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Appendix - Preparation of Solutions Appendix - Preparation of Solutions PREPARATION OF NEUROLYTIC SOLUTIONS - PHENOL (HYDROXYBENZENE) At 20 0 e one part phenol dissolves in 12 parts of water. Accordingly, phenol may be prepared in aqueous solution only in lower con­ centrations. If a stronger preparation is required a water-glycerin mixture is used as the solvent. Product: phenol injection 5% in glycerin Formula: phenol crystals 5 g glycerin (previously dried at 120 0 e and cooled) to 100 g Method o/preparation: Dissolve the phenol in glycerin with the aid of gentle heat. Whilst still warm pass through a No.3 sintered glass filter. Packaging: Pack in 2 ml or 5 ml ampoules. Protect from light. Store in a cool place. Sterilization: Dry heat at 1500 e for 1 h. Stability: 1 year from date of manufacture. 185 186 Appendix Product: aqueous phenol 5% phenol injection 7% Formula: phenol crystals 5 g phenol crystals 7 g water for injections glycerin 50% v/v in water for injec­ to 100ml tions to 100 ml Method of preparation: Pass through sintered glass filter, pack in ampoules and sterilize by autoclaving at U5°e for 30 min. Packaging: 2 ml or 5 ml ampoules. Protect from light. Store in a cool place. Precautions: Avoid prolonged contact with rubber or plastics. Stability: 1 year from date of sterilization. INJECTION ABSOLUTE ALCOHOL Method ofpreparation: In order to avoid absorption of moisture, the infiltration procedure is best carried out under positive pressure, using solvent inert membrane filters. The preparation is then packed in 2 ml or 5 ml ampoules. Sterilization: Autoclave at 155°e for 30 min. Special precautions: Absolute alcohol absorbs moisture from the atmosphere: once the ampoule is opened the content should be used at once. Stability: 2 years from date of sterilization. PREPARATION OF ORAL MORPHINE SOLUTION Product: oral morphine 5% (1 ml = 5 g) Formula: Morphine hydrochloride or sulphate powder 5 g + disodium edetate 50 mg sodium metabisulphite 1 g benzoic acid 1 g or + distilled water to 1 L Amber glass bottles Shelf life: 6 months Preparation of Solutions 187 Method of preparation: Dissolve powder in fresh distilled water. Add preservative (chloroform water or benzoic 'acid or alcohol) to 1000 ml. Packaging: 100 ml bottle. (1 ml will contain 5 mg). Protect from light. Store in a cool place. Stability: Up to 6 weeks. PREPARATION OF EPIDURAL MORPHINE Product: Epidural morphine Formula: 1 cgjl ml vial of morphine sulphate Preparation: Dissolve in 9 ml distilled water in a sterile 10 ml syringe SALIVA REPLACEMENT SOLUTION Syrup 40ml Glycerin to 200 ml Shelf life: 1 month Glossary Afferent A nerve fibre carrying stimuli from the periphery to the central nervous system Algesic Pain causing Algogenic Pain producing Allocheiria Reference of pain to the opposite side of the body Allodynia Pain (such as referred pain) which occurs on non-noxious stimulation of normal skin Analgesia Absence of pain on noxious stimulation Antidromic Impulse transmitted opposite to the normal direction Causalgia A syndrome which follows a traumatic nerve lesion, com- prising burning pain, vasomotor and sudomotor dysfunction and eventually trophic changes Central pain Pain caused by a lesion in the CNS Commissure A band of nerve fibres which run across the midline of the cord connecting corresponding parts on each side Deafferentation Nerve cells disconnected from normal afferent input Decubitus From the posture or position when lying in bed Denervated Deprived of innervation Dysaesthesia Unpleasant, abnormal sensation Efferent A nerve fibre carrying stimuli from the CNS to the periphery Endorphinergic Nerve fibres which release endorphin 189 190 Glossary Enkephalinergic Nerve fibres which release enkephalin Hyperaesthesia Great sensitivity to any somatic stimulation Hyperalgesia Increased sensitivity to noxious stimulation Hyperpathia A painful response to a stimulus involving delayed reaction, over-reaction and after-sensation Hypoaesthesia Diminished sensitivity to any somatic stimulation Hypoalgesia Diminished sensitivity to noxious stimulation Hypotonia Reduced muscle tone Inhibition A restraining effect Lancinating Intermittent, sharp shooting or stabbing (pain) Nociceptor Nerve receptor which responds to painful stimuli Noxious Pain causing Opioids Narcotic analgesics Paraesthesia A 'pins and needles' type of disturbance of sensation Somatotopical Orderly representation of part of the body in a part of the eNS Synapse Junction between two nerve cells Index A-delta fibres II antibiotics 90, 132 abdomen 95 anticholinergics 153. 164 coeliac plexus block 122 anticoagulants and coeliac plexus block 117 surgery 99 anticonvulsants 61, 84, 85 acceptance and adjustment 170 antidepressants 27,30,61,86, 169-70 acetominophen 61,71-2 antiemetic drugs 155 activity-precipitated pain 83 anti-fungal agents 152 acupuncture 33 antihistamines 155 acute pain 9, 38, 39 antimetabolites 90 addiction 5-6 antineoplastic drugs 90 adenocarcinoma 96 antioestrogens 90 adjuvant drugs 83-8 antispasmodic drugs 158 adrenalectomy 95, 132 antitumour chemotherapy, effectiveness 92 adriamycin 90 anxiety 10, 23-5, 85 aetiology of cancer pain 131 anxiolytics 30, 61, 88 afferent fibres 10-11 ascites 100 agitation 87 surgery 99 alcohol 108 aspirin 61,70-1 solution 186 administration 70 alcohol neurolytic block dosage 69 position III hypersensitivity 70 for upper thoracic levels 116 side effects 70-1, 156 alcoholic rhizotomy 140 assessment 37-54 algogenic effect 12 ataxia 86 alkylating agents 90 atropine ISS aminocaproic acid 165 autonomic nerve block 121-2 amitryptyline 61, 84, 86 axial nervous system involvement 102-3 and glaucoma 86 analgesic ladder 62 basic drug list 61 analgesics 60-3 bedsores 179 basic list 61 biochemistry 9-21 anger 24 biofeedback 31,33 anorexia 152 bladder carcinoma 92 191 192 Index bleomycin 90 collars 179 blood transfusion 169 colorectal carcinoma 96 bone, aseptic necrosis 52 colostomy 97 bone pain 85 colovesical fistula 175 corticosteroids 87 communication 175 bone tumour 45 confusion 78, 168-9 brachial plexus 48 in terminal care 181-3 chemotherapy 96 constipation postradiation pain 52 drug-induced 78, 86 chemical neurolysis 120 treatment 159-60 bradykinin 11, 12 continuing care 64--5 brain stimulation 17 cord compression, corticosteroids 87 brain tumours 96 cordotomy 144--9 breast cancer 171 corticosteroids 61,84,86-7,95 intercostal block 118 and aspirin 87 rhizotomy 137 cough 163-4 stellate ganglion block 124 counselling 31-2 surgery 99 counter-irritation 179 breathing exercises 179 cyclophosphamide 90 bronchus, carcinoma intercostal block 118 deafferentiation 14, 83 opiates 164 stellate ganglion block 126 bupivacaine 121, 128 death buprenorphine 61,80-1 approach of 183-4 Burkitt's lymphoma 92 fear of 173-4 burning pain 12, 48 home ix epidural neurolysis 116 death-rattle 162 buttock, unilateral block III decubitus 83 butyrophenones 155 dehydration 152 depression 27,85 C-fibres 11 dermatome chart 108 Cancer Pain Relief Program 7 descending inhibitory control 15-17 candidosis 153 dexamethasone 61,84,87, 153 carbamazepine 61,84,85-6 dextropropoxyphene 61 castration, chemical 97 dosage 74 catheter, urinary 164--5 diagnosis 26 caudal block 116 diagnostic block 104 causalgia 128, 132-3 peripheral nerve 117 central nervous system 10 sympathetic 128, 133 cerebral cortex 19 diagnostic procedures 42 cerebrospinal fluid evaluation 43 diazepam 61,84,88, 162 cervical cancer 92 diclofenac 70 cervical percutaneous rhizotomy 142 dietary measures 153 cervical vertebrae 47 distraction, in terminal care 179 chemical factors 12 doctor/patient relationship 29-30 chemo-hormono-radio-therapy 94-6 dorsal column stimulation 15 chemotherapy 81-3 dorsal hom 14--15 emotional distress 24 dorsal root 13-14 postchemotherapy pain 51-2 drug-induced vomiting 155 chlorpromazine 61,84 drug interactions 61 and pethidine 80,87,153,158,169 drug list, basic 61 chondrosarcoma 92 drugs, correct use 60-3 choriocarcinoma 92 dysaesthesia 83 chronic pain 9-10,38,39 superficial pain 85 clivus metastases 46 dying patient 173-84 codeine 61 assessment 40 dosage 73 communication 175 for cough 164 prognosis 175-6 coeliac plexus block technique 120-4 teamwork 174--5 cold and heat 179 treatment 177-8 Index 193 dyspeptic symptoms 87 hospital, referral xii dysphagia 153-4 hydromorphine 61 dyspnoea 16<}-2 hydroxyzine 61,84,88 hyoscine 155, 162 electrical stimulation 147 hypercalcaemia 156-7 emotional disorders 23-33 hypnotics, for insomnia 167 management 29-33 hypnotherapy 31,32,179 and surgery 130 hypomania 87 endocrine glands, ablation 100 hypophysectomy 95,149 enemas 159 ephedrine 124 ibuprofen 70 epidural catheter II9 image intensifier epidural neurolysis II7-19 percutaneous cordotomy 146 epidural space identification 118 spinal rhizotomy 142 examination of patient 42 stellate ganglion block 126 exercise in terminal care 178-9 trigeminal rhizotomy 139 expectorants 163 immobilization 179 extremities, surgery of tumours of the 101 impotence 29 incontinence face, alcohol block 121 after subarachnoid block 114 faecal softeners 160 treatment 164-5 family, care of 180-1 indomethacin 70, 168 family in terminal care 180 inhalations for cough 163 fistulae 165-75 inhibitory control 15-17 Floriani Foundation ix insomnia 167-8 5-fiuorouracil 90 intercostal nerve block 118 fracture, pathological 104 intestinal obstruction 158 surgery 101 intestinal occlusion 95 fungating tumours 166-7 surgery 99 intracranial pressure, raised 85,87, 157-9 gall bladder, coeliac plexus block 122 intra-orbital neurectomy 135 gastric distension pain 85 intrathecal
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