Table Of ContentPAIN MANAGEMENT AND ANESTHESIOLOGY
DEVELOPMENTS IN
CRITICAL CARE MEDICINE AND ANESTHESIOLOGY
Volume 33
The titles published in this series are listed at the end of this volume.
PAIN MANAGEMENT
AND ANESTHESIOLOGY
Papers presented at the 43rd Annual Postgraduate Course
in Anesthesiology, February 1998
edited by
MICHAEL A. ASHBURN, PERRY G. FINE
AND THEODORE H. STANLEY
Department of Anesthesiology,
The University of Utah Medical School,
Salt Lake City, Utah, USA.
SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
A CLP. Catalogue record for this book is available from the Library of Congress.
ISBN 978-94-010-6162-9 ISBN 978-94-011-5145-0 (eBook)
DOI 10.1007/978-94-011-5145-0
Printed on acid-free paper
Al l Rights Reserved
©1998 Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1998
Softcover reprint of the hardcover 1st edition 1998
No part of the material protected by this copyright notice may be reproduced or
utilized in any form or by any means, electronic or mechanical,
including photocopying, recording or by any information storage and
retrieval system, without written permission from the copyright owner
TABLE OF CONTENTS
Preface ix
List of Contributors xi
Mechanisms of Opioid Analgesia and Tolerance
Allan Basbaum 1
Descending Facilitation of Pain
Gerald F. Gebhart 13
The Contribution of NMDA and Second Messengers to the
Persistent Pain States Produced by Tissue and Nerve Injury
Allan Basbaum 19
New Clinical Pharmacology Concepts in Pain Management
Talmage D. Egan 29
The Contribution of Substance P to Long-term Changes in the
Spinal Cord Dorsal Horn: Reorganization in the Setting of
Persistent Injury
Allan Basbaum 55
Pain and the Surgical Stress Response
Henrik Kehlet 65
Visceral Pain and Visceral Hyperalgesia
Gerald F. Gebhart 75
Postoperative Pain: Assessment and Choice of Methods of
Treatment
L. Brian Ready 81
Patient-controlled Analgesia (Part I): Historical Perspective
Paul F. White 95
VI
Peripheral Treatment of Acute Pain
Henrik Kehlet and Juri Lind Pedersen 103
Patient-controlled Analgesia (Part II): Update on Its
Clinical Usage
Paul F. White 109
Organization and Operation of an Acute Pain Server
L. Brian Ready 125
Use of Non-opioid Analgesic Techniques
Paul F. White 137
Pain Management in Children
Linda Jo Rice
153
Effect of Postoperative Pain on Surgical Outcome
Henrik Kehlet
167
Pain Assessment in Kids-The Fifth Vital Sign
Linda /0 Rice 173
Complications and Relative Safety of Regional Anesthesia in
Children
Lynn M. Broadman 185
Pediatric Sedation Challenges Outside the Operating Room
Linda /0 Rice 205
Spinal Opioids: Clinical Applications for Acute and Chronic Pain
Suellen M. Walker, Michael f. Cousins, and Daniel B. Carr 217
Epidural Steroids
Alan P. Winnie 237
vii
Mechanisms and Treatment of Spinal Cord Injury Pain: An
Update
Philip J. Siddall, David A. Taylor, and Michael J. Cousins 247
Prevention of Post-Herpetic Neuralgia
Alon P. Winnie 263
Update on Anatomy, Physiology and Pharmacology of Epidural
Neural Blockade
Michael J. Cousins and Bernadette T . Verring 277
The Interface Between Acute and Chronic Pain Management
L. Brian Ready 295
Radiation Safety for the Pain Physician and the Use of a Laser
Guided C-arm to Facilitate Pain Block Placements
Lynn M. Broadman 303
Preface
Michael A. Ashburn, M.D.
Pain contains the refresher course manuscripts of the 43rd Annual
Postgraduate Course in Anesthesiology which took place at the Cliff
Conference Center in Snowbird, Utah on February 20-24, 1998. The chapters
reflect recent advances in the understanding of the basic science and clinical
management of pain. Sections on basic science related to pain processes as
well as sections on the clinical management of acute, chronic, cancer-related,
and pediatric pain are included. Each chapter represents a focused summary
of the salient points pertaining to the subject of interest and has been edited
only to the extent necessary to produce a coherent book.
The purposes of this textbook are to 1) act as a reference for the
individuals attending the meeting and 2) serve as a concise review of the
topic for those unable to participate in the meeting. Each presentation is
intended to stand by itself, but the views expressed by the multiple authors
offer the reader the opportunity to understand the multifaceted aspect of this
field.
This textbook is the sixteenth in a continuing series documenting the
proceedings of the postgraduate course in Salt Lake City. We hope that this
series continues to serve as a resource to document the continuing evolution
of anesthesiology and pain management.
ix
T. H. Stanley et al. (eds.), Pain Management and AnestheSiology, ix.
© 1998 Kluwer Academic Publishers.
LIST OF CONTRIBUTORS
Allan Basbaum, PhD
Department of Anatomy, University of California, San Francisco, San Francisco,
California, U.S.A.
Lynn M. Broadman, M.D.
Departments of Anesthesiology and Pediatrics, West Virginia University,
Morgantown, West Virginia, U.S.A.
Daniel B. Carr, MD, PhD
Departments of Anaesthesia and Medicine
Tufts University School of Medicine, New England Medical Center, Boston,
Massachusetts, U.S.A.
Michael J. Cousins, AM, MBBS, MD, FRCA, FANZCA
Department of Anesthesia and Pain Management, University of Sydney, Royal
North Shore Hospital, St. Leonards, NSW, Australia
Talmage D. Egan, MD
Department of Anesthesiology, University of Utah School of Medicine, Salt Lake
City, Utah, U.S.A.
Gerald F. Gebhart, PhD
Department of Pharmacology, The University of Iowa College of Medicine, Iowa
City, Iowa, U.S.A.
Henrik Kehlet, MD, PhD
Department of Surgical Gastroenterology, Hvidovre University Hospital,
Hvidovre, Denmark
Juri Lindy Pedersen, MD
Department of Surgical Gastroenterology, Hvidovre University Hospital,
Hvidovre, Denmark
L. Brian Ready, MD
Acute Pain Service, University of Washington School of Medicine, Seattle,
Washington, U.S.A
Linda Jo Rice, MD
Anesthesia Specialists, St. Petersburg, Florida, U.S.A.
xi
xii
Philip J. Siddall, MBBS, PhD, MMed (Pain Management)
Department of Anesthesia and Pain Management, University of Sydney, Royal
North Shore Hospital, St. Leonards, NSW, Australia
David A. Taylor, MA (Hons), MAppliedSc, PhD
Department of Anesthesia and Pain Management, University of Sydney, Royal
North Shore Hospital, St. Leonards, NSW, Australia
Bernadette T. Verring, MD, PhD
Department of Anaesthesiology, University of Leiden, Leiden, The Netherlands
Paul F. White, PhD, MD, FFARACS, FANZCA
Department of Anesthesiology and Pain Management, The University of Texas
Southwestern Medical Center at Dallas, Dallas, Texas, U.s.A.
Suellen M. Walker, MBBS, FANZCA
Department of Anesthesia and Pain Management, University of Sydney
Royal North Shore Hospital, St. Leonards, NSW, Australia
Alon P. Winnie, MD
Department of Anesthesiology and Critical Care, Cook County Hospital,
Chicago, Illinois 60612
