Hi semua, ini pertama kalinya aku posting dalam bahasa indonesia, soalnya akhir-akhir ini aku lagi sibuk skripsi

BTW saya mau beriklan dikit nih, Ronfhank Blog mulai saat ini membuka penawaran jasa Translasi bahasa inggris-indonesia dan indonesia-inggris dengan harga yang SANGAT MURAH dan kualitas terjamin dengan GARANSI 100% KEPUASAN- UANG KEMBALI.
Nantikan info selanjutnya di next post...Ok see you all...GBU

Nerve blocks.

Nerve blocks produce analgesia by interrupting the nervous transmission of pain signals either by temporary inhibition of conduction or by destruction of the nerve. Nerve blocks may be used alone or with analgesics in the management of acute or chronic pain associated with a well-defined anatomical site, especially when the pain is unresponsive to or not adequately controlled by conventional therapy. The route of administration and method employed depend on the site to be blocked but may include peripheral nerve block, autonomic nerve blocks such as sympathetic nerve blocks and coeliac plexus block, and central nerve blocks such as epidural (including caudal) and spinal block. Local anaesthetics are used when a temporary effect is required. Neurolytics such as phenol or alcohol or freezing of the nerve (cryoanalgesia) produce more prolonged block, but even so the effects may last no more than a few months, and the variable and non-selective neural damage produced correlates poorly with pain relief; some consider the risk of complications to outweigh the benefits obtained.

The use of nerve blocks in the management of cancer has declined following the refinement of the use of conventional analgesics. Some consider that their value may be limited to patients with a life expectancy of 3 months or less and that the main benefit of nerve blocks in cancer is to produce maximum pain relief rapidly. However, others consider that chemical and thermal neurolysis can provide long-term control of severe cancer pain without a substantial incidence of adverse effects. Neurolytic blocks may be of particular value in cancer pain syndromes involving the viscera or the torso, but are rarely applicable in the management of extremity pain. Neuropathic pain is rarely helped by somatic neural block and may even be aggravated, but block of the splanchnic nerves or coeliac plexus with alcohol or phenol is reputed to be effective in relieving severe intractable pain caused by cancer of the pancreas, stomach, small intestine, gallbladder, or other abdominal viscera, especially when the cancer has not spread to the parietal peritoneum.

Similar neurolytic blocks preceded by a local anaesthetic have also been used in patients with severe intractable pain of chronic pancreatitis, postcholecystectomy syndrome, or other chronic abdominal visceral diseases unrelieved by medical or surgical therapy.

Central nerve blocks using local anaesthetics with or without opioids are used for the management of acute pain such as labour pain and postoperative pain including that in children; they are also sometimes used for cancer pain.

Sympathetic nerve blocks using repeated injections of local anaesthetics or neurolytics have been used for sympathetically maintained pain. Intravenous regional sympathetic block is an alternative when a single limb is involved; guanethidine is one of the drugs that has been used.

Injections of local anaesthetics with or without corticosteroids are often used for blocks of localised painful joints. Nerve blocks are also used to block localised painful trigger areas such as postoperative or post-traumatic neuroma formation and for focal muscle pain.

Choice of analgesics for children

Choice of analgesics in children

Pain has often been undertreated in infants and children because of fears of respiratory depression, cardiovascular collapse, depressed levels of consciousness, and addiction with potent opioid analgesics. Assessment of pain is also a problem in children of all ages and it is not that long since it was widely believed that neonates were incapable of feeling pain.

Non-opioid analgesics are used in infants and children, either alone for minor pain or as an adjunct to opioid analgesics in severe pain. Paracetamol is frequently used but it lacks any anti-inflammatory effect. NSAIDs such as ibuprofen are useful for pain associated with inflammation. The use of aspirin is greatly restricted by its association with Reye's syndrome.

The opioids are still the mainstay of analgesia for moderate to severe pain in paediatric patients, and morphine is the standard against which the others are compared. Continuous intravenous infusion with or without initial loading doses has become popular for postoperative pain relief, but titration of the infusion rate is necessary to achieve a balance between analgesia and respiratory depression (particular care is needed in neonates, see below). Subcutaneous infusions of morphine have also been used, mostly for the relief of terminal cancer pain in children. Intramuscular injections can provide excellent analgesia but are painful and therefore probably only suitable for short-term use. Fentanyl has also been widely used for short-term analgesia in surgical procedures, and a variety of other opioids have been given. Patient-controlled analgesia using morphine has been tried in children.

Morphine has also been given to children by the epidural route; experience with the intrathecal route is more limited. Other methods of opioid drug delivery of possible value in paediatric analgesia include transmucosal, nasal, and transdermal administration.

Local anaesthetics are especially suitable for the management of acute pain in day-care situations. Single injections given by the epidural route are often used to provide analgesia during and after surgery. Continuous epidural infusions of local anaesthetics have also been used. However, simpler techniques such as wound infiltration or peripheral nerve blocks can also provide effective analgesia for some procedures and are free of the problems of lower limb weakness or urinary retention associated with caudal blocks. Application of eutectic creams containing lidocaine with prilocaine to intact skin, to produce surface anaesthesia, may be sufficient for some minor painful procedures in children.

Ketamine is used in outpatients for brief, painful procedures such as fracture reduction and to provide immobility for repair of facial lacerations in young children. The emergence reactions that limit its use in adults are less common in children.

Most neonates requiring analgesia and receiving respiratory support can be managed with an infusion of morphine but in neonates who are breathing spontaneously there is a substantial risk of respiratory depression. Morphine has been used in such neonates but should be limited to those under intensive care, as for example after major surgery. Fentanyl citrate and codeine phosphate have also been used in neonates. Sucrose and other sweet tasting solutions have been shown to reduce physiologic and behavioural indicators of stress and pain in neonates undergoing painful procedures although there had been some doubt expressed over whether this indicates effective analgesia.

Choice of Analgesics

Choice of analgesic

Paracetamol and NSAIDs are the first choice analgesics for treating mild to moderate pain and are also used in moderate to severe pain to potentiate the effects of opioids. They are suitable for use in acute or chronic pain. Aspirin and paracetamol are of similar potency in most types of pain but paracetamol only has a weak anti-inflammatory effect. NSAIDs are particularly effective in bone pain of malignant origin and pain due to inflammation. The selective inhibitors of cyclo-oxygenase-2 (COX-2) are said to be as effective as the non-selective NSAIDS. Dependence and tolerance are not a problem with non-opioid analgesics but as the dose is increased, their efficacy reaches a ceiling. Aspirin and other non-selective NSAIDs inhibit blood platelet function, adversely affect the gastrointestinal tract, and can precipitate hypersensitivity reactions including asthma. The risk of serious upper gastrointestinal adverse effects is lower with the COX-2 inhibitors than the non-selective NSAIDs; however, in other respects, the COX-2 inhibitors share similar side-effect profiles to those of the non-selective NSAIDs. Paracetamol does not have the haematological or gastrointestinal adverse effects of aspirin but large doses can produce severe or sometimes fatal hepatotoxicity.

For the treatment of moderate or moderate to severe opioid-sensitive pain codeine is the traditional choice; alternatives include dextropropoxyphene and dihydrocodeine. They are often given together with non-opioid analgesics. Combinations of codeine with paracetamol produce a small but significant increase in analgesia compared with paracetamol alone and might be appropriate for occasional pain relief, but the incidence of adverse effects increases with repeated use. Combinations of dextropropoxyphene with paracetamol or aspirin are no more effective in acute pain than the non-opioid alone; efficacy in chronic pain is unclear and adverse effects may become troublesome.

More potent opioids such as morphine are mainly used in the treatment of severe acute non-malignant pain and cancer pain. Their use in chronic non-malignant pain is somewhat controversial because of fears of psychological dependence and respiratory depression. However, in practice such problems rarely occur and those fears should not prevent patients being given effective analgesic therapy. Opioids may also be of value in neuropathic pain in some patients.

Morphine is the opioid of choice in severe pain. It is well absorbed when given orally and has a short half-life so that the use of immediate-release oral preparations offers a flexible means of dosage titration. Once initial pain relief has been achieved, administration of a modified-release preparation every 12 or 24 hours is more convenient for maintenance of analgesia in severe chronic pain. It may also be given parenterally, or rectally or transdermally, where there would be problems with the oral route.

Occasionally other opioids may be useful as an alternative to morphine. Methadone or oxycodone have a longer duration of action than morphine, but it should be noted that methadone, which has a long half-life, should not be given more than twice daily when used long term because of the risk of progressive CNS depression and overdosage. A rapid onset of action is provided by pethidine, alfentanil, and fentanyl. Diamorphine or hydromorphone may be preferred to morphine when the parenteral route has to be used because they are more soluble and can be given in a smaller volume.

Adverse effects of opioids include sedation, nausea, vomiting, constipation, and, most seriously, respiratory depression. Tolerance generally develops to all of these effects except constipation, which may be prevented by regular use of laxatives.

A number of other groups of drugs have significant roles in pain management either alone or as analgesic adjuvants.

Subantidepressant doses of tricyclic antidepressants (usually amitriptyline) are considered to be useful in refractory chronic pain, including neuropathic pain of the burning, dysaesthetic type such as postherpetic neuralgia and diabetic neuropathy; shooting pain has also been reported to respond. They may be used in addition to conventional analgesics, notably in the treatment of cancer pain of mixed aetiology. There is little evidence for benefit in acute pain although musculoskeletal pain has sometimes responded. Amitriptyline has also been found to be useful for tension-type headache and for the prophylaxis of migraine. The role of other antidepressants in the treatment of neuropathic pain is less clear although venlafaxine may be useful.

Antiepileptics (often carbamazepine and, more recently, gabapentin) have been found useful in the relief of neuropathic pain especially when there is a stabbing (lancinating) element, as in trigeminal neuralgia; there have also been reports of efficacy in the treatment of diabetic neuropathy and for migraine prophylaxis.

Benzodiazepines and other muscle relaxants such as baclofen or dantrolene are useful for relieving painful muscle spasm in acute or chronic conditions.

Bone modulating drugs such as calcitonin and bisphosphonates may be useful in cancer pain arising from bone metastases but have a slow onset of action and are second choice to NSAIDs. Bisphosphonates may cause an initial transient increase in bone pain.

Caffeine has been used with the aim of enhancing the effects of non-opioid and opioid analgesics but is of debatable benefit. There are similar doubts about whether caffeine enhances the effect of ergotamine in the treatment of migraine; it may also add to gastrointestinal adverse effects and in large doses can itself cause headache.

Corticosteroids have produced improvement, often substantial, in neuropathic pain. They can also relieve headache caused by raised intracranial pressure and refractory pain caused by bone metastases, and have the added benefits of increasing well-being and appetite.

Some inhalational anaesthetics are used in subanaesthetic doses as inhalation analgesics for acute pain. In particular, nitrous oxide is given with oxygen for pain relief in obstetrics and during dental and other procedures, and in emergency management. Isoflurane, enflurane, and in some countries methoxyflurane or trichloroethylene have been used similarly.

Miscellaneous drugs. Following the discovery that epidural or intrathecal injection of opioids can produce effective analgesia many other drugs have been tried by these routes, either alone or with opioids or local anaesthetics, but their role, if any, in the management of pain remains to be determined. Some of these drugs, such as clonidine and ketamine, also appear to have analgesic properties when given by other routes. Some antiarrhythmics may be effective in chronic neuropathic pain, but must be used with extreme caution. The use of antipsychotics, such as the phenothiazines, as adjuvant analgesics is controversial; levomepromazine is sometimes used as an adjunct in palliative care.

My iNtrOdUcTiOn

What a bright day today, and thanks to our Lord we can still breath the fresh air in the atmosphere until today...
Oh yeah, by the way my name is Ronald Ciu, but it's better to call me ronfhank or ron only 'cause it sounded more friendlier.

This is my first time creating a blog, i've just bought a guide book on who to use and write a good blog and I'm eagerly curious to try it out and here I am, looking at my very own first blog....hehehe... although it's not really my OWN because The Blogger had provide us with a heck free and easy to use instant Blog....thanks dude....

For an Instant preview, My blog will be mainly talking about health in common but i think drugs will become my main focus because I am a Pharmacist but there is a chance that I also talk about IT(Computer,CellPhone), Japan Manga, and video games as a side-writings because they are my hobbies.

The last but not the least, I REALLY appreciate if you give your comments. I accept Critics, Advise and also Questions about my articles or even though it's not related but if I by any chance can help U, Just contact me on my e-mail address at ronfhank@gmail.com

NB: I live in Indonesia and I'm Thinking to make a Translation for every articles that i wrote but maybe I'll save it for the next post

And here is my first Post, It's about everything u need to know about Analgesics and Pain....

Analgesia And Pain

Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.'

Under normal circumstances pain is the result of stimulation of peripheral receptors which transmit impulses through pain pathways to the brain. Pain receptors or nociceptors are of two basic types:

mechanoheat receptors have a high stimulation threshold and respond to intense or potentially damaging noxious stimuli. These receptors are associated with rapidly conducting, thinly myelinated Aδ fibres, and their stimulation produces rapid sharp localized pain that serves to activate withdrawal reflexes

polymodal nociceptors respond to mechanical, thermal, or chemical insults. These receptors are also activated by cellular components that are released following tissue damage. Their impulses are transmitted slowly along unmyelinated C type fibres and produce dull, aching, and poorly localised pain with a slower onset.

Nerve fibres from nociceptors terminate in the dorsal root of the spinal cord before transmission by ascending pathways to the brain. There have been many theories on the processing of pain signals at the spinal level but the 'gate theory' proposed by Melzack and Wall is one of the best known. This theory postulates that the transmission of impulses to the brain is modulated by a gate mechanism in the substantia gelatinosa. Stimulation of small fibres opens the gate and facilitates transmission whereas stimulation of large fibres, which normally carry non-painful sensory input, can close the gate and inhibit transmission. Transmission also appears to be modulated by several other mechanisms which can influence the sensitivity of the gate.

Inflammatory mediators such as bradykinin, histamine, serotonin, and prostaglandins produced in response to tissue damage can produce peripheral sensitisation so that receptors respond to low intensity or innocuous stimuli; central sensitisation also occurs. Pain associated with tissue damage hence results in increased sensitivity of the sensory system so that the pain can occur in the absence of a clear stimulus. There may be a reduction in the pain threshold (allodynia) resulting in an exaggerated response (hyperalgesia) or a prolonged effect (hyperpathia).

Pain is often classified as being acute or chronic in nature.

Acute pain is associated with trauma or disease and usually has a well-defined location, character, and timing. It is accompanied by symptoms of autonomic hyperactivity such as tachycardia, hypertension, sweating, and mydriasis.

Chronic pain is usually regarded as pain lasting more than a few months. It may not be clearly associated with trauma or disease or may persist after the initial injury has healed; its localisation, character, and timing are more vague than with acute pain. Furthermore, as the autonomic nervous system adapts, the signs of autonomic hyperactivity associated with acute pain disappear. Some forms of pain regarded as being chronic may consist of intermittent attacks of pain followed by relatively long pain-free periods. Patients with chronic pain experience physical, psychological, social, and functional deterioration which contributes towards exacerbation of the pain.

Physiologically, pain may be divided into nociceptive pain and neuropathic pain.

Nociceptive pain follows activation of nociceptors by noxious stimuli as described above but is not associated with injury to peripheral nerves or the CNS. It may be somatic or visceral, depending on which receptors or nerves are involved. Somatic pain is usually well localised and may be described as deeply located, sharp or dull, nagging, stabbing, throbbing, or pressure-like. Visceral pain is generally less localised and more diffuse than somatic pain and may be referred to remote areas of the body. Depending on the structure involved it is variously described as deeply located, aching, nagging, cramping, or pressing and may be accompanied by nausea and vomiting. Nociceptive pain usually responds to treatment with conventional analgesics.

Pain resulting from damage or dysfunction of peripheral nerves/receptors or of the CNS is known as neuropathic pain (or neurogenic pain). The term covers sympathetically maintained pain including causalgia and reflex sympathetic dystrophy, and painful conditions such as postherpetic and trigeminal neuralgia, and diabetic neuropathy. Neuropathic pain associated with central nervous tissue, such as in central post-stroke pain (the thalamic syndrome) is referred to as central pain. The clinical signs of neuropathic pain can vary greatly. Some of the more common features include heightened pain sensitivity and sensations of superficial burning or stabbing (lancinating) pain. The pain may be associated with areas of sensory deficit or some form of autonomic instability. Neuropathic pain responds poorly to conventional analgesics and can be difficult to treat.

Early treatment of pain is important as unrelieved pain can have profound psychological effects on the patient, and acute pain that is poorly managed initially can degenerate into chronic pain, which may prove to be much more difficult to treat. It is important to assess and treat the mental and emotional aspects of the pain as well as its physical aspects. Although drug therapy is a mainstay of pain treatment, physical methods such as physiotherapy (including massage and the application of heat and cold), surgery, and nervous system stimulation techniques such as acupuncture and transcutaneous electrical nerve stimulation (TENS) are also used.

See u at my next articles, I'll talk about the choice of analgesics.....