摘要:

Low intrathecal doses of opiates produce dose‐dependent long‐lasting elevation of the pain threshold in rats. The effect is postulated to be mediated by a direct action on the substantia gelatinosa of the spinal cord. Eight uncontrolled and two controlled studies in man showed a long duration of analgesia for most patients in the postoperative period. The duration of effect differs widely within and between studies. Using a double‐blind design, we compared the relative efficacy of epidural and parenteral pethidine to control postoperative pain after total hip replacement. Preliminary pharmacokinetic data from six patients show that epidural doses of 20 or 60 mg pethidine give a similar pattern of absorption and elimination in plasma as 1 mg pethidine/kg body weight intramuscularly. The terminal elimination half‐lives of pethidine in plasma are 5–7 h for all routes of administration. The possibility cannot be excluded that the analgesic effect of epidural pethidine is partly systemically

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01870.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Like other investigators, we have found that the postoperative period is characterized by high energy expenditure, pain, high plasma catecholamines and decreased arterial oxygen tension, and also glycogenolysis, lipolysis, proteolysis and a low turn‐over rate of glucose. Regional anaesthesia has often been supposed to counteract some of these phenomena without causing ventilatory depression. During the past few years a number of studies have been carried out in our department with the aim of elucidating possible differences between the effects of systemic analgesics and different regional anaesthetic blockades. Thus, we have found that both systemic analgesics and regional anaesthesia decrease the total postoperative energy expenditure. Adequately administered regional anaesthesia and systemic analgesic therapy both relieve postoperative pain, the former without interfering with normal ventilatory function. In addition, regional anaesthetic techniques cause less mental confusion, fewer bowel problems and possibly less postoperative lung complications. Moreover, high spinal blockades seem to be the only means of reducing the post‐traumatic metabolic stress react

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01871.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

A short review is given on the role of pain as a release mechanism of the endocrine‐metabolic response to surgery. It is concluded that: (1) the stress‐response is mainly released through afferent neurogenic stimuli from the surgical area; (2) pain may be an additional release mechanism but quantitatively of minor importance compared to other afferent stimuli; (3) neurogenic blockade and analgesia with local anaesthetics prevents a major part of the stress‐response to surgery; (4) systemically administered opiates may lessen the postoperative endocrine‐metabolic response, but further studies are needed before any definite conclusion can be drawn; and (5) epidural administration of opiates has no major influence on the postoperative stress‐

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1982.tb01872.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY