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Analgesics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Two major categories of headache are recognized, namely, (1) tension and (2) vascular (migraine). For mild to moderate headaches, aspirin, acetaminophen, ibuprofen, or naproxen usually provide satisfactory acute relief. Acetaminophen is the preferred analgesic for use during pregnancy. Aspirin in frequent and large doses should be avoided during pregnancy to maintain hemostasis, especially when headaches occur close to term. Aspirin increases the potential for bleeding because of decreased platelet activity. NSAIDs should not be used after 34 weeks gestational age because of the theoretical potential for premature closure of the ductus arteriosus and other potential adverse effects. If non-NSAID agents have failed, ibuprofen seems associated with the smallest risk for increased bleeding and premature ductus closure.
Complications of Obstetric Anaesthesia
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Bhaagya Gunetilleke, Asantha de Silva
Anaesthetic complications contribute to maternal morbidity and mortality. Although recent advances in obstetric anaesthesia have largely mitigated this risk, the potential for anaesthesia related complications should not be underestimated. Pregnant woman may require analgesia or anaesthesia in the following situations.LabourElective caesarean deliveryEmergency caesarean deliveryEmergency surgery for peripartum complicationsNon-caesarean surgery
Haematological disorders
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
The initial visit is key to establishing that all the elements of optimal preconception care (see Box 6.11) have been carried out and to plan antenatal care. A full and detailed medical, surgical and obstetric history will need to be recorded, and laboratory investigations undertaken (see Box 6.12). The frequency of sickle cell crisis and any organ damage needs to be established and appropriate referrals made for assessment. A review of current medications, including analgesia used for self-medication, should be made with any required adjustment regarding safe use in pregnancy. Baseline haemoglobin should be documented and any red cell alloimmunisation noted. A review of discussions regarding partner testing and prenatal diagnosis should be made and re-discussed if required21.
Prepontine cisternal routine for intrathecal targeted drug delivery in craniofacial cancer pain treatment: technical note
Published in Drug Delivery, 2022
Haocheng Zhou, Dong Huang, Dingquan Zou, Junjiao Hu, Xinning Li, Yaping Wang
In the end stage of tumor, one hallmark feature of cancer-related pain is the excruciating pain, that is insufficiently treated by oral analgesic medications. Likely, both cases presented with severe pain (8/10 VAS) at resting state and the worst suffering during breakthrough pain episodes, with considerable amounts of opioids consuming up to 380 and 790 mg equivalent morphine in 24 hours. Despite unsatisfactory control of pain, multiple side effects of analgesic effect are frequently reported, including dizziness, nausea, vomiting, constipation and physical dependence (Benyamin et al., 2008). One advantage of intrathecal therapy is the significant reduction of opioids intake, which may attenuate the side reaction. Oral opioids were totally replaced one week after implantation procedure in the first patient, and the intrathecal titration was completed one month after discharge for the other case. The daily cisternal amount of morphine ranged between 1.9 and 3.0 mg, accounting for about 0.05% of oral dosage. This data is consistent with the conventional 300:1 ratio (Sylvester et al., 2004). In addition to conversion ratio, one key parameter of intrathecal therapy is the pharmacratic formation. Combination of local anesthetics (bupivacaine) with morphine may contribute to provide supplementary pain control for the intractable cases (van Dongen et al., 1999). In this study, both cases achieved sufficient relief with prepontine cisternal morphine delivery.
Preventing pediatric chronic postsurgical pain: Time for increased rigor
Published in Canadian Journal of Pain, 2022
Christine B. Sieberg, Keerthana Deepti Karunakaran, Barry Kussman, David Borsook
During surgery, general anesthetics produce a state of drug-induced unconsciousness but not analgesia. The exception is ketamine, which produces dose-related unconsciousness and analgesia. Analgesics are administered according to weight-based dosing in response to clinical (patient movement) and autonomic (blood pressure, heart rate, respiratory rate, sweating) activity, rather than with a objective marker of nociception directly from the central nervous system. The mechanism and intensity of analgesia will vary with the class of drug, dosage, and route of administration. With respect to pain perception, a preclinical fMRI study in macaques found that noxious stimuli resulted in activation of the secondary somatosensory cortex and insula under propofol or pentobarbital anesthesia, whereas no activation was observed with isoflurane anesthesia.40 In humans, ongoing nociceptive processing has been shown to occur in adolescent patients under balanced general anesthesia.41
An Analysis of 13 Years of Prehospital Combat Casualty Care: Implications for Maintaining a Ready Medical Force
Published in Prehospital Emergency Care, 2022
Steven G. Schauer, Jason F. Naylor, Andrew D. Fisher, Michael D. April, Ronnie Hill, Kennedy Mdaki, Tyson E. Becker, Vikhyat S. Bebarta, James Bynum
The most common analgesic options utilized were morphine and fentanyl. Despite removal of intramuscular morphine from the TCCC guidelines before the recent wars began, its use persists. Moreover, despite the widespread use of oral transmucosal fentanyl citrate (OTFC) throughout the battlespace, it is not available for utilization at the Department of Defense’s largest trauma training center—Brooke Army Medical Center (BAMC). The prohibition of OTFC administration by military medical personnel within stateside military treatment facilities highlights mismatches between the garrison training mission, deployed readiness needs and the logistical supply chain. Similarly, this could be applied to other TCCC guideline recommendations as the garrison mission does not necessarily match the deployed mission or injury patterns.