Outcome of labor with epidural analgesia in primigravida at term

Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look into the effects of labour analgesia on maternal and fetal outcomes and compare the same with that of opioid analgesics.Methods: It was a prospective randomized controlled trial on 100 patients where parturients were randomly allocated to either group 1-( n=50 patients) who received epidural analgesia or group 2 (n=50) who received intramuscular tramadol. The two groups were compared for duration of labour, analgesic efficacy as assessed by using Visual Analogue Scale (VAS) ,type of delivery – normal/instrumental/operative interventions ,1 and 5 min neonatal Apgar score and  neonatal breast-feeding behavior between the two groups.Results: Epidural analgesic gave better pain relief than tramadol which was found to be stastically significant (p<0.001) on comparing the VAS scores and also gave statistically significantly higher satisfaction levels. Duration of both first and second stage of labor was comparable between the two groups and instrumental deliveries and caesarean sections were also comparable to that in tramadol group. There was a trend of  higher  neonatal  Apgar scores   in the  epidural group than in the  tramadol group.Conclusions: Use of effective analgesia in labour, does not prolong second stage of labor and may facilitate good labour outcome both for the mother and the fetus and should be offered to patients in   tertiary setups and equipped centres when the patients are apprehensive about labor pains.

Analysis of the Utilization of Opioids Analgesics for Cancer Pain in Inpatient Department of Our Hospital in 2014 / 中国药房

OBJECTIVE:To provide reference for rational use of opioids analgesics. METHODS:1 882 prescriptions of opi-oids analgesics for cancer pain collected from our hospital in 2014 were analyzed by defined daily dose(DDD)and drug utilization index(DUI). RESULTS:The diseases of opioids analgesics prescriptions for cancer pain in our hospital in 2014 were mainly lung cancer,accounting for 42.19%. Commonly used opioids analgesics included Morphine sulfate sustained-release tablets,Oxycodone Hydrochloride sustained-release tablets and so on,and their DUI were all below 1.0. Top one drug in the list of amount and con-sumption sum was Morphine sulfate sustained-release tablets,and its main dosage form were tablets,injection and patches,in which tablets occupied the largest proportion,reaching 97.30%. CONCLUSIONS:The application of opioids analgesics for cancer pain in our hospital is basically rational in terms of drug types,dosage form and route of administration,but the dose of opioids an-algesics is small and their DUI is lower than 1;at the same time,there are a few irrational prescription.

Analgesia con morfina intratecal por bomba de infusión implantada en un caso de dolor crónico no oncológico / Analgesia with intrathecal morphine infusion pump implanted in a case of chronic non cancer pain

Se comunica el caso de un paciente portador de dolor lumbar crónico post-cirugía de columna, al que se le implantó un sistema para infusión de morfina intratecal. Los resultados mostraron una disminución de las dosis de morfina sistémica y un satisfactorio control del dolor que disminuyó un 50% al año y un 75% a los 6 años. La interferencia del dolor sobre la capacidad de caminar disminuyó un 25% al año y un 50% a los 6 años, mientras que su repercusión sobre la calidad de vida disminuyó un 37.5% al año y un 62.5% a los 6 años, no habiendo requerido internaciones por dolor durante el período analizado. Si bien el requerimiento de morfina intratecal aumentó a lo largo de los 6 años, las dosis utilizadas fueron bajas, siendo 1.16 mg/d la dosis máxima alcanzada...

Hipopogonadismoeen paciente tratado con morfina intratecal por bomba de infusión implantada.

Se comunica un caso de hipogonadismo en un paciente en tratamiento crónico con morfina intratecal por bomba de infusión implantada. Los trastornos de la función sexual orientaron al diagnóstico de hipogonadismo, que se confirmó por el descenso de los valores sanguíneos de testosterona total y libre encontrados. Se considera que el hipogonadismo es consecuencia del tratamiento prolongado con morfina y se discuten otras posibles causas de hipogonadismo. Se describen los efectos del déficit de testosterona y la respuesta a su reposición. Luego de la administración de testosterona se corrigieron los valores séricos de testosterona, el paciente recuperó la libido y manifestó una mejoría parcial de la función eréctil. Se plantean otras posibles causas de la disfunción sexual. Se advierte sobre las posibles contraindicaciones al tratamiento con testosterona así como la necesidad de controles posteriores a su administración. Se concluye que el hipogonadismo es una complicación posible del tratamiento prolongado con morfina intratecal, que debe ser detectada por exámenes periódicos, tratada en caso de presentarse, y sobre la que los pacientes deben ser informados previamente.

A case of hypogonadism in a patient with an implanted intrathecal morphine infusion pump is reported. Sexual dysfunction lead to the diagnosis of hypogonadism wich was confirmed by low total serum testosterone and low free testosterone levels found. Hypogonadism secondary to prolonged morphine treatment is considered and other hypogonadism causes are discussed. The low testosterone effects and the testosterone replacement response are described. After testosterone replacement, testosterone serum levels were restored to normal, the patient recovered the libido and manifested a partial improvement of the erectile function. Other dysfunction sexual causes are considered. The possible complications of testosterone replacement and the need of controls after the administration are advised. We conclude that hypogonadism is a possible complication in a prolonged morphine intrathecal treatment, must be searched by periodic controls, treated if it is found, and the patients must be informed about it before the treatment.

Comunica-se um caso de hipogonadismo em um paciente em tratamento crônico com morfina intratecal por bomba de infusão implantada. Os transtornos da função sexual orientaram ao diagnostico de hipogonadismo, que foi confirmado pelo o descenso dos valores sanguíneos de testosterona total e livre. Considera-se que o hipogonadismo é conseqüência do tratamento prolongado com morfina é se discutem outras possíveis causas de hipogonadismo. Descrevem-se os efeitos do déficit de testosterona e a resposta a sua reposição. Logo após a administração de testosterona se corrigiram seus valores séricos, o paciente recuperou sua libido e manifestou uma melhora parcial da função erétil. Avaliam-se outras possíveis causas da disfunção sexual. Adverte-se sob as possíveis contra-indicações ao tratamento com testosterona assim como a necessidade de controles posteriores a sua administração. Concluiu-se que o hipogonadismo é uma complicação possível no tratamento prolongado com morfina intratecal, que deve ser detectada por análises periódicos, tratada no caso de apresentar-se, e que os pacientes devem ser informados previamente.

Drug misuse, dependence and addiction.

Drug addiction presents a chronic relapsing disorder characterized by persistent drug-seeking and taking behaviors. Given the significant detrimental effects of this disease both socially and economically, a considerable research has been dedicated to understanding a number of issues in addiction including behavioral and neuropharmacological factors that contribute to the development of addiction, loss of self control and persistence of compulsive addictive behaviors. This review was designed to list out the drugs and factors which initiate and maintain dependence and how the relapse of these substances occurs in drug dependent persons.

Evolución del uso de opioides como indicador centinela en cuidados paliativos adulto y pediátrico en el Hospital Clínico Guillermo Grant Benavente / Opoid use evolution as a sentinel indicator in adult and pediatric palliative care at Hospital Guillermo Gran Benavente

La investigación tuvo por objetivo cuantificar el uso de opioides para responder a las preguntas: ¿hay alguna evidencia que permita afirmar un incremento en el uso de opioides? y ¿el incremento observado se debe a un mayor uso de morfina? Tener claridad en este tema permitirá realizar intervenciones que fortalezcan el PAD y CP a nivel terciario en el HGGB. Para responder la primera pregunta se convirtió a gramos de morfina todos los opioides utilizados en el programa, los débiles y los fuertes, más los opioides utilizados para tratar los pacientes portadores de dolor crónico no oncológico. Los datos fueron analizados a nivel descriptivo con prograna EXCEl. Se confirmó la sospecha que se ha perdido paulatinamente el miedo a utilizar una herramienta tan eficaz como los opioides para control de dolor crónico. El hallazgo más importante fue la utilización cada vez más frecuente de otros opioides, en desmedro de la morfina.

The research aimed to quantify the use of opioids to answer the questions: is there any evidence to say an increase in the use of opioids? and the observer increase is due to increased use of morphine? Clarity on this issue will allow level in HGGB. To answer the first question was converted to grams of morphine all opioids used in the program, the weak and strong, most opioids used to treat patients with chronic non cancer pain. Data were analized with descriptive at EXCEL program. We confirmed the suspicion that has gradually lost fear of using a tool as effective as opioids for chronic pain control. The most important finding was the increasingly frequent use of other opiods, to the detriment of morphine.

Buprenorfina en el manejo de dolor por cáncer / The Use of Buprenorphine to Control Cancer Pain

Actualmente los opioides son el soporte del manejo farmacológico, en particular del dolor moderado a severo. En este sentido, es importante disponer de distintas formulaciones y vías de administración, aún más en el contexto del paciente oncológico. La buprenorfina tiene un bajo peso molecular, de alta potencia y liposolubilidad combinada a una favorable tolerabilidad y un bajo potencial de abuso. Por dichas razones la buprenorfina es ideal para aplicación transdérmica. La evidencia clínica disponible demuestra eficacia y seguridad en el empleo de la buprenorfina transdérmica en el tratamiento de dolor de moderado a severo en el paciente oncológico. Sin embargo, la buprenorfina no ha sido extensamente estudiada en ciertas poblaciones como otros opioides y se requieren nuevas investigaciones para definir el rol de esta en circunstancias clínicas específicas.

Opiods are the current pharmalogical remedies of choice for the control of moderate to severe pain. Subsequently, it is important to rely on a number of prescriptions and applications for these drugs, particularly in the case of oncological patients. Low molecular weight, high potency and liposolubility of buprenorphine combine with its favorable tolerance and low abuse probability. Clinical evidence reveals that the use of transdermal buprenorphine in the treatment of moderate to severe pain in oncological patients is effective and safe. However, buprenorphine has not been widely studied among certain populations, as have other opiods, thus making further research necessary in order to define its role under specific clinical circumstances.

Analgesia intratecal con morfina-fentanil en cirugía cardíaca

resumen objetivo Evaluar los efectos analgésicos intra y posoperatorios de la administración intratecal de morfina y fentanil, en cirugía cardíaca. material y métodos Estudio prospectivo, randomizado, controlado, simple ciego. Se analizaron 21 pacientes coordinados para cirugía cardíaca. Diez pacientes (grupo intratecal: IT) recibieron 1mcg/kg de fentanil más 500 mcg de morfina intratecales, previo a la inducción anestésica. Once pacientes (grupo control: C) no recibieron opiáceos intratecales. resultados No hubo diferencias estadísticamente significativas en: características demográficas y quirúrgicas, consumo de fármacos intraoperatorios ni en las variables hemodinámicas intraoperatorias. Se observó una menor intensidad de dolor, significativamente diferente para las 24 horas y menor consumo de analgésicos posoperatorios en el grupo IT. Los tiempos de extubación fueron más prolongados y la PaCO2 posoperatoria fue más elevada, pero en forma no significativa en el grupo IT. Un paciente requirió apoyo ventilatorio no invasivo por 12 horas. conclusiones La combinación de 1mcg/kg de fentanil más 500 mcg de morfina intratecales determinó analgesia posoperatoria.

summary purpose To evaluate the intra and postoperative effect of an intrathecal combination of morphine and fentanil during cardiac surgery. methods A prospective, randomized, single-blind and controlled study was carried out. 21 patients undergoing cardiac surgery were analyzed: 10 patients (Intrathecal group: I T) received a spinal injection of 500 mcg of morphine plus fentanil 1mcg/kg before anesthetic induction. 11 patients (control group:C) did not receive intrathecal opioids. results Patient and surgery characteristics, operative drugs consumption and hemodynamic variables were similar in both groups. Pain intensity and analgesics consumption were significantly lower in the IT group within the first 24 hours in the post-operative period. Even though higher paCO2 values and extubation time were observed in the IT group they were not significant.. One patient required 12 hours of non-invasive respiratory support. conclusions Morphine (500 mcg) combined with fentanil (1mcg/kg) provided post-operative analgesia.

resumo objetivo Avaliar os efeitos analgèsicos intra e pós-operatórios da administração Intratecal de morfina e fentanil, em cirurgia cardíaca. material e método Estudo prospectivo, randomizado, controlado, simples cego. Foram analisados 21 pacientes eletivos para cirurgia cardíaca. 10 pacientes (grupo intratecal: IT) receberam 1mcg/Kg de fentanil mais 500 mcg de morfina intratecais, previamente a indução anestésica. 11 pacientes (grupo controle: C) não receberam opioides intratecais. resultados Não houve diferença estatisticamente significativa em: características demográficas e cirúrgicas, consumo de fármacos intraoperatórios, tão pouco nas variáveis hemodinâmicas intraoperatórias. Se observou uma menor intencidade de dor, significativamente diferente nas primeiras 24 hs e menor consumo de analgésicos postoperatórios no grupo IT. Os tempos de extubação foram mais prolongados e a PaCO2 pós-operatória foi mais elevada, mas de forma não significativa, no grupo IT. Um paciente necessitou apoio ventilatório não invasivo por 12 hs. conclusões A combinação de 1mcg/Kg de fentanil mais 500 mcg de morfina intratecais determinou analgesia pósoperatória.

Analysis on the Application of Narcotic Analgesics in Our Hospital During 2003～2007 / 中国药房

OBJECTIVE: To investigate the clinical application and developing trend of narcotic analgesics in our hospital.METHODS: Analgesics used in our hospital during 2003～2007 were analyzed statistically.RESULTS: The consumption(amount of money and quantity) of narcotic analgesics especially that of morphine preparation witnessed an year-on-year increase while that of pethidine injection decreased year by year.CONCLUSION: The use of narcotic analgesics in our hospital was reasonable on the whole,but the dosage form and variety should be increased further.