How readable are practice leaflets?
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Documentation↗
Biomedical subjects
S Chadwick
Publications and source records attributed to S Chadwick.
Solving the problems with patient controlled analgesia.
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Analgesia, Patient-Controlled↗
Pain on injection of propofol. Methods of alleviation.
A controlled randomised double-blind design was used to study the effect of lignocaine on the pain produced by intravenous injection of propofol. Patients received a 2-ml pretreatment solution with temporary venous occlusion, followed by an induction solution. One hundred and three patients were assigned to one of five groups: saline pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 20 mg pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 40 mg pretreatment, followed by induction with propofol plus saline 2 ml; saline pretreatment, followed by induction with propofol plus lignocaine 20 mg; or saline pretreatment, followed by induction with propofol plus lignocaine 40 mg. Pain was reduced significantly in all groups in which lignocaine was used and a dose of 40 mg was more effective than 20 mg. There were no significant differences in the incidence of pain among the groups which received lignocaine as pretreatment and the groups which received lignocaine mixed with propofol. Sixty-eight percent of patients who experienced pain or discomfort recalled it in the postoperative period.
Double-Blind Method↗
Use of the subcutaneous route for the administration of narcotics in patients with cancer pain.
From February 1985 until January 1987, 108 consecutive patients with pain due to advanced cancer requiring parenteral narcotics were treated with a subcutaneous infusion of morphine (62 patients) or hydromorphone (46 patients). Mean maximal daily dose of morphine and hydromorphone was 305 mg (range, 80-3000 mg) and 310 mg (range, 40-4024 mg), respectively. The infusion was maintained for a mean of 31 +/- 16 days (range, 2-156). Seventy patients were treated with a portable pump. Of these patients, 33 (45%) were discharge home for a mean of 29 +/- 20 days. Eighty-six of one hundred eight (86/108, 80%) patients experienced adequate pain control (less than two extra doses of analgesics per day). The duration of the site of the infusion was 7 days (range, 2-31). The mean daily increase in those was 2.4 +/- 1.6% of the initial dose (only 15% of patients needed an increase more than or equal to 5% per day). Systemic toxicity consisted of respiratory depression in two patients, severe sedation in six, and confusion in three; all patients improved upon reduction of the daily dose of narcotics. Local toxicity consisted in infection in two patients, bleeding in one, and chemical irritation in six. Cost analysis shows that subcutaneous infusion reduced costs by either allowing home discharges, or replacing intravenous infusion. The authors conclude that this method is safe and effective in patients admitted and at home, and should be considered the first choice when parenteral analgesia is required.
Cost-Benefit Analysis↗
Continuous sc infusion of narcotics using a portable disposable device in patients with advanced cancer.
Fifty-six patients with chronic pain due to advanced cancer were treated with an sc infusion of morphone (34 patients) or hydromorphone (22 patients) using a portable disposable infusor. The infusion was maintained for 26 +/- 14 days. Twenty-five patients (45%) were discharged to the home for a mean period of 18 days (range, 2-138). The mean daily increase in dose was 2.6% +/- 1.4% of the initial dose. The sc site needed to be changed every 8 days (range, 2-31). Local toxicity consisted of infection in two patients (3%), chemical irritation in three (5%), and bleeding in one (2%). After 48 hours of treatment, 54 of 56 patients (96%) preferred the sc infusion to their previous parenteral treatment. We conclude that this is a safe and simple method for the administration of narcotics to inpatients and outpatients.
Ambulatory Care↗
Diagnosis of testicular torsion using Doppler ultrasonic flowmeter.
Thirty-one patients with intrascrotal disease process have been studied with the Doppler ultrasonic flowmeter to determine if testicular torsion can be differentiated from acute epididymitis when clinical characteristics are ambivalent. In all instances of proved torsion there was a loss of blood flow in the involved testes, whereas in acute epididymitis or other epididymal and gonadal diseases blood flow ranged from normal to hyperemic.
Doppler Effect↗