Acute pain in patients with renal or hepatic impairment

2011 ◽  
Author(s):  
Ramini Moonesinghe ◽  
Sue Mallett
Keyword(s):  
Renal Disease ◽  
Acute Pain ◽  
Binding Sites ◽  
Hepatic Impairment ◽  
Hepatic Disease ◽  
Analgesic Drugs ◽  
P Protein ◽  
Protein Binding Of Drugs ◽  
Significant Impairment ◽  
Inflammatory Drugs

The metabolism and excretion of many analgesic drugs will be altered in the presence of renal or hepatic impairment. Some analgesic drugs can cause renal or hepatic damage. Protein binding of drugs may be altered by hepatic reduction in production or uraemic displacement from binding sites. In renal disease, paracetamol is the simple analgesic of choice. Morphine can be used with care in mild to moderate renal disease, but fentanyl or oxycodone may be better alternatives. Non-steroidal anti-inflammatory drugs should be avoided in renal disease. In hepatic disease with significant impairment, doses of morphine must be reduced and the dosage interval lengthened. Fentanyl should be avoided in severe hepatic disease.

Acute pain

2021 ◽  
pp. 1151-1180
Author(s):  
Adrian Dashfield ◽  
David Kibblewhite
Keyword(s):  
Pain Management ◽  
Epidural Analgesia ◽  
Peripheral Nerve ◽  
Acute Pain ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Electrical Nerve Stimulation ◽  
Analgesic Drugs ◽  
Peripheral Nerve Blockade ◽  
Inflammatory Drugs

This chapter discusses the management of acute pain. It begins with an introduction which describes the benefits of acute pain management and the measurement of pain. Analgesic drugs are then described, including paracetamol; non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (including their comparative efficacy). Patient-controlled analgesia (PCA), epidural analgesia, and continuous peripheral nerve blockade are described. Transcutaneous electrical nerve stimulation (TENS) and acupuncture are discussed. The management of the patient with persistent pain and a substance misuse disorder is also discussed. The chapter concludes with a discussion of non-opioid adjuvant analgesics.

Acute pain

2016 ◽  
Author(s):  
Adrian Dashfield
Keyword(s):  
Acute Pain ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Substance Misuse ◽  
Patient Controlled Analgesia ◽  
Comparative Efficacy ◽  
Acute Pain Management ◽  
Electrical Nerve Stimulation ◽  
Analgesic Drugs ◽  
Peripheral Nerve Blockade ◽  
Inflammatory Drugs

This chapter discusses the management of acute pain. It begins with an introduction which describes the benefits of acute pain management and the measurement of pain. Analgesic drugs are then described, including paracetamol, non-steroidal anti-inflammatory drugs, and opioids (including their comparative efficacy). Patient-controlled analgesia, epidural analgesia, and continuous peripheral nerve blockade are described. Transcutaneous electrical nerve stimulation and acupuncture are discussed. The management of the patient with a substance misuse disorder is discussed. The chapter concludes with a discussion of non-opioid adjuvant analgesics.

Acute pain

2018 ◽  
Author(s):  
Adrian Dashfield
Keyword(s):  
Acute Pain ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Substance Misuse ◽  
Patient Controlled Analgesia ◽  
Comparative Efficacy ◽  
Acute Pain Management ◽  
Electrical Nerve Stimulation ◽  
Analgesic Drugs ◽  
Peripheral Nerve Blockade ◽  
Inflammatory Drugs

This chapter discusses the management of acute pain. It begins with an introduction which describes the benefits of acute pain management and the measurement of pain. Analgesic drugs are then described, including paracetamol, non-steroidal anti-inflammatory drugs, and opioids (including their comparative efficacy). Patient-controlled analgesia, epidural analgesia, and continuous peripheral nerve blockade are described. Transcutaneous electrical nerve stimulation and acupuncture are discussed. The management of the patient with a substance misuse disorder is discussed. The chapter concludes with a discussion of non-opioid adjuvant analgesics.

scholarly journals Nonsteroid anti-inflammatory drugs (NSAID) and risk of cardiovascular events. Literature review and clinical implications

2015 ◽  
Vol 82 (3) ◽  
Author(s):  
Pier Luigi Temporelli ◽  
Giovanni Battista Zito ◽  
Roberto Franco Pedretti ◽  
Francesco Iachini Belisarii ◽  
Giuseppe Putortì ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cardiovascular Events ◽  
Large Body ◽  
Cyclooxygenase Inhibitors ◽  
Current Status ◽  
Analgesic Drugs ◽  
Drug Agency ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Artery Disease

Non steroid anti-inflammatory drugs (NSAIDs) are largely used for treatment of acute and chronic pain, even for long periods of time (months or years). While it is known that their use is frequently associated with gastrointestinal damage, including major bleedings from peptic ulcer, the risk of cardiovascular events related to NSAID has received much less attention. However, there is a large body of evidence showing that NSAIDs (both “traditional”, such as diclofenac or indobufen, and selective cyclooxygenase inhibitors, COX-2) are associated with a significant increase of risk of cardiovascular events, both fatal and nonfatal. Consequently, several options have been proposed for the treatment of pain, including the use of analgesic drugs with different mechanisms of action, such as the opiates. Of interest, the Italian Drug Agency (AIFA) published a few years ago a warning (Nota 66) on the careful prescription of NSAIDs in patients with overt heart disease, such as coronary artery disease and heart failure. Aim of this paper is to present the current status of knowledge on the proper use of NSAIDs and other analgesic drugs in the management of acute and chronic pain.

scholarly journals Anaesthesia and analgesia for dogs and cats in South Africa undergoing sterilisation and with osteoarthritis - an update from 2000 : report

2006 ◽  
Vol 77 (4) ◽  
Author(s):  
K.E. Joubert
Keyword(s):  
South Africa ◽  
Continuing Education ◽  
South African ◽  
Surgical Procedures ◽  
Acute Pain ◽  
Death Rate ◽  
Analgesic Drugs

A survey was conducted in 2000 into the use of analgesic drugs by veterinarians in South Africa. This survey was repeated in 2005 to establish whether the use of analgesic drugs has increased and which analgesic drugs are being used for acute pain and osteoarthritis. The number of sterilisations performed and the number of new cases of osteoarthritis in dogs and cats was estimated. It is estimated that approximately 260 000 cats are operated on each year in South Africa and that 150 000 cats are sterilised. Five hundred thousand dogs undergo surgery, of which 242 000 are sterilised. It appears that the number of surgical procedures performed in South Africa has decreased. The estimated death rate following anaesthesia has remained unchanged at 1:1004. Overall, the use of analgesics by South African veterinarians has increased significantly. Fifty-six per cent of cats and 74% of dogs were given peri-operative analgesics but this increased to 94 % and 84 % after including pre-anaesthetic medications with analgesic properties. The use of opioids (morphine and buprenorphine) and propofol has increased significantly. Approximately 253 000 dogs and 33 000 cats with osteoarthritis are seen by veterinarians in South Africa annually. The recognition by veterinarians of osteoarthritis in cats appears to be poor and is in need of attention. Carprofen and glucosamine / chondroitin are the most commonly used agents for the treatment of osteoarthritis. Details of the drugs used by veterinarians are given. Knowledge of analgesic drugs has increased significantly over the last 5 years. Continuing education is thought to have played an important role in the changes reported in this study.

Torsemide: A Pyridine-Sulfonylurea Loop Diuretic

1995 ◽  
Vol 29 (4) ◽  
pp. 396-402 ◽  
Author(s):  
Jamie S Blose ◽  
Kirkwood F Adams ◽  
J Herbert Patterson
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Disease ◽  
English Language ◽  
Loop Diuretic ◽  
Antihypertensive Agents ◽  
Hepatic Disease ◽  
Loop Diuretics ◽  
Once Daily ◽  
Medline Search

Objective: To review the clinical pharmacology of torsemide and to compare it with currently available loop diuretics, particularly furosemide. Data Sources: An English-language MEDLINE search, 1985 to October 1994, was used to identify pertinent literature, including review articles. Data Extraction: Data from scientific literature were extracted, evaluated, and summarized for presentation. Pivotal and representative studies are discussed relating to the pharmacology, pharmacokinetics, and use of torsemide in patients with congestive heart failure, renal disease, hepatic disease, and hypertension. Data Synthesis: Torsemide is a loop diuretic of the pyridine-sulfonylurea class. The bioavailability of torsemide is approximately 80%, with little first-pass metabolism, and torsemide can be given without regard to meals. The serum concentration reaches its peak within 1 hour after oral administration and diuresis lasts approximately 6—8 hours. Torsemide is eliminated both hepatically (80%) and renally (20%) as unchanged drug with an elimination half-life of about 3.5 hours. Because of the high bioavailability, oral and intravenous doses are therapeutically equivalent. Torsemide, and other loop diuretics such as furosemide, are indicated for the treatment of edema associated with congestive heart failure, renal disease, and hepatic disease. They also are indicated for the treatment of hypertension alone or in combination with other antihypertensive agents. Depending on the indication, the recommended initial adult dosage of torsemide is between 5 and 20 mg once daily orally or intravenously. Special dosage adjustments in the elderly are not necessary. Conclusions: Torsemide is a loop diuretic similar to furosemide, with similar indications. Torsemide is characterized by good bioavailability and once-daily dosing and, compared with furosemide, provides generally equivalent therapeutic efficacy.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

2021 ◽  
Vol 24 (1) ◽  
pp. 4-30
Author(s):  
Paulo V Steagall ◽  
Sheilah Robertson ◽  
Bradley Simon ◽  
Leon N Warne ◽  
Yael Shilo-Benjamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Assessment Tools ◽  
Mental Wellbeing ◽  
Team Approach ◽  
Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

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