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Re: Analgesics » cubbybear

Posted by ed_uk on March 18, 2005, at 8:18:29

In reply to Re: Analgesics Shoulder injury » ed_uk, posted by cubbybear on March 18, 2005, at 5:00:44

Hi cubbybear!

>My biggest fear is being told that I'll need surgery--not least of which is because I'm taking Parnate and that raises all sorts of issues vis a vis anaesthesia.

Did you read my posts to ace about MAOIs/anesthesia? I posted a few days ago.

Some drugs used in anesthesia need to be avoided but others are safe, there are *many* myths surrounding MAOIs and anesthesia/drug interactions. Some of the drugs listed as interactions don't really interact at all!

Parnate may increase the incidence of hypotension during general anesthesia, the doses of drugs used to treat the hypotension would need to be carefully titrated. Some 'pressors' are best avoided, others are safe.

Pethidine (meperidine) and tramadol shouldn't be combined with MAOIs, there are many alternatives though, that's not an issue. You'd need to make sure that all the important interactions were written all over your drug chart!

I know it could be very difficult in Thailand though, I remember you saying that no one was knowledgeable about MAOIs. If you *could* find an anesthetist who was knowledgeable about MAOIs, you almost certainly wouldn't need to discontinue the Parnate.

>No, there's never pain at rest, but only during certain movements, such as bringing the arm up and out to a horizontal or vertical position.

Pain that occurs on movement (incident pain) doesn't usually respond well to opioids, including oxycodone and morphine. There are usually more effective alternatives :-)

>Voltaren --NSAID pills, generally as needed, at most 50-100 mg/day

We call it Voltarol here, we do use imported Voltaren though, it's common practice in the UK for pharmacies to import drugs from elsewhere in the European Union, especially Belgium, Spain and Greece - where drugs are sold more cheaply.

You'd probably need about 50mg diclofenac three times a day, this is a common for musculo-skeletal pain, a lower dose might be adequate if you are over 65. At 50mg 3x a day, some analgesia may appear straight away. If significant inflammation is present, the full effects can take up to three weeks to develop. Diclofenac is often a good choice for musculo-skeletal pain.

Did you have any side effects from Voltaren when you took it before? Have you asked your doctor whether it is safe to take a higher dose?

I see you are worried about gastric side effects.
Are you at high risk....

1. Over 65.

2. History of peptic ulcers (stomach or duodenal) or bleeding of the gastrointestinal tract.

3. Takes a corticosteroid eg. prednisone, prednisolone.

4. History of H. Pylori infection, even if eradicated.

If any of the above apply to you, a gastro-protective drug would be advisable. Lansoprazole is a popular choice, I think it's called Prevacid in Thailand, we call it Zoton!

If you don't want to take a higher dose of diclofenac, you could consider combining a low dose of diclofenac with a standard dose of acetaminophen (paracetamol).

>Myonal--muscle relaxant --as needed about 50-100 mg. day

I just looked this drug up: eperisone, I hadn't heard of it before, very interesting. It looks like it's only available in the Far East. It said the usual dose was 50mg three time a day. Is it helping?

Baclofen (Lioresal) can be a useful drug for severe muscle spasm. 5-10mg baclofen three times a day is a common dose for pain associated with injuries. As is the case with incident pain, pain due to muscle spasm doesn't usually respond that well to opioids.

Best regards,
Ed.


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