(TALwIN| is the N-dimethylallyl analogue of phenazocine. It has weak narcotic antagonistic effects as well as moderately strong analgesic properties when given either by mouth or parenterally3 During the past five years, pentazocine has undergone clinical trials and appears to provide satisfactory analgesia in a broad range of pain syndromes? -4 Originally, the dose recommended for parenteral administration was two to three times that of morphine 6 but, with more experience, it appeared that three to five times was a more realistic requirement. This higher dose level had some disadvantages. ~ Following a careful study in animals and in human volunteers, 7-1~ it appeared to us that pentazocine might be useful as a supplement to balanced anaesthesia because it was claimed that it seldom caused addiction, and both respiratory depression and psychic side effects were not prominent, n-~4 This report deals with our clinical evaluation of pentazocine as a supplement to balanced anaesthesia for major abdominal surgery in relatively poor-risk patients.
MATElalALS AND METHODS
Clinical managementInformed consent for the study was obtained from each patient. Premedication was with atropine 0.3 mg and scopolamine 0.3 mg subcutaneously one hour before surgery. Upon arrival in the operating room, blood samples were drawn, an electrocardiogram recording taken, and an intravenous infusion of lactated Ringer's solution started.After vital signs were obtained and recorded, 30 patients were induced with repeated serial intravenous injections of 30 mg pentazocine at one-to two-minute intervals. When an alteration in vital signs (respiration, blood pressure or state of awareness) indicated drug effect, nitrous oxide-oxygen (2--3:1) by face mask was introduced until the patient was judged to be anaesthetized. Succinylcholine (100 mg) was then administered intravenously and endotracheal intubation was accomplished. The patient was then connected to a mechanical respirator set to produce a tidal volume of 10 ml/kg at a rate of 15 to 18 per minute. During maintenance, pentazocine was administered intravenously in 30 mg increments. A dilute infusion of succinylcholine (0.1 per cent) was used to maintain muscle relaxation. Whole blood or packed red cells and electrolyte infusions were administered as indicated. No dextrose solution was given. Pentazocine and succinylcholine administration were discontinued as soon as the abdominal fascia was closed.
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