- Email: [email protected]
Electrical stimulation for the control of pain
199
SURGERY Electrical stimulation for the control of pain. -- D.M. Long, Arch. Surg., 112 (1977) 884--888 Electrical stimulation for the control of pain is now a well accepted therapeutic modality. Transcutaneous application of electrical stimulation is the most common technique employed and has bee,a used to treat chronic pain, acute ,,;urgical pain, and acute pain of other origins. Percutaneous application of electricity to the nervous system through needle electrodes is useful in predicting the efficacy of implantable stimulators and has served the same function as diagnostic nerve block. Implantable stimulators have been used for stimulation of peripheral nerves, the anterior and posterior surfaces of the spinal cord, and the brain. Peripheral nerve stimulators exe the most efficacious of the implantable devices. They are used specifically for pain of peripheral nerve injms~ origin. Their use for pail~ outside the distribution of the nerve stimulated is not yet proved.
Physiopathology and control of postoperative pain. -- A.E. Pflug and J.J. Bonica, Arch. Surg., 112 (1977) 21--27 Potent systemic (narcotic) analgesics, when given in doses sufficient to produce ~mple pain reliei, usually also prod ace mental and respiratory depression and, at times, ci::culatory impairmen:~, theft prolong postoperative morbidity. Complications 0ue to morphine sulfate or meperidine ~ydrochloride can be minimiz~ by titrating the patient's pain with small intravenous doses of narcotics (morphine sulfate, 2--3 mg, or meperidine hydrochloride, 15--25 rag) admini,~t~red slowly at 15--20-rain intervals until the pain is relieved. On the third or fourth postoperative day, acetaminophen tablets usually suffice to provide relief of pain with little or no risk to patients. Continu,)us segmental epidural block or intercostal block, with or without splanchnic block, provide excellent pain relief that, in contrast to the narcotic, is complete. These are especially useful after operations on the chest or abdomen or the lower extremity. Regional analgesia is especially indicated in patients not adequately relieved from severe postoperative pain with narcotics, or when these drugs are contraindicated by advanced pulmo.. nary, renal, or hepatic disease. Continuous caudal analgesia is also effective to completely relieve severe postoperative pain in the lower limbs and perineulTl.
The pharmacolo~.':cal management of postoperative p a i n . - - C . P . Venter, S. Aft. reed. J., 52 (~.977) 21--27 The physiology and pharmacological management of postoperative pain arE: briefly discus::',ed. Although narcotic analgesics are still the mainstay in the management of postoperative pain, the judicious use of non-narcotic analgesics, ~.nticholinergics, tranquilizers and soporifics as well as the admini.st!,:atior,, of local anesthetic agents could contribute g~eatly to the alleviation of postope~'ative pair) and discomfort.
SURGERY Electrical stimulation for the control of pain. -- D.M. Long, Arch. Surg., 112 (1977) 884--888 Electrical stimulation for the control of pain is now a well accepted therapeutic modality. Transcutaneous application of electrical stimulation is the most common technique employed and has bee,a used to treat chronic pain, acute ,,;urgical pain, and acute pain of other origins. Percutaneous application of electricity to the nervous system through needle electrodes is useful in predicting the efficacy of implantable stimulators and has served the same function as diagnostic nerve block. Implantable stimulators have been used for stimulation of peripheral nerves, the anterior and posterior surfaces of the spinal cord, and the brain. Peripheral nerve stimulators exe the most efficacious of the implantable devices. They are used specifically for pain of peripheral nerve injms~ origin. Their use for pail~ outside the distribution of the nerve stimulated is not yet proved.
Physiopathology and control of postoperative pain. -- A.E. Pflug and J.J. Bonica, Arch. Surg., 112 (1977) 21--27 Potent systemic (narcotic) analgesics, when given in doses sufficient to produce ~mple pain reliei, usually also prod ace mental and respiratory depression and, at times, ci::culatory impairmen:~, theft prolong postoperative morbidity. Complications 0ue to morphine sulfate or meperidine ~ydrochloride can be minimiz~ by titrating the patient's pain with small intravenous doses of narcotics (morphine sulfate, 2--3 mg, or meperidine hydrochloride, 15--25 rag) admini,~t~red slowly at 15--20-rain intervals until the pain is relieved. On the third or fourth postoperative day, acetaminophen tablets usually suffice to provide relief of pain with little or no risk to patients. Continu,)us segmental epidural block or intercostal block, with or without splanchnic block, provide excellent pain relief that, in contrast to the narcotic, is complete. These are especially useful after operations on the chest or abdomen or the lower extremity. Regional analgesia is especially indicated in patients not adequately relieved from severe postoperative pain with narcotics, or when these drugs are contraindicated by advanced pulmo.. nary, renal, or hepatic disease. Continuous caudal analgesia is also effective to completely relieve severe postoperative pain in the lower limbs and perineulTl.
The pharmacolo~.':cal management of postoperative p a i n . - - C . P . Venter, S. Aft. reed. J., 52 (~.977) 21--27 The physiology and pharmacological management of postoperative pain arE: briefly discus::',ed. Although narcotic analgesics are still the mainstay in the management of postoperative pain, the judicious use of non-narcotic analgesics, ~.nticholinergics, tranquilizers and soporifics as well as the admini.st!,:atior,, of local anesthetic agents could contribute g~eatly to the alleviation of postope~'ative pair) and discomfort.