FENTANYL BY CONSTANT RATE I.V. INFUSION FOR POSTOPERATIVE ANALGESIA
|
|
- Ophelia Hill
- 6 years ago
- Views:
Transcription
1 Br. J. Anaesth. (1985), 5, FENTANYL BY CONSTANT RATE I.V. INFUSION FOR POSTOPERATIVE ANALGESIA W. S. NIMMO AND J. G. TODD is a synthetic opioid analgesic 50 times more potent than morphine, with a more rapid onset and shorter duration of effect (Romagnoli, 193). The drug has been administered by i.v. infusion during anaesthesia and for short periods thereafter (McQuay et al., 199; Hengstmann, Stoeckel and Schuttler, 1980), but there is little information concerning attempts to prevent the onset of postoperative pain by infusing fentanyl i.v. for 24 h. Accurate infusion of drugs for 24 h usually requires a mechanical or electrical syringe driver or pump, and it is likely that this has reduced the popularity of this approach. We report a 24-h infusion study using a disposable infusion device requiring no external power source the Baxter Travenol Infusor. THE BAXTER TRAVENOL INFUSOR The infusor (fig. 1) (Ausman et al., 1982) consists of an elastomeric balloon which is distended by the operator filling it with 60 ml of the desired solution; the distension of the balloon provides the pressure for infusion. This pressure is in excess of 620 mm Hg and the infusion will continue even if the i.v. cannula is kinked or comes out of the vein and enters the tissues. The device is designed to run for 24 h, a flow restrictor within it regulating the rate of infusion to 2 ml h" 1. The 12 ml of infusion that remains within the device after this time is a reserve and should be discarded. The accuracy of the device depends on the viscosity of the solution and the manufacturers recommend that 5% dextrose is used as the diluent. Throughout our study, regular observations of the WALTER S. NIMMO*, M.D., M.R.C.P., F.F.A.R.C.S.; J. GORDON TODD, M.B., CH.B., F.F.A.R.C.S.; University Department of Anaesthesia, Western Infirmary, Glasgow Gil 6NT. *Present address: University Department of Anaesthesia, Medical School, Beech Hill Road, Sheffield S10 2RX. SUMMARY by continuous i. v. infusion (1.5 fig kg- 1 min or 0.5 \ig kg min ') was compared with placebo infusion as an analgesic regimen for 24 h after hysterectomy. The drugs were infused using a new disposable device which required no external power source. All patients were allowed morphine i.m. if they experienced pain. Patients in the higher dose fentanyl group demanded less i.m. morphine and had better pain relief after operation, without important respiratory depression. volume left in the infusor were made and no deviation from the predicted infusion rate was recorded. PATIENTS AND METHODS Twenty-four women undergoing elective hysterectomy through a transverse abdominal incision were studied on consecutive operating lists of one consultant gynaecologist. Informed consent and ethics committee approval were obtained. The patients were allocated randomly to three groups to receive one of three infusion regimens: (1) 1.5 jig kg" 1 h" 1 (nine patients) (2) 0.5 xg kg" 1 h" 1 (eight patients) (3) infusion of 5% dextrose (seven patients) The infusion was instituted 1-2 h before induction of anaesthesia. Premedication was with atropine 0.6 mg i.m. After induction of anaesthesia with thiopentone 3-5 mg kg"! and neuromuscular blockade, the trachea was intubated and the lungs were ventilated with 6% nitrous oxide and 1% halothane or enflurane in oxygen. A bolus dose of fentanyl 100 [xg was given i.v. At the end of anaesthesia, each patient was prescribed Cyclimorph (morphine 10 mg and cyclizine 50 mg) i.m., to be given on
2 I.V. FENTANYL INFUSION DEVICE 251 FIG. 1. The Baxter Travenol Infusor. The device is filled with the calculated amount of fentanyl diluted in 5% dextrose to a volume of 60 ml. It administers 2 ml h~' for 24 h. The reserve is then discarded. demand at the discretion of the recovery room nurse. All operations were carried, out by one surgeon, and anaesthesia was carried out by one of two anaesthetists. All assessments were carried out by an anaesthetist not otherwise involved in the care of the patient. The patient, surgeon, recovery room nurses and the assessor for the study were unaware of which infusion had been administered. The following assessments and observations were made by the assessor in the period after operation, at 4, 8, 12 and 24 h after the start of the infusion: (1) Pain scores. Pain was graded as none, mild, moderate or severe. (2) Conscious level. (3) Respiratory rate. (4) Heart rate. (5) Arterial pressure. (6) Peak respiratory flow using a Wright minipeak flow meter. The best of three attempts was expressed as a percentage of the value before operation. () Nausea or vomiting. (8) The number of doses of Cyclimorph administered. All observations were made with the patient semirecumbent in bed. Arterial blood-gas tensions were measured at 12 and 24 h. Plasma fentanyl concentrations were measured by radioimmunoassay at 12 and 24 h (Michiels, Hendriks and Heykants, 19). An overall assessment of pain was made by the patient and by the observer at 24 h. Statistical analysis was by analysis of variance, Mann-Whitney U test or Fisher's exact probability test. RESULTS Patient data are given in table I. There were no significant differences between the groups. Pain assessment Patients receiving the more concentrated infusion of fentanyl demanded significanfly fewer doses of Cyclimorph than those in the placebo group (P < 0.05) (table II). Compared with patients receiving placebo (18 of 28 observations of moderate to severe pain), both groups receiving fentanyl had a statistically significant reduction in the frequency of moderate to severe pain after surgery, the more concentrated infusion giving greater relief (fentanyl 1.5 (xg kg" 1 h~': of 5b observations were ot moderate to severe pain (P < 0.01 compared with placebo); fentanyl
3 252 BRITISH JOURNAL OF ANAESTHESIA TABLE I. Patient data (mean ± SD) l.sugkg" 1 h" 1 0.5ngkg"' h" 1 n 9 8 Age (yr) 36 ± 3 ± ± 15 Weight (kg) 5.6± ± ± 5.5 Duration of surgery (min) 6 ± ±20. 6 ± T; 0.5 ug kg 'h ': 12 of 20 observations were of moderate to severe pain (P < 0.05)). Independent patient and observer assessments of the overall pain experienced in the 24 h were in complete agreement, and are shown in table II. Both fentanyl groups experienced significantly less pain than the placebo group, but relief was statistically greater with fentanyl 1.5 ug kg" 1 h" 1 (P < 0.01) than with 0.5 ug kg" 1 h" 1 (P < 0.05). Respiratory effects There was no evidence of important respiratory depression in any of the groups (table III). In four patients the respiratory rate decreased to less than 12 b. p. m. once in the 24 h, but it was never less than 8 b.p.m. These patients were all in the high-dose fentanyl group, and the group as a whole had respiratory rates at 12 and 24 h which were significantly less than those of patients in the placebo group. In only two patients (one in the placebo group and one in the high-dose fentanyl group) did arterial carbon dioxide tension reach a value greater than 5.8 kpa (44 mm Hg) (6.2 kpa (4 mm Hg) in each). There were no statistically significant differences between the groups in the arterial blood-gas tensions of oxygen or carbon dioxide at 12 and 24 h (table III). There was a significant difference between the groups in the number of observations of greater than 50% of the preoperative peak expiratory flow (table III), compatible with the improved analgesia in the group receiving fentanyl 1.5 ug kg" 1 h~". The mean peak expiratory flow at 12 h was 62%, 61% and 46% of the _preoperative value in the fentanyl 1.5 ug kg" 1 h" 1, fentanyl 0.5 ug kg" 1 h" 1 and placebo groups, respectively. Other observations Throughout the study, there were no important changes in heart rate, arterial pressure or level of consciousness. In particular, all patients remained conscious and orientated throughout. There was a high incidence of vomiting in all three groups, but no significant difference between them: six patients in the fentanyl 1.5 ug kg"' h~', four in the fentanyl 0.5 ug kg" 1 h" 1 and three in the placebo groups, respectively, vomited. Plasma fentanyl concentrations The mean plasma fentanyl concentrations are shown in table IV. There were no statistically significant within-group differences between the concentrations at 12 and 24 h in the two groups who received fentanyl. Assuming the concentration at 24 h represented a steady state concentration, the mean fentanyl clearance was 1.0 ± 5.6 ml kg" 1 min" 1 (± SD) in the fentanyl 0.5 ug kg" 1 h" 1 infusion and 1.0 ± 9.2 ml kg" 1 min" 1 in the fentanyl 1.5 ug kg" 1 h" 1 infusion. TABLE II. Pain assessment. Compared with placebo: *P<0.05; **P<0.0I l.sugkg-'h- 1 O.Sugkg-'h- 1 Doses of Cyclimorph (mean ± SD) 2.0 ±0.* 2.6 ± ±0.8 Pain: no. None-mild observations Moderate-severe ** 12* h assessment of pain None-mild Moderate-severe 8 1** 4 4* 0
4 I.V. FENTANYL INFUSION DEVICE 253 l.sngkg-'h- 1 o.sngkg-'h- 1 TABLE III. Respiration (mean + SD). Compared with placebo: * <0.0S; **P<0.01 Resp. rate (b.p.m.) 12h 24 h 14 ±3* 19 ±2 21±1 15 ±4* 18 ± 2 19± 1 12h 10.8 ± ± PO 2 (kpa) 24 h ± h ±0.6 PC0 2 (ki 24 h ± ±0.6 Peak expiratory flow: no. of observations <50%normal >50% normal 12 24** 13 19* 20 8 DISCUSSION Infusion of fentanyl 1.5 ug kg" 1 h" 1 for 24 h produced satisfactory postoperative analgesia without important respiratory depression. Patients receiving this regimen had less pain, better peak expiratory flow measurements and demanded less additional prescribed opioids. An infusion regimen of 0.5 ug kg" 1 h" 1 did not differ markedly from placebo, although the pain relief was significantly better. The regimen was designed so that fentanyl infusion began 1-2 h before surgery and a bolus dose of 100 ug was given during anaesthesia in the hope that plasma concentrations would approximate to the "analgesic" steady state concentrations when the patients recovered from anaesthesia. Other studies, in which opioid infusions have been established after surgery, have experienced early failure of analgesia or have included a bolus dose of opioid in the recovery room (Stapleton, Austin and Mather, 199; Rutter, Murphy and Dudley, 1980). However, patients in the group receiving fentanyl 1.5,ug kg" 1 h" 1 received a larger combined total dose of opioid agents than the placebo group, in spite of the fact that the latter group demanded more doses of Cyclimorph. This smaller dosage in our placebo group is compatible with previous studies that have suggested that patients prescribed i.m. pulsed doses of opioid analgesia "on demand" receive too little drug in the period after operation (Hug, 1980; Hull and Sibbald, 1981). TABLE IV. Plasma fentanyl concentrations (ng mt') (mean ± SD) 12 h 24 h l.sug 1.62 ± ± ± The clearance of fentanyl described in this study (1 ml kg^min" 1 ) is not very different from that reported after a single i.v. dose in volunteers (13.3 ml kg^min" 1 ) (McClain and Hug, 1980). The use of disposable infusors might make this type of provision of analgesia easier for patients and nursing staff. The device itself is quite expensive and requires that some drug is discarded after 24 h. The high pressure within the balloon means that the infusion will not stop if the catheter leaves the vein and enters the tissues. Little is known of prolonged infusion of fentanyl to the tissues. However, this method of delivering analgesia seems worthy of study in other types of postoperative pain. It improves pain relief and avoids the high capital investment and maintenance costs of conventional electrical infusion pumps. ACKNOWLEDGEMENTS We are grateful to Travenol Laboratories Ltd for supplies of the infusor and to Dr Susanne Bower for analysis of plasma fentanyl concentrations. REFERENCES Ausman, R. K., Caballero, G. A., Quebbeman, E., and Ausman, D. C. (1982). Long term ambulatory, continuous intravenous infusion of 5-fluorouracil for the treatment of metastatic adenocarcinoma in the liver. Wis. Med.J., 81, 25. Hengstmann, J. G., Stoeckel, H., and Schuttler, J. (1980). Infusion model for fentanyl based on pharmacokinetic analysis. Br. J.Anaesth., 52, Hug, C. C. (1980). Improving analgesic therapy. Aneslhesiology, 53,441. Hull, C. J., and Sibbald, A. (1981). Control of postoperative pain by interactive demand analgesia. Br. J. Anaesth., 53, 385. McClain, D. A., and Hug, C. C. (1980). Intravenous fentanyl kinetics. Clin. Pharmacol. Ther., 28, 106. McQuay, H. J., Moore, R. A., Paterson, G. M. C, and Adams, A. P. (199). Plasma fentanyl concentrations and clinical observations during and after operation. Br. J. Anaesth., 51, 543. Michiels, M., Hendriks, R., and Heykants, J. (19). A sensitive radioimmunoassay for fentanyl plasma level in dogs and man. Eur.J. Clin. Pharmacol., 12, 153.
5 254 BRITISH JOURNAL OF ANAESTHESIA Romagnoli,A.(193). Duration of action of fentanyl. Anesthesiology, 39, 568. Rutter, P. C, Murphy, F., and Dudley, H. A. F. (1980). Morphine: controlled trial of different methods of administration for postoperative pain relief. Br. Med.J., 1, 12. Stapleton, J. V., Austin, K. L., and Mather, L. E. (199). A pharmacokinetic approach to postoperative pain: continuous infusion of pethidine. Anaesth. Intens. Care,, 25.
PHARMACOKINETICS OF FENTANYL DURING CONSTANT RATE I.V. INFUSION FOR THE RELIEF OF PAIN AFTER SURGERY
Br. J. Anaesth. (1986), 58, 950-956 PHARMACOKINETICS OF FENTANYL DURING CONSTANT RATE I.V. INFUSION FOR THE RELIEF OF PAIN AFTER SURGERY D. J. R. DUTHIE, A. D. McLAREN AND W. S. NIMMO Acute pain after
More informationPLASMA FENTANYL CONCENTRATIONS DURING TRANSDERMAL DELIVERY OF FENTANYL TO SURGICAL PATIENTS
Br. J. Anaesth. (988), 6, 64-68 PLASMA FENTANYL CONCENTRATIONS DURING TRANSDERMAL DELIVERY OF FENTANYL TO SURGICAL PATIENTS D. J. R. DUTHIE, D. J. ROWBOTHAM, R. WYLD, P. D. HENDERSON AND W. S. NIMMO Pain
More informationIBUPROFEN IN THE MANAGEMENT OF POSTOPERATIVE PAIN
Br.J. Anaesth. (1986), 58, 171-175 IBUPROFEN IN THE MANAGEMENT OF POSTOPERATIVE PAIN H. OWEN, R. J. GLAVIN AND N. A. SHAW In addition to the control of symptoms associated with arthritis, non-steroidal
More informationPREMEDICATION WITH SLOW RELEASE MORPHINE (MST) AND ADJUVANTS
Br. J. Anaesth. (1988), 60, 825-830 PREMEDICATION WITH SLOW RELEASE MORPHINE (MST) AND ADJUVANTS K. H. SIMPSON, M. J. DEARDEN, F. R. ELLIS AND T. M. JACK Opioids are used widely for premedication, as they
More informationSINGLE BREATH INDUCTION OF ANAESTHESIA WITH ISOFLURANE
Br. J. Anaesth. (987), 59, 24-28 SINGLE BREATH INDUCTION OF ANAESTHESIA WITH ISOFLURANE J. M. LAMBERTY AND I. H. WILSON Two studies have demonstrated that the induction of anaesthesia using a single breath
More informationPREMEDICATION WITH PIROXICAM IN PATIENTS HAVING DENTAL SURGERY UNDER GENERAL ANAESTHESIA WITH HALOTHANE OR ISOFLURANE
Br. J. Anaesth. (1988), 61, 702-706 PREMEDICATION WITH PIROXICAM IN PATIENTS HAVING DENTAL SURGERY UNDER GENERAL ANAESTHESIA WITH HALOTHANE OR ISOFLURANE M. PARSLOE, S. N. CHATER, M. BEMBRIDGE AND K. H.
More informationControlled Trial of Wound Infiltration with Bupivacaine for Post Operative Pain Relief after Caesarean Section
Bahrain Medical Bulletin, Vol.23, No.2, June 2001 Controlled Trial of Wound Infiltration with Bupivacaine for Post Operative Pain Relief after Caesarean Section Omar Momani, MD, MBBS, JBA* Objective: The
More informationPharmacokinetics of propofol when given by intravenous
Br. J. clin. Pharmac. (199), 3, 144-148 Pharmacokinetics of propofol when given by intravenous infusion DENIS J. MORGAN', GWEN A. CAMPBELL2,* & DAVID P. CRANKSHAW2 'Victorian College of Pharmacy, 381 Royal
More informationCOMPARISON OF INFUSIONS OF ALFENTANIL OR PETHIDINE FOR SEDATION OF VENTILATED PATIENTS ON THE ITU
Br.J. Anaesth. (1986), 58, 1091-1099 COPARISON OF INFUSIONS OF ALFENTANIL OR PETHIDINE FOR SEDATION OF VENTILATED PATIENTS ON THE ITU P.. YATE, D. THOAS, S.. SHORT, P. S. SEBEL AND J. ORTON The ideal agent
More informationCOMPARISON OF SUFENTANIL-OXYGEN AND FENTANYL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY BYPASS GRAFTING
Br. J. Anaesth. (1988), 60, 530-535 COMPARISON OF SUFENTANIL-OXYGEN AND FENTANYL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY BYPASS GRAFTING H. M. L. MATHEWS, G. FURNESS, I. W. CARSON, I. A. ORR, S. M. LYONS
More informationComparison of Bolus Bupivacaine, Fentanyl, and Mixture of Bupivacaine with Fentanyl in Thoracic Epidural Analgesia for Upper Abdominal Surgery
Original Article DOI: 10.17354/ijss/2016/156 Comparison of Bolus Bupivacaine, Fentanyl, and Mixture of Bupivacaine with Fentanyl in Thoracic Epidural Analgesia for Upper Abdominal Surgery Sachin Gajbhiye
More informationPOST-TETANIC COUNT AND PROFOUND NEUROMUSCULAR BLOCKADE WITH ATRACURIUM INFUSION IN PAEDIATRIC PATIENTS
Br. J. Anaesth. (9), 60, 3-35 POST-TETANIC COUNT AND PROFOUND NEUROMUSCULAR BLOCKADE WITH ATRACURIUM INFUSION IN PAEDIATRIC PATIENTS S. A. RIDLEY AND D. J. HATCH Atracurium degrades rapidly and, because
More informationBETA-ADRENOCEPTOR BLOCKADE, ALPHA-STIMULATION AND CHANGES IN PLASMA POTASSIUM CONCENTRATION AFTER SUXAMETHONIUM ADMINISTRATION IN DOGSf
Br.J. Anaesth. (987), 59, 6-66 BETA-ADRENOCEPTOR BLOCKADE, ALPHA-STIMULATION AND CHANGES IN PLASMA POTASSIUM CONCENTRATION AFTER SUXAMETHONIUM ADMINISTRATION IN DOGSf D. R. GOLDHILL, J. A. J. MARTYN AND
More informationEFFECTS OF POSTURE AND BARICITY ON SPINAL ANAESTHESIA WITH 0.5 % BUPIVACAINE 5 ML
Br.J. Anaesth. (1988), 61, 139-143 EFFECTS OF POSTURE AND BARICITY ON SPINAL ANAESTHESIA WITH 0.5 % BUPIVACAINE 5 ML A Double-Blind Study R. W. D. MITCHELL, G. M. R. BOWLER, D. B. SCOTT AND H. H. EDSTROM
More informationSEDATION DURING SPINAL ANAESTHESIA: COMPARISON OF PROPOFOL AND MIDAZOLAM
British Journal of Anaesthesia 1990; 64: 48-52 SEDATION DURING SPINAL ANAESTHESIA: COMPARISON OF PROPOFOL AND MIDAZOLAM E. WILSON, A. DAVID, N. MACKENZIE AND I. S. GRANT SUMMARY Propofol and midazolam
More informationEvaluation of Oral Midazolam as Pre-Medication in Day Care Surgery in Adult Pakistani Patients
Evaluation of Oral Midazolam as Pre-Medication in Day Care Surgery in Adult Pakistani Patients Abstract Pages with reference to book, From 239 To 241 Nauman Ahmed, Fauzia A. Khan ( Department of Anaesthesia,
More informationCONCENTRATIONS OF DIETHYL ETHER IN THE BLOOD OF INTUBATED AND NON-INTUBATED PATIENTS
Brit. J. Anaesth. (1954), 26, 111. CONCENTRATIONS OF DIETHYL ETHER IN THE BLOOD OF INTUBATED AND NON-INTUBATED PATIENTS BY A. MACKENZIE, E. A. PASK AND J. G. ROBSON Medical School, King's College, and
More informationKetoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults?
British Journal of Anaesthesia 82 (1): 56 60 (1999) Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults? P. Tarkkila* and L. Saarnivaara Department of Anaesthesia, Otolaryngological
More informationALFENT ANIL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY SURGERY
Br.J. Anaesth. (191), 53, 1291 ALFENT ANIL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY SURGERY S. DE LANGE, T. H. STANLEY AND M. J. BOSCOE SUMMARY The anaesthetic properties of alfentanil were evaluated in
More informationMORPHINE ADMINISTRATION
Introduction Individualised Administration Drug of Choice Route of Administration & Doses Monitoring of Neonates & high risk patients Team Management Responsibility Morphine Protocol Flow Chart Introduction
More informationPropofol administered by a manual infusion regimen
British Journal of Anaesthesia 995; 74: 362-367 CLINICAL INVESTIGATIONS Propofol administered by a manual infusion regimen J. W. SEAR AND J. B. GLEN Summary We have evaluated the clinical utility and blood
More informationNITROUS OXIDE-CURARE ANESTHESIA UNSUPPLEMENTED WITH CENTRAL DEPRESSANTS
Brit. J. Anasth. (1953). 25, 237 NITROUS OXIDE-CURARE ANESTHESIA UNSUPPLEMENTED WITH CENTRAL DEPRESSANTS By HENNING RUBEN The Finsen Institute, Copenhagen IN a previous communication (Ruben and Andreassen,
More informationType of intervention Anaesthesia. Economic study type Cost-effectiveness analysis.
Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery Li S T, Coloma M, White P F, Watcha M F, Chiu J W, Li H, Huber P J Record Status This is a
More informationTHIS paper is written in an attempt to assess the value
Brit. J. Anccsth. (1953). 25, 244 INTRAVENOUS PETHIDINE IN ANESTHESIA By PHILIP WOLFERS St. George's Hospital, London THIS paper is written in an attempt to assess the value of intravenous pethidine as
More informationDROPERIDOL, FENTANYL AND MORPHINE FOR I.V. SURGICAL PREMEDICATION
Br.J. Anaesth. (97),, 463 DROPERIDOL, FENTANYL AND MORPHINE FOR I.V. SURGICAL PREMEDICATION J. T. CONNER, G. HERR, R. L. KATZ, F. DOREY, R. R. PAGANO AND D. SCHEHL SUMMARY. mg and morphine mg alone and
More informationRespiratory Depression
Respiratory Depression H. William Gottschalk, D.D.S. Fellow, Academy of General Dentistry Fellow, American Dental Society of Anesthesiology Diplomate, American Board of Dental Anesthesiology Diplomate,
More informationCOMPARISON OF FENTANYL AND MORPHINE IN INTRAVENOUS PATIENT-CONTROLLED ANALGESIA AFTER OPEN GASTRECTOMY SURGERY
COMPARISON OF FENTANYL AND MORPHINE IN INTRAVENOUS PATIENT-CONTROLLED ANALGESIA AFTER OPEN GASTRECTOMY SURGERY Nguyen Toan Thang, Nguyen Huu Tu Department of Anesthesia Critical Care, Hanoi Medical University
More informationSetting The setting was tertiary care. The economic study appears to have been performed in Heidelberg, Germany.
Comparative analysis of costs of total intravenous anaesthesia with propofol and remifentanil vs. balanced anaesthesia with isoflurane and fentanyl Epple J, Kubitz J, Schmidt H, Motsch J, Bottiger B W,
More informationTHE ANALGESIC PROPERTIES OF SUB-ANAESTHETIC DOSES OF ANAESTHETICS IN THE MOUSE
Brit. J. Pharmacol. (1964), 22, 596-63. THE ANALGESIC PROPERTIES OF SUB-ANAESTHETIC DOSES OF ANAESTHETICS IN THE MOUSE BY M. J. NEAL AND J. M. ROBSON From the Department of Pharmacology, Guy's Hospital
More informationEfficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting
European Review for Medical and Pharmacological Sciences 2001; 5: 59-63 Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane
More informationPOST-TETANIC COUNT AND INTENSE NEUROMUSCULAR BLOCKADE WITH VECURONIUM IN CHILDREN
Br. J. Anaesth. (988), 6, 55-556 POST-TETANIC COUNT AND INTENSE NEUROMUSCULAR BLOCKADE WITH VECURONIUM IN CHILDREN S. A. RIDLEY AND N. BRAUDE Monitoring of profound neuromuscular blockade may be based
More informationNITROUS OXIDE ELIMINATION AND DIFFUSION HYPOXIA DURING NORMO- AND HYPOVENTILATION
British Journal of Anaesthesia 1993; 71: 189-193 NITROUS OXIDE ELIMINATION AND DIFFUSION HYPOXIA DURING NORMO- AND HYPOVENTILATION S. EINARSSON, O. STENQVIST, A. BENGTSSON, E. HOULTZ AND J. P. BENGTSON
More informationMAC reduction of isoflurane by sufentanil in
British Journal of Anaesthesia 1994; 72: 42^16 MAC reduction of isoflurane by sufentanil M. D. BRUNNER, P. BRAITHWAITE, R. JHAVERI, A. I. MCEWAN, D. K. GOODMAN, L. R. SMITH AND P. S. A. GLASS SUMMARY We
More informationEfficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L
Efficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L CRD summary This review evaluated the efficacy of post-operative epidural analgesia. The authors
More informationIntravenous Dezocine for Postoperative Pain: A Double-Blind, Placebo-Controlled Comparison With Morphine
Intravenous for Postoperative Pain: A Double-Blind, Placebo-Controlled Comparison With Morphine Uma A. Pandit, MD, S aria P. Kothary, MD, and Sujit K. Pandit, MD, PhD, a new mixed agonist-antagonist opioid
More informationSUMMARY OF PRODUCT CHARACTERISTICS. 1 ml solution contains 75 micrograms of sufentanilcitrate, corresponding to 50 micrograms of sufentanil.
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT Sufentanil Narcomed, 50 microgram / ml, solution for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 ml solution contains 75
More informationD. R. DERBYSHIRE, A. BELL, P. A. PARRY AND G. SMITH
Br. J. Anaesth. (1985), 57, 858-865 MORPHINE SULPHATE SLOW RELEASE Comparison with i.m. Morphine for Postoperative Analgesia D. R. DERBYSHIRE, A. BELL, P. A. PARRY AND G. SMITH There has been increasing
More informationCLINICAL SIGNIFICANCE OF THE EFFECTS OF THIOPENTONE AND ADJUVANT DRUGS ON BLOOD SUGAR AND GLUCOSE TOLERANCE
Brit. J. Anaesth. (195), 3, 77 CLINICAL SIGNIFICANCE OF THE EFFECTS OF THIOPENTONE AND ADJUVANT DRUGS ON BLOOD SUGAR AND GLUCOSE TOLERANCE BY JOHN W. DUNDEE AND URSULA M. TODD Department of Anaesthesia,
More informationSign up to receive ATOTW weekly Regarding the use of propofol in total intravenous anaesthesia:
TARGET CONTROLLED INFUSIONS IN ANAESTHETIC PRACTICE ANAESTHESIA TUTORIAL OF THE WEEK 75 26th NOVEMBER 2007 Dr Subash Sivasubramaniam University Hospitals of North Staffordshire subashken@yahoo.com SELF
More informationProblem Based Learning. Problem. Based Learning
Problem 2013 Based Learning Problem Based Learning Your teacher presents you with a problem in anesthesia, our learning becomes active in the sense that you discover and work with content that you determine
More informationEXTRADURAL BUPIVACAINE AND METHADONE FOR EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSYf
Br. J. Anaesth. (1989), 62, 82-86 EXTRADURAL BUPIVACAINE AND METHADONE FOR EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSYf B. DRENGER, Y. SHIR, D. PODE, A. SHAPIRO, F. MAGORA AND J. T. DAVIDSON Fragmentation of
More informationThe effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy
Br J Clin Pharmacol 1998; 45: 57 62 The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy Annie Woodhouse* & Laurence E. Mather
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationEFFECT OF HALOTHANE, ENFLURANE AND ISOFLURANE ON BODY TEMPERATURE DURING AND AFTER SURGERY
Br. J. Anaesth. (1989), 6, 409-414 EFFECT OF HALOTHANE, ENFLURANE AND SOFLURANE ON BODY TEMPERATURE DURNG AND AFTER SURGERY V. RAMACHANDRA, C. MOORE, N. KAUR AND F. CARL Heat loss occurs during anaesthesia
More informationDORIS DUKE MEDICAL STUDENTS JOURNAL Volume V,
Continuous Femoral Perineural Infusion (CFPI) Using Ropivacaine after Total Knee Arthroplasty and its Effect on Postoperative Pain and Early Functional Outcomes Eric Lloyd Scientific abstract Total Knee
More informationE to be the analgesic method of choice for painful
Thoracic Versus Lumbar Epidural Fentanyl for Postthoracotomy Pain Corey W. T. Sawchuk, MD, Bill Ong, MD, Helmut W. Unruh, MD, Thomas A. Horan, MD, and Roy Greengrass, MD Departments of Anesthesia and Surgery,
More informationEffect of Preincisional Epidural Fentanyl and Bupivacaine on Postthoracotomy Pain and Pulmonary Function
Effect of Preincisional Epidural Fentanyl and Bupivacaine on Postthoracotomy Pain and Pulmonary Function Yasser Mohamed Amr, MD, Ayman Abd Al-Maksoud Yousef, MD, Ashraf E. Alzeftawy, MD, Wail I. Messbah,
More informationAssistant Professor, Anaesthesia Department, Govt. General Hospital / Guntur Medical College, Guntur, Andhra Pradesh, India.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 8 Ver. I (August. 2016), PP 87-91 www.iosrjournals.org A Comparative Study of 0.25% Ropivacaine
More informationKetofol: risky or revolutionary: CPD article IV
Ketofol: risky or revolutionary: CPD article IV Abstract Ketofol, a sedative/analgesic combination of ketamine and propofol, which can be administered as a mixture in the same syringe or independently,
More informationSedation in children and young people. Appendix J. Sedation for diagnostic and therapeutic procedures in children and young people
SEDATION IN CHILDREN AND YOUNG PEOPLE 1 Sedation in children and young people Sedation for diagnostic and therapeutic procedures in children and young people Appendix J 2 SEDATION IN CHILDREN AND YOUNG
More informationPAEDIATRIC DOSAGE GUIDELINES For management of post-operative acute pain
Index No: MMG43 PAEDIATRIC DOSAGE GUIDELINES For management of post-operative acute pain Version: 3.1 (Includes anti-emetics and naloxone) Date ratified: July 2013 Ratified by: (Name of Committee) Name
More informationSedation For Cardiac Procedures A Review of
Sedation For Cardiac Procedures A Review of Sedative Agents Dr Simon Chan Consultant Anaesthesiologist Department of Anaesthesia and Intensive Care Prince of Wales Hospital Hong Kong 21 February 2009 Aims
More informationCare of the Dying: Is Pain Control Compromised or Enhanced by Continuation of the Fentanyl Transdermal Patch in the Dying Phase?
398 Journal of Pain and Symptom Management Vol. 24 No. 4 October 2002 Original Article Care of the Dying: Is Pain Control Compromised or Enhanced by Continuation of the Fentanyl Transdermal Patch in the
More informationPOLICY and PROCEDURE
Misericordia Community Hospital Administration of Intravenous FentaNYL During Labour POLICY and PROCEDURE Labour and Delivery Manual Original Date Revised Date Approved by: Director, Women s Health, Covenant
More informationPOTENTIATION OF THE NEUROMUSCULAR BLOCKADE PRODUCED BY ALCURONIUM WITH HALOTHANE, ENFLURANE AND ISOFLURANE
Br.J. Anaesth. (987), 9, 0-06 POTENTIATION OF THE NEUROMUSCULAR BLOCKADE PRODUCED BY ALCURONIUM WITH HALOTHANE, ENFLURANE AND ISOFLURANE S. J. KEENS, J. M. HUNTER, S. L. SNOWDON AND J. E. UTTING Volatile
More informationDOCUMENT CONTROL PAGE
DOCUMENT CONTROL PAGE Title Title: UNDERGOING SPINAL DEFORMITY SURGERY Version: 2 Reference Number: Supersedes Supersedes: all other versions Description of Amendment(s): Revision of analgesia requirements
More informationComparison of Ease of Insertion and Hemodynamic Response to Lma with Propofol and Thiopentone.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 12 Ver. IV (Dec. 2015), PP 22-30 www.iosrjournals.org Comparison of Ease of Insertion and Hemodynamic
More informationEffects of analgesia methods on serum IL-6 and IL-10 levels after cesarean delivery
Effects of analgesia methods on serum IL-6 and IL-10 levels after cesarean delivery Z.-M. Xing*, Z.-Q. Zhang*, W.-S. Zhang and Y.-F. Liu Anesthesia Department, No. 1 People s Hospital of Shunde, Foshan,
More informationCOMPARATIVE STUDY OF PROPOFOL-NITROUS OXIDE(N 2 O) WITH CONVENTIONAL BALANCED ANAESTHETIC TECHNIQUE FOR DAY CARE LAPAROSCOPIC SURGERY.
COMPARATIVE STUDY OF PROPOFOL-NITROUS OXIDE(N 2 O) WITH CONVENTIONAL BALANCED ANAESTHETIC TECHNIQUE FOR DAY CARE LAPAROSCOPIC SURGERY. Alka Kewalramani. 1*,Dr.Gaurav Chhabra 2,Dr.Vaishali Shelgoankar 3
More informationRemifentanil. Addressing the challenges of ambulatory orthopedic procedures 1-3
Remifentanil Addressing the challenges of ambulatory orthopedic procedures 1-3 INDICATIONS AND IMPORTANT RISK INFORMATION INDICATIONS ULTIVA (remifentanil HCl) for Injection is indicated for intravenous
More informationGeneral anesthetics. Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine
General anesthetics Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine Rationale General anesthesia is essential to surgical practice, because it renders patients analgesic,
More informationI ve Got You Under My Skin: A Comparison of IV and s/c PCA. Nick Williamson Clinical Nurse Specialist
I ve Got You Under My Skin: A Comparison of IV and s/c PCA Nick Williamson Clinical Nurse Specialist How did PCA get under my skin? Started in 2009 when I started working at KCH Subcut PCA!!! PCA refers
More informationJanuary 27, 1992 to November 26, A total of 120 patients (60/site) were enrolled in the study as follows: PATIENT ENROLLMENT
STUDY SYNOPSIS Study Number: Title: GHBA-533 A Phase II, Randomized, Open-Label Study to Compare the Safety and Efficacy of Sevoflurane Versus Halothane Administered with Nitrous Oxide and Oxygen in ASA
More informationChapter 25. General Anesthetics
Chapter 25 1. Introduction General anesthetics: 1. Analgesia 2. Amnesia 3. Loss of consciousness 4. Inhibition of sensory and autonomic reflexes 5. Skeletal muscle relaxation An ideal anesthetic: 1. A
More informationALFENTANIL INJECTION, USP Ampul
ALFENTANIL INJECTION, USP Ampul R x only DESCRIPTION Alfentanil Injection, USP is an opioid analgesic chemically designated as N-[1-[2-(4-ethyl-4,5- dihydro-5-oxo-1h-tetrazol-1-yl)ethyl]-4-(methoxymethyl)-4-piperidinyl]-n-phenylpropanamide
More informationRauf et al. The evidence for this effect is equivocal. Studies of volunteers and non-cardiac surgery patients have concluded that there is no toleranc
British Journal of Anaesthesia 95 (5): 611 15 (2005) doi:10.1093/bja/aei237 Advance Access publication September 9, 2005 Remifentanil infusion in association with fentanyl propofol anaesthesia in patients
More informationTHE FIRST YEAR'S EXPERIENCE OF AN ACUTE PAIN SERVICE
British Journal of Anaesthesia 1991; 67: 353-359 THE FIRST YEAR'S EXPERIENCE OF AN ACUTE PAIN SERVICE R. G. WHEATLEY, T. H. MADEJ, I. J. B. JACKSON AND D. HUNTER SUMMARY The benefits, risks and resource
More informationRegional Anaesthesia for Caesarean Section
Regional Anaesthesia for Caesarean Section "The Best Recipe" Warwick D. Ngan Kee Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong What I will not do. Magic recipes One shoe to fit
More informationAUSTRALIAN PRODUCT INFORMATION REMIFENTANIL APOTEX (REMIFENTANIL HYDROCHLORIDE) POWDER FOR INJECTION
AUSTRALIAN PRODUCT INFORMATION REMIFENTANIL APOTEX (REMIFENTANIL HYDROCHLORIDE) POWDER FOR INJECTION 1 NAME OF THE MEDICINE Remifentanil (as hydrochloride) 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each
More informationTrust Guideline for the Management of Patient Controlled Analgesia (PCA) in Adults
Patient Controlled Analgesia (PCA) in Adults A clinical guideline recommended for use For Use in: In all Clinical Areas By: Anaesthetists, Ward Nurses, Recovery Staff Acute Pain Service Staff For: Adult
More informationStandard Operating Procedure (SOP) Management of intervention group patients SOP 001
` Standard Operating Procedure (SOP) Management of intervention group patients SOP 001 Authors: Mark Edwards & Rupert Pearse Authorisation: Rupert Pearse (Chief Investigator) Scope To provide guidance
More informationULTIVA GlaxoSmithKline
ULTIVA GlaxoSmithKline Remifentanil QUALITATIVE AND QUANTITATIVE COMPOSITION Remifentanil for injection is a sterile, endotoxin-free, preservative-free, white to off white, lyophilised powder, to be reconstituted
More informationClosed-loop Double-pump Automated System Manual Boluses
Closed-loop Double-pump Automated System versus Manual Boluses to treat Hypotension during Spinal Anaesthesia for Caesarean Section: randomised controlled trial Dr. Ban Leong SNG MBBS, MMED, FANZCA, FFPMANZCA,
More informationPRODUCTION OF LAUDANOSINE FOLLOWING INFUSION OF ATRACURIUM IN MAN AND ITS EFFECTS ON AWAKENING
Br. J. Anaesth. (1989), 63, 76-80 PRODUCTION OF LAUDANOSINE FOLLOWING INFUSION OF ATRACURIUM IN MAN AND ITS EFFECTS ON AWAKENING G. H. BEEMER, A. R. BJORKSTEN, P. J. DAWSON AND D. P. CRANKSHAW The continuous
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationLACK OF A CEILING EFFECT FOR INTRATHECAL BUPRENORPHINE ON C FIBRE MEDIATED SOMATOSYMPATHETIC REFLEXES
British Journal of Anaesthesia 1993; 71: 528-533 LACK OF A CEILING EFFECT FOR INTRATHECAL BUPRENORPHINE ON C FIBRE MEDIATED SOMATOSYMPATHETIC REFLEXES C. WANG, M. K. CHAKRABARTI AND J. G. WHITWAM SUMMARY
More informationInhalational Anesthesia. Munir Gharaibeh, MD, PhD, MHPE School of Medicine The University of Jordan February, 2018
Inhalational Anesthesia School of Medicine The University of Jordan February, 2018 mgharaib@ju.edu.jo Inhalational Anesthesia n Gases or volatile liquids n Administration and Elimination is by the lungs
More informationSEDATION OF CHILDREN REQUIRING ARTIFICIAL VENTILATION USING AN INFUSION OF MIDAZOLAM
Br.J. Anaesth. (986), 8, 0-08 SEDATION OF CHILDREN REQUIRING ARTIFICIAL VENTILATION USING AN INFUSION OF MIDAZOLAM P. D. BOOKER, A. BEECHEY AND A. R. LLOYD-THOMAS Long-term intubation of the trachea and
More informationVECURONIUM BROMIDE IN ANAESTHESIA FOR LAPAROSCOPIC STERILIZATION
Br. J. Anaesth. (1985), 57, 765-769 VECURONIUM BROMIDE IN ANAESTHESIA FOR LAPAROSCOPIC STERILIZATION J. E. CALDWELL, J. M. BRAIDWOOD AND D. S. SIMPSON Although artificial ventilation can be used to avoid
More informationPHARMACOKINETICS OF MIDAZOLAM IN TOTAL I.V. ANAESTHESIA
Br. J. Anaesth. (1987), 59, 548-556 PHARMACOKINETICS OF MIDAZOLAM IN TOTAL I.V. ANAESTHESIA P. PERSSON, A. NILSSON, P. HARTVIG AND A. TAMSEN Total i.v. anaesthesia, defined as anaesthesia provided solely
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency
More informationProblems in day care surgery
The Ulster Medical Journal, Volume 60, No. 2, pp. 176-182, October 199 1. Problems in day care surgery E M Thompson, H M L Mathews, D M McAuley Accepted 6 August 1991. SUMMARY In-patient admission represents
More informationPre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery
Page 1 of 5 Anaesthetics & Critical Care Pre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery B Lim 1, SY Thong
More informationADULT (>16) ACUTE SICKLE PAIN GUIDELINE
ADULT (>16) ACUTE SICKLE PAIN GUIDELINE ID 2013 065 Author s Name Dr Anna Wood Author s Job Title Consultant Haematologist Division Consultant Haematologist Department Haematology Version number 3 Ratifying
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationSedation in Children
CHILDREN S SERVICES Sedation in Children See text for full explanation and drug doses Patient for Sedation Appropriate staffing Resuscitation equipment available Monitoring equipment Patient suitability
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 3/ Issue 74/Dec 29, 2014 Page 15535
RANDOMISED CLINICAL TRIAL TO COMPARE THE EFFECT OF PRETREATMENT OF KETAMINE AND LIGNOCAINE ON PROPOFOL INJECTION PAIN Hanumanthappa V. Airani 1, Bhagyashree Amingad 2, Chandra Kumar B. M 3 HOW TO CITE
More informationLOGISTIC REGRESSION ANALYSIS OF FIXED PATIENT FACTORS FOR POSTOPERATIVE SICKNESS: A MODEL FOR RISK ASSESSMENT
British Journal of Anaesthesia 1993; 70: 135-140 LOGISTIC REGRESSION ANALYSIS OF FIXED PATIENT FACTORS FOR POSTOPERATIVE SICKNESS: A MODEL FOR RISK ASSESSMENT M. PALAZZO AND R. EVANS SUMMARY One hundred
More informationPOST-OESOPHAGECTOMY ANALGESIC REGIMES: A 15-YEAR REVIEW OF 90 CASES AT UNIVERSITY HOSPITAL, KUALA LUMPUR
Med. J. Malaysia Vol. 40 1\,1 March 1985 POST-OESOPHAGECTOMY ANALGESIC REGIMES: A 15-YEAR REVIEW OF 90 CASES AT UNIVERSITY HOSPITAL, KUALA LUMPUR A. E. DELILKAN R. VIJAYAN SANNASI SUMMARY 24-48 hour IPPV
More informationOpioid-induced respiratory effects: new data on buprenorphine
Palliative Medicine 2006; 20: s3-s8 Opioid-induced respiratory effects: new data on buprenorphine Albert Dahan Department of Anesthesiology, Leiden University Medical Center, Leiden When selecting the
More informationTotal Intravenous Anaesthesia
Total Intravenous Anaesthesia Balasubramanian Thiagarajan Stanley Medical College Abstract: Total intravenous anaesthesia (TIVA) is a technique of anaesthesia which involves use of intravenous drugs to
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationThe minimum effective doses of pethidine and doxapram in the treatment of post-anaesthetic shivering
The minimum effective doses of pethidine and doxapram in the treatment of post-anaesthetic shivering I. J. Wrench, P. Singh, A. R. Dennis, R. P. Mahajan and A. W. A. Crossley University Department of Anaesthesia,
More informationPCA PRESCRIPTION is valid for a maximum of 4 days unless ceased earlier. Date: BINDING MARGIN - NO WRITING BINDING MARGIN - NO WRITING
Attach ADR Sticker THESE INSTRUCTIONS EXPLAIN WHEN TO MAKE A CLINICAL REVIEW OR RAPID RESPONSE CALL, YOUR LOCAL ESCALATION PROTOCOL WILL EXPLAIN HOW TO MAKE A CALL PCA ALLERGIES & ADVERSE DRUG REACTIONS
More informationMulti-center (5 centers); United States and Canada. September 10, 1992 to April 9, 1993
vi STUDY SYNOPSIS Study Number: Title: Investigator: GHBA-534 A Phase III, Randomized, Open-Label Study To Compare The Safety, Tolerability And Recovery Characteristics of Sevoflurane Versus Halothane
More informationULTIVA. Remifentanil hydrochloride
ULTIVA Remifentanil hydrochloride QUALITATIVE AND QUANTITATIVE COMPOSITION Remifentanil for injection is a sterile, preservative-free, white to off white, lyophilised powder, to be reconstituted before
More informationCLINICAL POLICY FOR THE USE OF INTRANASAL DIAMORPHINE FOR ANALGESIA IN CHILDREN ATTENDING THE PAEDIATRIC EMERGENCY DEPARTMENT, SASH
CLINICAL POLICY FOR THE USE OF INTRANASAL DIAMORPHINE FOR ANALGESIA IN CHILDREN ATTENDING THE PAEDIATRIC EMERGENCY DEPARTMENT, SASH Background Adequate analgesia is a vital aspect of early management of
More informationThe Effect of Preemptive Analgesia in Postoperative Pain Relief A Prospective Double-Blind Randomized Study
PAIN MEDICINE Volume 10 Number 1 2009 The Effect of Preemptive Analgesia in Postoperative Pain Relief A Prospective Double-Blind Randomized Study Seetharaman Hariharan, MD, Harley Moseley, FFARCS, Areti
More informationInternational Journal of Drug Delivery 5 (2013) Original Research Article
International Journal of Drug Delivery 5 (2013) 239-244 http://www.arjournals.org/index.php/ijdd/index Original Research Article ISSN: 0975-0215 Comparative study of duration of analgesia with epidural
More information