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Analgesia best practice after cardiac surgery.
Anesthesiol Clin. 2008 Sep;26(3):591-602
Authors: Konstantatos A, Silvers AJ, Myles PS
Sources of pain after cardiac surgery include sternotomy, rib retraction, conduit harvest, and drain tubes sites. An analgesic regimen should consider individual patient characteristics, including age, preoperative history of pain and response to analgesics, comorbidities, and psychologic state. Intraoperative and postoperatively administered opioids remain the mainstay of therapy, but adjunctive analgesics such as paracetamol, nonsteroidal anti-inflammatory drugs and tramadol, and regional techniques, can reduce opioid consumption and opioid-induced respiratory depression. This may facilitate earlier tracheal extubation, mobilization, and recovery.
PMID: 18765224 [PubMed - in process]
(Source: Anesthesiology Clinics)
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A few months following the FDA approval of Lyrica for the treatment of Fibromyalgia, I brought it up to my doctor at the time. He was eager to give a shot and even had samples for me to take home. He had said I might not feel any different right away and that we might have to play with the dosage.
A month later I got a job two states away. I was so carried away with finding a new house, figuring out how to get the husband, the puppy and a house full of stuff to Texas in two weeks that I wasn’t as focused on the Lyrica. I kept taking it at the low dosage my doctor in Arizona had prescribed. I didn’t notice a giant change.
When I found my current doctor, she was skeptical of Lyrica. She pointed out that it’s spendy for something we’re not sure is really going to do anything. She was more apt to try and get me to use Flexeril more often. (I still just use it case-by-case, because I’m stubborn.) So, I haven’t really given Lyrica a shot.
I have concerns, like a lot of people, about the “off label” use of drugs. Back 10 years ago, I was taking Neurontin coupled with an onslaught of others (the only one I’m still taking is Tramadol). Neurontin, like Lyrica, was a medicine designed for something else—in this case epilepsy. However, doctors were sure that using it with other pain medicine was the answer to decreasing Fibromyalgia patients’ pain levels. After about a year on Neurontin, I decided it wasn’t working. We had played with different medication variations, and I didn’t feel any different without it.
A few years later it’s discovered that the drug company Pfizer was bribing doctors, among other things, to convince them to prescribe Neurontin for off-label uses it knew wouldn’t work. The company ended up pleading guilty to two Federal felonies. Pfizer is the same company that is marketing Lyrica. Maybe it learned a lesson through Neurontin. The company has brought plenty of great drugs to the market, but it’s hard to shake the feeling that they may be preying on Fibromyalgia patients longing for a cure.
So, I am debating whether it’s time to talk to my doctor again about trying the medicine. I don’t think it will be some magic pill, but wonder if it may do something noticeable. Some people say blending Tramadol and Lyrica is a godsend, while others heavily warn against it. Some of the anecdotal evidence I’ve read about the drug says the swelling of appendages, particularly fingers, is not worth the degree of pain recession. I hope my doctor has some real answer to whether Lyrica can help. She’s been right before.
[/caption]
A few months following the FDA approval of Lyrica for the treatment of Fibromyalgia, I brought it up to my doctor at the time. He was eager to give a shot and even had samples for me to take home. He had said I might not feel any different right away and that we might have to play with the dosage.
A month later I got a job two states away. I was so carried away with finding a new house, figuring out how to get the husband, the puppy and a house full of stuff to Texas in two weeks that I wasn’t as focused on the Lyrica. I kept taking it at the low dosage my doctor in Arizona had prescribed. I didn’t notice a giant change.
When I found my current doctor, she was skeptical of Lyrica. She pointed out that it’s spendy for something we’re not sure is really going to do anything. She was more apt to try and get me to use Flexeril more often. (I still just use it case-by-case, because I’m stubborn.) So, I haven’t really given Lyrica a shot.
I have concerns, like a lot of people, about the “off label” use of drugs. Back 10 years ago, I was taking Neurontin coupled with an onslaught of others (the only one I’m still taking is Tramadol). Neurontin, like Lyrica, was a medicine designed for something else—in this case epilepsy. However, doctors were sure that using it with other pain medicine was the answer to decreasing Fibromyalgia patients’ pain levels. After about a year on Neurontin, I decided it wasn’t working. We had played with different medication variations, and I didn’t feel any different without it.
A few years later it’s discovered that the drug company Pfizer was bribing doctors, among other things, to convince them to prescribe Neurontin for off-label uses it knew wouldn’t work. The company ended up pleading guilty to two Federal felonies. Pfizer is the same company that is marketing Lyrica. Maybe it learned a lesson through Neurontin. The company has brought plenty of great drugs to the market, but it’s hard to shake the feeling that they may be preying on Fibromyalgia patients longing for a cure.
So, I am debating whether it’s time to talk to my doctor again about trying the medicine. I don’t think it will be some magic pill, but wonder if it may do something noticeable. Some people say blending Tramadol and Lyrica is a godsend, while others heavily warn against it. Some of the anecdotal evidence I’ve read about the drug says the swelling of appendages, particularly fingers, is not worth the degree of pain recession. I hope my doctor has some real answer to whether Lyrica can help. She’s been right before.
