Analgesia case studies

Intravenous nalbuphine 3 mg (n — 101) has been compared with intravenous propofol 20 mg (n = 90) in a double-blind, randomized study, to determine efficacy in the treatment of intrathecal morphine-induced pruritus after cesarean delivery 10 minutes after the drug was administered (6). Nalbuphine was significantly more effective, especially in cases of moderate but not severe pruritus. Adverse effects such as reduced analgesia and increased nausea, vomiting, sedation, and dizziness were not significantly different between the two groups. 

In a prospective randomized, double-blind, placebo-controlled study in 100 patients scheduled for elective orthopedic surgery and presenting with pruritus induced by epidural or intrathecal morphine, intravenous ondansetron 8 mg was effective in 70% of cases and placebo in 30% (23). Ondansetron was well tolerated, did not change the degree of analgesia, and was not associated with adverse effects usually associated with ondansetron, such as headache, abdominal pain, and cardiac dysrhythmias. 

Oxycodone has been available in oral form for at least 70 years and is rarely given by other routes. In a study of subcutaneous oxycodone hydrochloride 100 mg/ml for opioid rotation in 63 patients with cancer pain (maximum dose 4.5-660 mg in 24 hours for 1-49 days) there was local toxicity in only two cases, and this included central pallor of the skin at the needle site with surrounding erythema and bruising there was no necrosis (10). The design of the study made it difficult to compare the adverse effects profile of subcutaneous oxycodone with oral oxycodone or other opioids. Randomized controlled trials are needed to support the conclusions that subcutaneous oxycodone is free from adverse effects and is a better vehicle for analgesia in terminal cancer. 

In studies carried out in postoperative human patients, ketorolac provided analgesia equal to or superior to that provided by opiate agents (Grisneaux et al 1999, Sunshine et al 1993). Although its efficacy has not been evaluated in the horse, it has been used in clinical cases (Planborg et al 1994). Further studies are necessary, however, to determine the safety and efficacy of ketorolac in horses. 

Early attempts to explain opiate analgesia by involvement of the receptor concept was followed by later demonstration of the existence of opiate receptors in the early 1970s in their characterization by sophisticated binding studies. This led to the realization that opiate receptors show considerable heterogeneity, and that they are not homogenous. They exist as subtypes with different properties and, in some cases, differ in anatomical loci. Initial work by Martin and co-workers (1976) with the spinal dog, utilizing morphine and certain... 

Direct modulation of opioid pathways has been the major focus of modern analgesic research, but other modalities for antinociception appear to involve such pathways only Indirectly or not at all. Stress, of which traditional Chinese acupuncture and modern electroacupuncture may be considered special cases, is one such mode. Early reports of naloxone blockade of acupuncture analgesia suggested mediation by endogenous opioids.However, more recent studies contradict this hypothesis. ... 

A 15-year-old boy was found to have a subtherapeutic valproate level (43 micrograms/rriL) 3 days after starting to take ibuprofen 600 mg every 6 hours for post-fracture analgesia. The ibuprofen was stopped, and after one week the valproate levels were within the therapeutic range (60 micrograms/mLV The general importance of this isolated case is unknown. More study is needed. 

Yukawa Y, Kato F, Ito K, Nakashima H, MacHino M, Hirano K, Tauchi R. A case-control study of preemptive analgesia for postoperative pain in patients undergoing posterior lumbar interbody fusion continuous subcutaneous morphine alone and combined with intrathecal injection. J Spinal Disord Tech 2010 23 333-7. 

Epidural for post-operative pain controb most studies have tested ropivacaine 0.2% for post-operative epidural infusion. Infusion rates of 6-14 mL per hour of 0.2% ropivacaine provide adequate analgesia with only slight and non-progressive motor block in cases of moderate to severe pain. Most studies have dosed ropivacaine for up to 72 hours. 

Gastrointestinal In a retrospective case-control study of 75 patients undergoing laparoscopic colorectal resection with primary anastomosis, there was a higher rate of anastomotic leakages in patients who took oral diclofenac for postoperative analgesia (seven of 33 patients) compared with patients who received opioid analgesia (one of 42 patients) [36 ]. 

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