Submited on: 31 Jan 2012 06:34:26 PM GMT
Published on: 01 Feb 2012 07:51:29 PM GMT
In reply to Author's comment
Posted by Dr. Tudor A Codreanu on 10 Apr 2012 06:24:21 PM GMT

Dear Colleague,

I value your posted comment. Generally speaking, in disaster medicine, one should not set up systems which were not there before the event, or, if such systems are set, an exit strategy should be also designed, ideally before the setting up of the up-graded system. As such, one would argue that (medium/long term) opiate and opiod analgesia should have not been offered in the first place. This would be in line with the WHO recommendation for oral medications and not intravenous ones, as for example in the deployment  as response to the floods in Pakistan. The use of opiate and opioid analgesia in soldiers is different as "their" home health system would offer such medications normally. From a medical point of view then, the following question arises: if the amount of opiate / opioid analgesia was given in such amounts that the patient became dependent (not tolerant!), then one should wonder if the underlying cause of the pain was treated appropriately.

Going back to the article posted, I do not seem to find any discussion about opiate / opioid analgesia, for the discussion is about the reduction in consumption of paracetamol...

 

 

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In reply to Dr. Tudor A Codreanu
Posted by Dr. Francesco Lauretta on 10 Apr 2012 10:32:10 PM GMT

Dear Colleague,

 

first of all, I'd like to thank you for your interest into my short article. Secondly, it would be my pleasure to underline something about my experience during disaster events. Believe or not, when we are called to treat patients injured during disaster events ( earthquakes, wars and so on), several times we must fight against opioid dipendance! Our experience suggest us that there are big problems concerning the management of acute pain during disaster events! I agree with you when you assert that (medium/long term) opiate and opiod analgesia should have not been offered in the first place.  Surely, I notice that the amount of opiate / opioid analgesia is given in such amounts that the patient become dependent , and surely pain is not treated appropriately!

When we worked in Haiti, we experienced a better pain management for the first time. That's the reason why we tried to investigate if a multimodal pain management involving also the utilization of the hyperbaric chamber, would have played a significative role.

Unfortunately in our study, we focused our attention exclusively on soft tissue injuries on the limbs. In fact, those wounds were treated most frequently. We were able to focus our attention only on paracetamol just for this methodological reason (you know that soft tissue injuries are treated with NSAIDS and not with opioids). But through the demonstration of a reduction in paracetamol consumption, we intended to show a reduction in analgesic consumption. Obviously our intent is to stimulate for further investigations with opioid. Our study can be only a first step.

We believe that a multimodal way for the management of acute pain involving also the hyperbaric chamber, could lead to a reduction of inappropriate opioid administrations also during disaster events. Moreover, that's  the reason why I decided to submit my article in the disaster medicine section.

Thank you for your precious attention again....I hope to learn a lot from you and I'am looking forward to receiving your new reply.

Best regards.

 

Francesco Lauretta

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Opioid
Posted by Dr. Gabriel Conca on 15 Apr 2012 01:18:18 PM GMT

It would be interesting to conduct a trial with opioid. Literature is full of studies about hyperbaric and analgesic effect conducted on mice, if I remember well. This study is interesting for the unusual application of hyp. oxyg. therapy.

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    I practice anaesthesia

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