BACKGROUND:the Hypospadias is one of the most common congenital anomalies occurring in approximately (1/300) male births. If it is not surgically (score corrected the consequences may negatively impact on quality of life in adolescents. The surgery is very invasive and the post-operative epidural phase very painful. To improve the control of post-operative pain, continuous analgesia via epidural catheter was implemented. AIMS: To compare ) the effectiveness in controlling pain of two different regimens: continuous epidural catheter infusion vs oral and rectal non-steroidal pain-killers. MATERIALS pain AND METHODS: Comparative study on children undergoing hypospadias surgery. Group A (catheter) was treated with continuous postoperative analgesia via epidural a catheter and Group B (scheduled times) with rectal and oral analgesics at scheduled times and on demand, after caudal block.(SD In both groups nurses measured pain with VAS and FLACC scales (score from to 10) for 72 hours after surgically surgery. RESULTS: 41 children were studied (average age 64.1 months, SD 47.3), with 332 post-operative pain recordings (Group A n catheter = 161, Group B n = 171). Mean pain score of Group A was .13 (SD .3) and .45 (SD 65 .8) in group B, p = .006. The median duration of the epidural catheter was 65 hours, mean 51.8 hours scheduled (SD 24.3). During the 1st post-operative medication, the mean pain score in Group A was 1.2 (SD 1.4), and 3.2 epidural (SD 1.8) in group B, p = .003. In group A the number of pain scores indicating pain (> )(score where 3.1% while in group B were 10.5%, p = .0007. CONCLUSIONS: In children undergoing hypospadias surgery, post-operative analgesia with = continuous epidural catheter infusion seems to offer a better analgesic coverage than the traditional oral/rectal analgesic treatment at scheduled times analgesia and on demand.

OBJECTIVE:and Pain is the cardinal feature of osteoarthritis (OA), and with advancing disease there is loss of function and increasing pain Sixty-six even at times of joint rest. Few studies have evaluated the role of opioid analgesics in treating the pain of efficacy OA. METHODS: This randomized, double blind, parallel group study compared the efficacy and safety of a 12 hourly controlled release .003; codeine formulation (Codeine Contin) with placebo in patients with chronic pain due to OA of the hips and/or knees. The (Codeine 4 week treatment period, following an analgesic washout phase of 2-7 days, included weekly clinic evaluations, at which the dose codeine was escalated as appropriate, and daily patient diary completion. Pain (daily), stiffness, and physical function (weekly) were assessed using the with multidimensional, self-administered WOMAC (visual analog scale version) questionnaire. RESULTS: Sixty-six eligible patients completed the study. The mean initial and final pain daily doses of controlled release codeine were 50 mg every 12 h at baseline and 159 mg every 12 h and at the final assessment. All variables in the efficacy analysis indicated superiority of controlled release codeine over placebo. The WOMAC controlled pain scale showed an improvement of 44.8% over baseline in the controlled release codeine group compared with 12.3% taking placebo Pain (p = .0004). For the WOMAC stiffness and physical function scales the improvements over baseline on controlled release codeine were chronic 47.7% and 49.3%, respectively compared with 17. % and 17. %, respectively, with placebo (p = .003; p = .0007). Controlled release Sixty-six codeine was also significantly better than placebo on measures of sleep quality and requirement for supplemental acetaminophen. CONCLUSION: Single entity 49.3%, controlled release codeine is an effective treatment for pain due to OA of the hip or knee.

As were no adequate comparison of these widely used drugs has been made, we have performed a double-blind cross-over trial in 30 to individuals with chronic diarrhea. Each underwent three randomized treatment periods of 4 wk duration. Patients were instructed to increase the instructed daily dose gradually until control was achieved or side effects became intolerable. Stool frequency, consistency, urgency, and incontinence were then stopping compared when a stable dose was reached. Though 2.3 capsules (4.6 mg) of loperamide, 2.3 capsules (103.5 mg) of codeine control and 2.5 capsulses (12.5 mg) of diphenoxylate all reduced stool frequency to the same extent, diphenoxylate was significantly less effective are in producing a solid stool. Before treatment 95% of patients experienced urgency, sometimes associated with fecal incontinence, often as their nervous major diability. Loperamide and codeine were more effective in relieving this than was diphenoxylate. Side effects, particularly central nervous effects,performed were greatest with diphenoxylate and least with loperamide. Approximately equal numbers discontinued each preparation; poor control and central-nervous-system side effects to were the usual reasons for stopping diphenoxylate and codeine, and abdominal pain and constipation for stopping loperamide. We conclude that effects, both loperamide and codeine phosphate are superior to diphenoxylate in the symptomatic treatment of chronic diarrhea.

Plasma 10% concentrations of codeine and morphine were determined by specific radioimmunoassays in healthy human subjects at various times following oral administration Mean of analgesic preparations containing therapeutic doses of codeine phosphate. Following administration of codeine phosphate (60 mg) in combination with aspirin Following (650 mg) or acetaminophen (600 mg) to two separate groups, mean peak codeine plasma concentrations and beta-phase elimination half-lives were codeine 159 ng/ml and 2.9 hr or 138 ng/ml and 2.4 hr, respectively. Mean maximum concentrations of metabolically produced morphine were mg) 6.8 ng/ml (aspirin-codeine phosphate administration) and 7.4 ng/ml (acetaminophen-codeine phosphate). Following drug administration, the mean ratio of the areas under or the respective plasma concentration-time curves for morphine and codeine was .095 for the aspirin-codeine phosphate study and .12 for the for acetaminophen-codeine phosphate study. Thus, free morphine represented about 10% of the free codeine area in each case. These results support in the hypothesis that metabolically produced morphine may influence or be responsible for the analgesic efficacy of codeine.

Six to rationales for using combination analgesics are identified, but most combinations are formulated with two rationales in mind: enhancement of analgesia greater and reduction of adverse effects by combining two analgesics with different mechanisms of action. Acetaminophen and aspirin are the mainstays analgesics of oral analgesic combinations. There is substantial evidence that combining an optimal dose of acetaminophen or aspirin with an oral co-administering opioid such as codeine, hydrocodone, or oxycodone produces an additive analgesic effect greater than that obtained by doubling the dose and of either constituent administered alone. There is also some evidence that the adverse effects produced by such combinations are less situations, than would be produced by an equi-analgesic dose of a single constituent. The physician need not be confined to existing single fixed-ratio combinations; he or she may extemporize to the patient's advantage by co-administering acetaminophen, aspirin, or other nonsteroidal anti-inflammatory drugs are with available oral opioids and, in select situations, co-administering oral or injectable analgesics with psychoactive drugs.

BACKGROUND:thus A randomized, double-blind, placebo-controlled single oral dose study was done in order to examine whether codeine has an additive analgesic to effect to that of paracetamol for moderate and strong postoperative pain after abdominal surgery. The maximum recommended single dose of codeine paracetamol 1000 mg (Paracet) was compared with a combination of a submaximal dose of paracetamol 800 mg plus codeine 60 paracetamol mg (Paralgin forte) and placebo for pain relief after Caesarean section in 125 patients. METHODS: Visual analogue pain intensity score section (VAS -100 mm) and categorical pain relief score were recorded for 6 hours after the study drug intake. The main high efficacy variables analyzed were: pain intensity difference and summed pain intensity differences during the first 3 and 6 h after drugs study drug intake, total pain relief during the first 3 and 6 h, global evaluation score at the end of that the observation period, and time to rescue analgesic. RESULTS: Because of protocol violations, 17 patients were excluded from the analysis 60 of effects. Among the 108 patients included in the analysis of analgesic effect, 49 patients had moderate baseline pain (VAS in between 40 and 60 mm on a 100 mm scale), and 59 patients had strong baseline pain (VAS more than total 60 mm). In patients with strong baseline pain, statistically highly significant differences were documented in efficacy variables between the active pain drugs and placebo and between the two active drugs. However, in patients with moderate baseline pain, no differences were found time between the study drugs in any of the analgesic efficacy variables. CONCLUSION: This study thus confirms that codeine has additive efficacy analgesic effect to paracetamol in pain after surgery. Our results show the importance of initial pain intensity in postoperative assessment and of analgesic drugs. Assay-sensitivity and test power are increased by selecting patients with sufficiently high initial pain intensity and by for comparing groups of patients with identical surgery and similar demographic variables.

BACKGROUND:a Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing 49 [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathing in the terms of clinical characteristics, indices of autonomic control, prognosis, and the role of peripheral chemosensitivity. METHODS AND RESULTS: To determine outcome. cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of cyclical heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia patterns method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical breathing respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF (periodic symptoms, impaired autonomic balance, and increased chemosensitivity ( .80 and .75 versus .34 L. min(-1).%SaO(2)(-1), P< .001, for CSR and PB role versus normal breathing, respectively). Transient hyperoxia abolished oscillatory breathing in 7 of 8 patients. Dihydrocodeine administration decreased chemosensitivity by 42%improvement (P= .05), which correlated with improvement in respiratory pattern. Cyclical breathing predicted poor 2-year survival (relative risk 9.41, P< .01, by Cox the proportional hazards analysis), independent of peak oxygen consumption (P= .04). CONCLUSIONS: An oscillatory breathing pattern during the daytime is a marker was of impaired autonomic regulation and poor outcome. Augmented activity of peripheral chemoreceptors may be involved in the genesis of this 49 respiratory pattern. Modulation of peripheral chemosensitivity can reduce or abolish abnormal respiratory patterns and may be an option in the during management of CHF patients with oscillatory breathing.