlying disease) (n = 10). Analgesic properties and effect of each scheme were assessed according to a rating scale of pain NRS (10 points) and VAS (100 points) studied. Additionally we evaluated the effect of nefopam and paracetamol on the functional properties of platelets and hemostasis, platelet levels while monitoring and indicators of thromboelastogram (TEG). RESULTS: Application of paracetamol + trimeperidin accompanied with effectively reducing of postoperative pain (less than 5 points on the NRS). The level of postoperative pain was lower in patients who were treated with corticosteroids within the therapy of the underlying disease before surgery and who continued to receive it in postoperative period (2-3 points NRS). Nefopam use in the perioperative period is not only inferior to the analgesic effect of paracetamol, but also causes frequent side effects. Consumption of narcotic analgesic--trimeperidin when applying nefopam averaged 43 mg/day, the appointment of paracetamol--28 mg/day, using a combination of paracetamol + GC--20 mg/day. Thus, GC within the underlying disease treatment substantially reduces the need for opioid analgesics. A monitoring of the number of platelets and TEG did not shows negative effect of paracetamol and nefopam on platelet and plasma hemostasis. CONCLUSIONS: Nefopam and paracetamol may be used in patients with thrombocytopenia, as do not affect the hemostasis and platelet count. Application of postoperative analgesia scheme paracetamol + trimeperidin in patients receiving corticosteroids provides the maximum reduction of pain with the least consumption of narcotic analgesics.
Asunto(s)
Analgesia/métodos , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Esplenectomía , Trombocitopenia/cirugía , Acetaminofén/administración & dosificación , Acetaminofén/efectos adversos , Acetaminofén/uso terapéutico , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Plaquetas/citología , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nefopam/administración & dosificación , Nefopam/efectos adversos , Nefopam/uso terapéutico , Recuento de Plaquetas , Promedol/administración & dosificación , Promedol/efectos adversos , Promedol/uso terapéutico , Trombocitopenia/sangreRESUMEN
A prospective, randomized, comparative study was conducted. 3 analgesia protocols were used: 1) patient controlled analgesia (PCA) with trimeperidine in combination with a nefopam constant infusion; 2) PCA with trimeperidine in combination with a nefopam bolus; 3) PCA with trimeperidine separately during early postoperative period in cardiac surgery patients. The study included 60 patients agedf rom 40 to 65 years of age (20 patients in each group). The analgesia efficacy was evaluated with a 5-point verbal rating scale (VRS) for pain intensity and inspiratory lung capacity (ILC), measured with incentive spirometer. The safety of nefopam during early postoperative period in cardiac surgery patients was shown. The combination of nefopam and trimeperidine led to a more pronounced analgetic effect. Trimeperidine consumption was significantly lower in nefopam groups than in the group of isolated PCA. Wholly adverse effects were associated with trimeperidine and were dose-related The incidence of nausea, vomiting, dizziness, weakness, bowel paresis was significantly higher in isolated PCA group than in the other two groups.
Asunto(s)
Analgesia/métodos , Analgésicos no Narcóticos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos , Nefopam/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Procedimientos Quirúrgicos Cardíacos/métodos , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Nefopam/administración & dosificación , Nefopam/efectos adversos , Dimensión del Dolor , Promedol/administración & dosificación , Promedol/efectos adversos , Promedol/uso terapéutico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Comparative study of postoperative analgesia and sedation with trimeperidine and dexmedetomidine and their effects on haemodynamics and vegetative nervous system was performed. Assessment of analgesia and sedation during vagotonia (first part of the study) and hypokinetic type of haemodynamics (second part of the study) was carried out with visual analogue scale (VAS) and Richmond scale. Results of the study showed that dexmedetomidine is more effective and safer than trimeperidine for analgesia and sedation in patients with spontaneous breathing after abdominal surgery. Dexmedetomidine use allows keeping optimal type of haemodynamics and vegetative nervous system parameters on first day of postoperative period.
Asunto(s)
Abdomen/cirugía , Analgésicos no Narcóticos/uso terapéutico , Dexmedetomidina/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Dolor Postoperatorio/prevención & control , Receptores Adrenérgicos alfa 2/metabolismo , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Sedación Consciente/métodos , Dexmedetomidina/administración & dosificación , Dexmedetomidina/efectos adversos , Hemodinámica/efectos de los fármacos , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Dolor Postoperatorio/metabolismo , Sistema Nervioso Parasimpático/efectos de los fármacos , Promedol/administración & dosificación , Promedol/efectos adversos , Promedol/uso terapéutico , Resultado del TratamientoRESUMEN
4 combinations of analgesia were studied: 1) Nefopam and patient-controlled analgesia (PCA) with Trimeperidine; 2) Ketoprofen (100 microg each 12 hours intramuscular) and PCA with Trimeperidine; 3) Nefopam, Ketoprofen and PCA with Trimeperidine; 4) PCA with Trimeperidine as monotherapy in early postoperative period in cardio-surgical patients. 80 patients (age from 40 to 70) were divided into 4 groups, 20 patients in each group. Administration of Nefopam and Ketoprofen before extubation reduced the intensity of pain syndrome (in average on 90%) and promoted the early stirring up of patients. Combination of Nefopam and Ketoprofen provided the most expressed analgesic and opioids-saving effects. In this group average amount of Trimeperidine per 24 hours was 14.7 microg that was 4.9 times less than in group of PCA with Trimeperidine as monotherapy. Dynamics of maximal inspiratory capacity of the lungs in the first three groups was better than in group of PCA with Trimeperidine as monotherapy beginning from 6th hour of study. In common undesirable effects was connected with Trimeperidine administration and depended on its dose. The frequency of nausea, vomit, dizziness and weakness was authentically higher in the group of PCA with Trimeperidine as monotherapy than in other groups.
Asunto(s)
Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Procedimientos Quirúrgicos Cardíacos , Cetoprofeno/uso terapéutico , Nefopam/uso terapéutico , Dolor Postoperatorio/prevención & control , Promedol/uso terapéutico , Adulto , Anciano , Analgesia Controlada por el Paciente , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada , Humanos , Cetoprofeno/administración & dosificación , Cetoprofeno/efectos adversos , Persona de Mediana Edad , Nefopam/administración & dosificación , Nefopam/efectos adversos , Promedol/administración & dosificación , Promedol/efectos adversos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Efficacy of systemic application of opiates (promedol) for the pain relief after big open abdominal operations, using visual-analogue scale (VAS), was estimated in 50 patients. During 36-48 h postoperatively analgesia was inadequate (VAS in a rest state more than 3 points and while movement--more than 4 points). Intensive pain (VAS 6 points and more) was noted in 58% of patients, while they are moving, and in 26%--in a rest state. Inadequate anesthesia may constitute one of causes of excessive systemic inflammatory reaction development in patients postoperatively.
Asunto(s)
Cavidad Abdominal/cirugía , Analgesia/métodos , Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/prevención & control , Promedol/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Proteína C-Reactiva/análisis , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Promedol/administración & dosificación , Promedol/efectos adversos , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The analysis of publications is devoted to the application of skin conductance monitoring in anesthesiology and intensive care. Rates of skin conductance (baseline values, the amplitude and frequency of the waves) are closely linked with the state of the sympathic nervous system. According to their dynamics it is possible to judge on the pain and stress in patients with whom the contact is difficult: newborns, infants, patients of all age groups during general anesthesia and in critical condition. According to published data monitoring skin conductance showed itself as a sensitive and promising method to identify and determine the severity of pain in all age groups, approaching by its characteristics the theses of the pain assessment perfect tool.
Asunto(s)
Analgesia/métodos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Catéteres de Permanencia , Dolor Postoperatorio/prevención & control , Analgesia/instrumentación , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Femenino , Respuesta Galvánica de la Piel , Humanos , Conducta del Lactante , Recién Nacido , Enfermedades del Recién Nacido/cirugía , Infusiones Intravenosas , Masculino , Dimensión del Dolor , Promedol/administración & dosificación , Promedol/uso terapéutico , Irrigación Terapéutica/instrumentación , Irrigación Terapéutica/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The aim of the study is to discover adequate method of early postoperative period pain management in patients after cardiac surgery. In prospective randomized competitive study were analyzed three algorithms of analgesia: first patients controlled analgesia (PCA) with trimeperidine and (NSAID) ketoprofen, second PCA with only trimeperidine and third is ketoprofen combined with intramuscular injection of trimeperidine. There were 75 pations studied at the age of 40 to 65. The pain level was assessed according to verbal 5 points scale, inspiration lung capacity which was measured by incentive spirometry. It was shown that NSAID were safe to use in early postoperative period in patients after cardiac surgery. Combination of ketoprofen and trimeperiden showed best results in pain management. Consumption dose of trimeperidine was smaller in first group but larger than in third group where this drug was introduced fractional. All side effects were associated with trimeperedine and were depended on a dose. Patients of second group had nausea, vomiting, dizziness, weakness, enteroparesis considerably often comparing to patients of other groups, moreover rate of enteroparesis was minimal in the third group.
Asunto(s)
Analgesia Controlada por el Paciente/métodos , Cetoprofeno/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Promedol/administración & dosificación , Adulto , Anciano , Algoritmos , Analgesia Controlada por el Paciente/efectos adversos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Humanos , Cetoprofeno/efectos adversos , Persona de Mediana Edad , Promedol/efectos adversos , Estudios ProspectivosRESUMEN
INTRODUCTION: A pilot unicenter blind placebo-controlled study comparing different analgesics was conducted in parallel groups, by concurrently using two patient-controlled analgesia (PCA) apparatuses in one patient, was conducted Subjects and methods. The study included patients after laparotomy. Group I patients (n=22) were proposed 2 PCA apparati, one of which contained trimeperidine solution and the other did placebo. Group 2 patients (n=17) were proposed 2 PCA apparatuses, one of which contained trimeperidine solution and the other did lornoxycam. PCA was adjusted in the same manner in both apparati. The patients were asked to determine which analgesic is best in providing 24-hour analgesia. RESULTS: There were no differences in the intensity of pain between the groups. The latter did not differ in the number of adverse reactions. Comparison showed no significant differences in the use of trimeperidine between Groups 1 and 2 patients. Among Group 1 patients, 61% considered trimeperidine as the best analgesic and 22% did placebo; 17% called none. Group 2 patients chose trimeperidine in 41% of cases and lornoxycam in 41%, none was called in 18%. CONCLUSION: Comparative assessment of analgesics, by employing 2 PCA apparatuses in one patient, allows evaluation of the efficacy of analgesics added to the conventional methods.
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Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Dolor Postoperatorio/prevención & control , Piroxicam/análogos & derivados , Promedol/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Relación Dosis-Respuesta a Droga , Humanos , Piroxicam/administración & dosificación , Piroxicam/efectos adversos , Piroxicam/uso terapéutico , Promedol/administración & dosificación , Promedol/efectos adversos , Autoadministración/instrumentación , Factores de Tiempo , Resultado del TratamientoRESUMEN
The study included 90 patients who had undergone laparoscopic cholecystectomy. The patients were divided into 3 groups: 1) paracetamol was given for preemptive and postoperative analgesia; 2) ketorolac tromethamine; and 3) promedol (a control group). The visual analogue scale (VAS) and the determination of the time course of changes in the blood levels of tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), and glucose were used to evaluate the degree of pain syndrome. Preemptive analgesia in laparoscopic surgery using ketorolac and paracetamol could reduce the degree of postoperative pain syndrome by 40.1%, as shown by the VAS. Comparative analysis of the characteristics of the agents showed that paracetamol produced a more powerful antistress defense, as confirmed by the time course of changes in the levels of TNF-alpha and CRP.
Asunto(s)
Acetaminofén/administración & dosificación , Analgesia/métodos , Analgésicos no Narcóticos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Colecistectomía Laparoscópica/efectos adversos , Ketorolaco Trometamina/administración & dosificación , Dolor Postoperatorio/prevención & control , Cuidados Preoperatorios , Adulto , Analgésicos Opioides/administración & dosificación , Femenino , Enfermedades de la Vesícula Biliar/cirugía , Humanos , Masculino , Persona de Mediana Edad , Promedol/administración & dosificación , SíndromeRESUMEN
The study was to evaluate the analgesic and opioid-sparing effect of intravenous paracetamol injections in cardiosurgical patients in the early postoperative period. Adequate analgesia within the first 12-18 hours of the early postoperative period is very important for a good prognosis of the further course of pain syndrome and for the reduction of a risk for its progression to its chronic form. In early studies, propacetamol lowered morphine use after orthopedic and gynecological operations. The efficacy of paracetamol used in cardiac surgery has been little studied and the results of the studies are conflicting. The randomized, blind, placebo-controlled study included patients after aortocoronary bypass surgery, of them 22 patients received paracetamol and 23 had placebo. The test drug (perfalgan 100 ml or placebo) was intravenously injected 30 min before extubation and then every 6 hours within succeeding 18 hours. The intensity of the pain syndrome was rated by a 5-score verbal scale every 2 hours. With pain score of 2 or more, promedol was intramuscularly administered in a dose of 10 mg. Inspiratory volume was recorded before extubation and the first administration of a drug just after extubation and then every 2 hours. The baseline indices did not differ in both groups. Throughout the observation, the inspiratory volume was lower in the paracetamol group than in the placebo group; however, there was a statistically significant difference (p = 0.012) in the reduction in the manifestations of the pain syndrome (by 81%) only just after tracheal extubation. During this period, inspiratory volume values were higher in the paracetamol group; however, a statistically significant (39%) difference between the groups in the mean values was obtained only during and 2 hours after extubation. In the perfalgan group, the mean total use of promedol was 36% less than in the placebo-group, which was statistically significant (p = 0.019). The early postoperative use of paracetamol after myocardial revascularization reduces the intake of opioids and diminishes the intensity of the pain syndrome within the first hours after extubation, which promotes a higher thoracic excursion, as confirmed by a statistically significant increase in the maximum inspiratory capacity.
Asunto(s)
Acetaminofén/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Puente de Arteria Coronaria/métodos , Dolor Postoperatorio/prevención & control , Promedol/uso terapéutico , Acetaminofén/administración & dosificación , Adulto , Anciano , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Periodo Posoperatorio , Promedol/administración & dosificación , Método Simple Ciego , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: To compare quality of anesthesia with opioid drug and nonsteroid anti-inflammatory drugs in 123 patients after extensive operative interventions of the lungs and trachea, abdominal organs, lower limbs. MATERIAL AND METHODS: Patients of group 1 took lornoxicam for relief of postoperative pain syndrome, those of group 2--promedol. Quality of anesthesia was assessed by visual-analogue and verbal scales, day dose of analgetic drug, administration of promedol, side effects incidence. RESULTS: Lornoxicam in a dose 8 mg intravenously has comparable with 20 mg promedol analgetic effect. This justifies its use as a basic analgetic for treatment of acute pain after extensive surgery. Lornoxicam allows surgeons to do without opioids in 10-45% patients or to reduce their dose by 32-65%. CONCLUSION: Adequate anesthesia with lornoxicam and promedol early after surgery on the chest and abdominal organs, major vessels of the lower limbs occurs in 82 and 87% patients, respectively. Lornoxicam administration as continuous intravenous infusion and controlled analgesia in older patients eliminates the need in opioid analgetics in 45% cases and is well tolerated.
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Analgesia/métodos , Antiinflamatorios no Esteroideos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Piroxicam/análogos & derivados , Cuidados Posoperatorios/métodos , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Relación Dosis-Respuesta a Droga , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Dimensión del Dolor , Dolor Postoperatorio/fisiopatología , Piroxicam/administración & dosificación , Piroxicam/uso terapéutico , Periodo Posoperatorio , Promedol/administración & dosificación , Promedol/uso terapéutico , Resultado del TratamientoRESUMEN
The authors have compared various modes of spontaneous labor. Prolonged epidural infusion of naropine in combination with fentanyl has been found to cause a less motor block and therefore it may be used in the late first-to-second period of labor. Adequate analgesia ensures a smooth course of the second labor period and promotes the reduction in its duration and the correction of central hemodynamic and hormonal homeostastic disorders. The administration of moradol provides adequate analgesia of the first labor period, prevention, and elimination of abnormal labor activity, without exerting a depressive effect on maternal and neonatal respiration, which makes it possible to consider this procedure as an alternative mode of labor pain relief if there are contraindications to epidural analgesia.
Asunto(s)
Analgesia Obstétrica/métodos , Analgesia/métodos , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Parto/metabolismo , Adolescente , Adulto , Amidas/administración & dosificación , Amidas/efectos adversos , Amidas/uso terapéutico , Analgesia Epidural/métodos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Bupivacaína/administración & dosificación , Bupivacaína/efectos adversos , Bupivacaína/uso terapéutico , Butorfanol/administración & dosificación , Butorfanol/efectos adversos , Butorfanol/uso terapéutico , Quimioterapia Combinada , Epinefrina/sangre , Femenino , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Fentanilo/uso terapéutico , Humanos , Hidrocortisona/sangre , Infusiones Parenterales , Inyecciones Intravenosas , Norepinefrina/sangre , Embarazo , Resultado del Embarazo , Promedol/administración & dosificación , Promedol/efectos adversos , Promedol/uso terapéutico , RopivacaínaAsunto(s)
Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Colecistectomía Laparoscópica , Dolor Postoperatorio/prevención & control , Piroxicam/análogos & derivados , Piroxicam/administración & dosificación , Procaína/administración & dosificación , Promedol/administración & dosificación , Colecistitis/cirugía , Colecistitis Aguda/cirugía , Colelitiasis/cirugía , Quimioterapia Combinada , Humanos , Inyecciones Intramusculares , Complicaciones PosoperatoriasRESUMEN
Continuous intravenous infusion of promedol, 0.1 mg/kg, with additional boluses, 0.5 mg/kg, was used as postoperative analgesia in 20 newborns. Fifteen (25%) children were operated for congenital gastrointestinal defects or peritonitis, 2 children (10%)--for chylothorax, and tumor was eradicated in 3 (15%) children. On the basis of behavioral reactions, physiological indices (cardiac rate, arterial pressure, SpO2, and respiration rate/artificial pulmonary ventilation--APL) as well as of laboratory "stress" tests (blood glucose and cortisol and acid-base balance) it was proven that analgesia with continuous intravenous promedol infusion was effective. It was shown as possible to administer the promedol infusion in newborns while switching them from APL to independent breathing until the spontaneous breathing with constant positive pressure is ensured provided the pO2, pCO2 and SpO2 respiration indices are satisfactory.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Cuidados Posoperatorios/métodos , Promedol/uso terapéutico , Analgésicos Opioides/administración & dosificación , Hemodinámica/efectos de los fármacos , Hemodinámica/fisiología , Humanos , Conducta del Lactante/efectos de los fármacos , Conducta del Lactante/fisiología , Recién Nacido , Infusiones Intravenosas , Monitoreo Fisiológico , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/fisiopatología , Promedol/administración & dosificación , Respiración ArtificialRESUMEN
We used lornoxicam (n = 16) and ketorolac (n = 20) to study the possibilities of applying the non-steroid anti-inflammatory drugs within the postoperative patient-controllable analgesia (PCA). With respect to a used analgetic, the frequency rate of good PCA anesthetic results was found, on day 1, to be 60-77%. The good anesthetic results were registered in 25% of patients when the routine scheme was in use. Non-steroid anti-inflammatory agents (lornoxicam, ketorolac) can be prescribed within the early postoperative PCA as basic analgetics, which essentially reduces the need in promedol without worsening the analgesia efficiency.
Asunto(s)
Analgesia Controlada por el Paciente , Antiinflamatorios no Esteroideos/administración & dosificación , Ketorolaco/administración & dosificación , Dolor Postoperatorio/prevención & control , Piroxicam/análogos & derivados , Piroxicam/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Femenino , Humanos , Ketorolaco/uso terapéutico , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Piroxicam/uso terapéutico , Periodo Posoperatorio , Promedol/administración & dosificación , Promedol/uso terapéutico , AutoadministraciónAsunto(s)
Analgesia/métodos , Analgésicos Opioides/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Primeros Auxilios , Dolor/tratamiento farmacológico , Piroxicam/análogos & derivados , Transporte de Pacientes , Heridas y Lesiones , Adulto , Quimioterapia Combinada , Humanos , Piroxicam/administración & dosificación , Promedol/administración & dosificaciónRESUMEN
The efficiency and safety of postoperative use of propacetamol was estimated in 30 patients by means of double blind placebo controlled method. The first group consisted of 15 patients to whom propacetamol was introduced intravenously in single dose of 2 g along with patient controlled anesthesia with promedol. Placebo in combination with patient control anesthesia were used in 15 patients from the 2nd group. Intravenous introducing of propacetamol in dose of 2 g in 15 minutes provides relief of pain intensity in postoperative period. So it permits to consider propacetamol as basic non-opioid analgesic. In early postoperative period combination of propacetamol and opioid analgesic (promedol) reduces demands in the latter by 44%.
Asunto(s)
Acetaminofén/análogos & derivados , Acetaminofén/uso terapéutico , Analgesia Controlada por el Paciente , Analgésicos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Acetaminofén/administración & dosificación , Adulto , Analgésicos/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Periodo Posoperatorio , Promedol/administración & dosificación , Promedol/uso terapéuticoRESUMEN
Lornoxicam was used for analgesia in 64 patients on days 1-2 after extensive interventions. The drug efficiency and safety were evaluated depending on the dose and route of administration. Intravenous infusion of lornoxicam in a daily dose of 24 mg (basic therapy) did not involve the use of opioids in 35% patients and its analgesic effect was higher than that of promedol monotherapy. Combined therapy with lornoxicam and promedol allows reduction of promedol dose by 25-50% and the incidence of untoward effects by 27-44%.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Piroxicam/análogos & derivados , Piroxicam/uso terapéutico , Promedol/uso terapéutico , Adulto , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Piroxicam/administración & dosificación , Promedol/administración & dosificaciónRESUMEN
Analgesia with nonsteroid antiinflammatory drugs (NSAID) becomes a pressing problem today. One such drug is ketorolak tromethamine (KT), characterized by expressed analgesic activity comparable with that of opioid analgesics morphine or promedol. Our purpose was to assess KT efficacy in analgesia performed by different methods, including analgesia controlled by the patient (ACP) after surgery. In medium severe and strong pain KT was used in group I (n = 60) "as needed" in a dose of 30 mg up to 3-4 times a day, in group 2 (n = 12) by the ACP method, in group 3 (n = 16) KT was incessantly infused in a daily dose of up to 120 mg, and in group 4 (n = 11) KT was injected 3-4 times a day in a dose of 30 mg in combination with morphine ACP. The results indicate a high efficacy of KT: 83% after a single injection. Combined use of KT and promedol decreased the dose by 40-50%. Side effects were observed in 15% of patients: most often it was a sense of fever and sweating (in 4% of patients), nausea and vomiting (in 2%), insomnia (in 2%). ACP and planned injections in a daily dose of 90-120 mg is the optimal method of analgesia in patients after extensive surgical interventions.