Use Of Oral Analgesics Research Articles

Clonidine Added to a Continuous Interscalene Ropivacaine Perineural Infusion to Improve Postoperative Analgesia: A Randomized, Double-Blind, Controlled Study

Although clonidine has been shown to increase the duration of local anesthetic action and prolong postoperative analgesia when included in single-injection nerve blocks, the only controlled investigation of the efficacy of this practice to improve analgesia for continuous perineural local anesthetic infusion failed to discern any clinically relevant benefits. For this study, we used a larger dose of clonidine in an attempt to improve analgesia. Patients (n = 20) undergoing moderately painful orthopedic surgery of the shoulder received an interscalene brachial plexus block (40 mL of mepivacaine 1.5%, epinephrine 2.5 microg/mL, and clonidine 50 microg) and a perineural catheter before surgery. After surgery, ropivacaine 0.2% or ropivacaine 0.2% plus clonidine 2 microg/mL was delivered via the catheter for 3 days (basal rate, 5 mL/h; patient-controlled bolus, 5 mL; lockout, 1 h). Investigators and patients were blind to random group assignment. The primary outcome variable was designated as the most intense pain during the day after surgery. Secondary end-points included additional pain scores, patient-controlled bolus doses, oral analgesic use, sleep quality, and catheter- or infusion-related complications. There were no statistically significant differences between groups for any of the variables investigated. We conclude that adding clonidine 2 microg/mL to a ropivacaine interscalene perineural infusion does not decrease breakthrough pain intensity the day after surgery. For the additional end-points, our negative findings are only suggestive of a lack of effect and require further study for verification.

Proximal humeral fractures with minimal displacement treated conservatively.

We reviewed 27 patients with a minimally displaced proximal humeral fracture treated conservatively after a mean follow-up of 25 (12-34) months. All fractures had united. Patients were evaluated using the Constant-Murley scoring system, and isokinetic muscle strength was tested using a Cybex dynamometer. Finally, all shoulders were examined ultrasonographically. The mean Constant score for all patients were 81 (54-100). Twenty-three patients had no or only mild pain, while three had moderate and one severe pain necessitating regular use of oral analgesics. Twenty patients were able to perform all activities of daily living, but seven had mild trouble in overhead activities and weight carrying. Only in one patient, the abduction peak torque equalled the one of the opposite shoulder. In all other patients, the peak torque was lower than, and in 14 patients below, 50%. In nine patients, rotator cuff tears were seen at ultrasonography.

Evidence for and against the use of opioid analgesics for chronic nonmalignant low back pain: a review.

Opioid analgesics are very effective for treating pain, but their chronic use in nonmalignant conditions is controversial. Low back pain is a common condition, and chronic low back pain (CLBP) is the most frequent regional pain syndrome in the United States. This article reviews the evidence for and against the use of chronic opioid analgesic therapy (COAT) for patients with CLBP unrelated to cancer. A literature review was conducted looking for reports of oral or transdermal opioid analgesic therapy for CLBP. There are very few randomized controlled trials of COAT for CLBP. The scant evidence that is available suggests that over the short-term, COAT is helpful with patients with CLBP. In the published reports, most of which are brief in duration, COAT is associated with moderate side effects but a low risk of abuse or drug addiction. COAT was not associated with adverse long-term sequelae. Longer-acting opioid analgesics may be preferable to shorter-acting agents. Patient selection and close follow-up are critical to good outcomes. There is a place for the use of chronic oral or transdermal opioid analgesics in the treatment of some patients with CLBP.

Effectiveness of perioperative bupivacaine infiltration in tonsillectomy patients

Purpose: To determine the effectiveness of perioperative local anesthesia in tonsillectomy patients. Design: Two-group prospective, blinded, randomized study. Patients in one group received a local infiltration of 10 mL 0.5% bupivacaine solution, and in the other group they were infiltrated with 10 mL of normal saline. Results: Thirty-four adults agreed to participate in the study over a 2-year period, with 20 patients returning completed questionnaire forms. Regarding pain intensity over a 10-day period, oral analgesic use after surgery, and oral intake after surgery, there were no differences between the two groups, with P values of.25,.32, and.34, respectively. Conclusion: The effect of perioperative local marcain infiltration in tonsillectomy patients was similar to placebo. (Am J Otolaryngol 2002;23:76-80. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Laparoscopic ureterolithotomy: technical considerations and long-term follow-up.

To analyse the technical details and the long-term results of laparoscopic ureterolithotomy. Laparoscopic ureterolithotomy was undertaken in 101 patients between 1991 and 2001; in only one patient with retroperitoneal fibrous adhesions was the procedure transperitoneal, being retroperitoneal in all the others, using Gaur's balloon retroperitoneoscopy. The mean (range) stone size was 16 (10-47) mm, and the stones were in the upper ureter in 75, mid-ureter in 11 and lower ureter in 15 patients. Nine patients had more than one stone, the maximum being six, in a megaureter. Most were impacted for > 2 months, the maximum being 240 months. Laparoscopic ureterolithotomy was successful in 93 patients, with the eight failures being mostly early in the series. The mean operative duration was 79 min (66 min when the ureter was left open and 92 min when it was sutured). The overall mean duration of urinary leakage was 5.5 days, which was reduced to 3.2 days by stenting and suturing the ureter. The mean (range) blood loss was 25 (5-100) mL. The overall complication rate was high (31%) because of prolonged urinary leakage in 20 patients. No patient required morphine for pain relief and the mean for oral analgesic use was 2.5 days. The mean hospital stay was 3.5 days and that for resuming work 14 (7-28) days. Laparoscopic ureterolithotomy by the retroperitoneal approach is a safe and reliable minimally invasive procedure. Although its role as a salvage procedure for failed extracorporeal shock wave lithotripsy and ureteroscopy is undisputed, in selected patients with large chronically impacted ureteric stones and particularly with solitary kidneys, it may be considered the first-line treatment.

A randomized comparison of postcesarean pain between closure and nonclosure of peritoneum

Objective: To compare the intensity of postcesarean pain between closure and nonclosure of peritoneum in the women with a midline incision and one previous cesarean section. Study Design: The setting was an obstetrics unit of a university teaching hospital. A double-blind randomized trial was performed on 60 pregnant women with a midline incision and one previous cesarean section who underwent elective repeated cesarean section. Thirty women each were allocated to the “closure” group and the “nonclosure” group. The principal outcome measure was the postcesarean pain assessed by visual analog scale (VAS). Results: There was no difference in postoperative pain for closure and nonclosure of peritoneum groups in repeated cesarean patients; while resting ( P=0.8), while moving in bed ( P=0.94), and while walking ( P=0.52). The use of opiate ( P=0.27) and oral analgesics ( P=0.37) also suggested no difference. No differences were found in duration of the operation, incidence of postoperative complications, time of returned bowel function, and length of the hospital stay. Conclusion: The VAS showed no difference in postcesarean pain between closure and nonclosure of peritoneum.

Hysteroscopy in 2001: a comprehensive review.

Keywords: diagnostic hysteroscopy; endometrial ablation; hysteroscopic metroplasty; hysteroscopic myomectomy; outpatient hysteroscopy

Outcomes of Therapeutic Selective Nerve Root Blocks for Whiplash Induced Cervical Radicular Pain

This study was designed to investigate the clinical efficacy of fluoroscopically guided therapeutic cervical selective nerve root blocks (SNRBs) in patients with whiplash induced cervical radicular pain. Study design was restrospective with independent clinical review. Twenty two patients were included. Each patient met specific physical examination criteria and failed to improve clinically after at least four weeks of physical therapy and the use of oral analgesics. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic cervical SNRB. Patients were excluded for radiographic evidence of a focal disc protrusion or foraminal stenosis at the symptomatic level. Therapeutic cervical SNRBs were administered in conjunction with physical therapy. Data collection and analysis were performed by an independent clinical reviewer. Outcome measures included VAS pain scores, work status, medication usage, and Oswestry disability scores. Results showed the patients' symptom duration prior to diagnostic injection averaged 6 months. An average of 2.1 therapeutic injections was administered. Follow up data collection transpired at an average of 33.3 weeks following the final therapeutic injection. Good or excellent results were observed in 14% of patients. In higher functioning individuals a significantly greater (F=.0427) improvement in pain of 48.9% was observed. In these initial findings suggest that fluoroscopically guided therapeutic SNRBs, except possibly for higher functioning individuals, are not effective in the treatment of whiplash induced cervical radicular pain.

Therapeutic zygapophyseal joint injections for headaches emanating from the C2-3 joint.

To report our experience using fluoroscopically guided therapeutic intra-articular C2-3 zygapophyseal joint injections in patients with chronic headaches after a whiplash event. Restrospective study (n = 18 patients) with independent clinical review. Each patient experienced persistent daily headache symptoms which failed to improve after at least 3 mo of physical therapy, activity restriction, and the use of oral analgesics. Each patient demonstrated initially a positive response to a diagnostic intra-articular C2-3 joint injection. Data collection and analysis were performed by an independent clinical reviewer. Outcome measures included headache frequency, medication usage, symptom response to medication, and employment status. Patients' symptom duration before diagnostic injection averaged 34 mo. Follow-up data collection transpired at an average of 19 mo after the final therapeutic injection. In 61% of patients, fewer than three headaches were experienced each week; these headaches were relieved with the use of oral analgesics. Although the inherent limitations of this study preclude a definitive statement regarding the efficacy of C2-3 injections, these initial findings suggest that therapeutic intra-articular zygapophyseal joint injections are effective in the treatment of headaches emanating from the C2-3 joint after a whiplash event. Future controlled, prospective studies are necessary to clarify the role of such injections in this challenging patient population.

Efficacy and tolerability of celecoxib versus hydrocodone/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults

Background: Current outpatient management of postoperative pain includes the use of oral opioid analgesics or nonsteroidal anti-inflammatory drugs; however, both types of medications are associated with side effects that can limit their usefulness in the outpatient setting. Objective: Two studies with identical protocols assessed the single- and multiple-dose analgesic efficacy and tolerability of celecoxib, a specific cyclooxygenase-2 inhibitor, in the treatment of acute pain after orthopedic surgery. Methods: These were multicenter, randomized, placebo- and active-controlled, double-blind, parallel-group trials conducted between January and June 1998. Both consisted of a single-dose assessment period (SDAP) and a multiple-dose assessment period (MDAP). In the SDAP, patients who had undergone orthopedic surgery received a single oral dose of celecoxib 200 mg, hydrocodone 10 mg/acetaminophen 1000 mg, or placebo within 24 hours after the end of anesthesia, with pain assessments conducted over the following 8-hour period. In the MDAP, extending from 8 hours after the first dose of study medication up to 5 days, patients who had received ≤1 dose of rescue medication during the SDAP continued on study medication (placebo recipients were rerandomized to active treatment), which could be taken up to 3 times a day as needed. Results: A total of 418 patients were enrolled in the 2 trials. During the SDAP, 141 patients received celecoxib, 136 received hydrocodone/acetaminophen, and 141 received placebo. During the MDAP, 185 patients received celecoxib and 181 received hydrocodone/acetaminophen. When the combined data were analyzed, mean pain intensity difference (PID) scores generally favored the active treatments over placebo from 1 to 6 hours (with the exception of 1.5 hours) after dosing ( P ≤ 0.016) and favored celecoxib over the other treatments at 7 and 8 hours after dosing ( P < 0.001). The active treatments demonstrated superior summed PID scores through 8 hours ( P < 0.001), significantly shorter median times to onset of analgesia ( P < 0.05), and significantly longer median times to first use of rescue medication ( P < 0.05). During the MDAP, more hydrocodone/acetaminophen-treated patients (20%) than celecoxib-treated patients (12%) required rescue medication ( P < 0.05), and the celecoxib group had significantly lower maximum pain intensity scores ( P < 0.001, days 2–5), required fewer doses of study medication ( P ≤ 0.01, days 3–5), and had superior scores on a modified American Pain Society Patient Outcome Questionnaire ( P ≤ 0.013). In addition, a significantly lower proportion of celecoxib-treated patients experienced adverse events (43%) compared with hydrocodone/acetaminophen-treated patients (89%; P < 0.001). Conclusions: Over 8 hours, patients with moderate to severe pain after orthopedic surgery experienced comparable analgesia with single doses of celecoxib and hydrocodone/acetaminophen. Over a 5-day period, oral doses of celecoxib 200 mg taken 3 times a day demonstrated superior analgesia and tolerability compared with hydrocodone 10 mg/acetaminophen 1000 mg taken 3 times a day. Most patients required no more than 2 daily doses of celecoxib 200 mg for the control of their postorthopedic surgical pain.

A comparison of bupivacaine-fentanyl-morphine with bupivacaine-fentanyl-diamorphine for caesarean section under spinal anaesthesia

In a randomised double-blind trial, postoperative analgesia and side effects of intrathecal morphine 0.1mg and intrathecal diamorphine 0.25mg were compared. Sixty women were randomised to receive intrathecal injection of 12.5mg hyperbaric bupivacaine and 12.5μg fentanyl with either morphine 0.1mg (group M), or diamorphine 0.25mg (group D). All women received 100mg diclofenac rectally at the end of surgery and were given intravenous morphine via a patient controlled analgesia (PCA) system. Pain, PCA morphine usage and side effects were assessed at 2, 4, 8 and 24h after spinal anaesthesia. The two groups were comparable for quality of intraoperative analgesia. There were no significant differences between the groups in time to first PCA demand, morphine consumption or oral analgesic use in each time period. Significantly more patients in group M were nauseated at 4h whilst at 24h nausea was significantly worse in group D. There was no significant difference between the groups in the number of women vomiting in the 24-h period. The two groups were comparable for pruritus and drowsiness. We conclude that 0.25mg subarachnoid diamorphine is a suitable alternative to 0.1mg morphine for post caesarean section analgesia.

Botulinum toxin (Dysport®) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study

OBJECTIVETo define a safe and effective dose of Dysport for treating hip adductor spasticity.METHODSPatients with definite or probable multiple sclerosis, and disabling spasticity affecting the hip adductor muscles of both...

Obstructive sleep apnea surgery: Risk management and complications

BACKGROUND: Hypoxemia, hypertension, airway obstruction, and death have been associated with surgery for obstructive sleep apnea syndrome (OSAS). Patient analysis was undertaken to identify potential factors that could affect risk-management outcome. METHODS: One hundred eighty-two consecutively treated patients with OSAS undergoing 210 procedures were evaluated. Fifty-four factors were analyzed. RESULTS: Group characteristics included a mean age of 48.2 years, a mean respiratory disturbance index of 42.3, and a mean low oxyhemoglobin desaturation (LSAT) of 77.5%. Surgery included a combination of uvulopalatopharyngoplasty (162 patients; 77%) and maxillofacial procedures (173 patients; 82%). Patients with a respiratory disturbance index greater than 40 and an LSAT less than 80% (117 patients; 64%) were maintained on nasal continuous positive airway pressure. Thirty-nine patients (18.6% had difficult intubations. There was a positive correlation ( p > 0.001) of difficult intubations, neck circumference (>45.6 cm) and skeletal deficiency (Sella-Nasion-Point B < 75 degrees). All tubes were removed with the patient awake in the operating room with two transient episodes of airway obstruction. One hundred forty-eight of the patients (70.5%) required postoperative intravenous antihypertensive medications. Patients with a preoperative history of hypertension had a significantly increased risk ( p > 0.01) of requiring intraoperative and postoperative intravenous antihypertensive medications. The mean hospital stay was 2.2 days (SD ± 0.9). Analgesia was achieved with intravenous morphine sulfate or meperidine HCl (intensive care unit) and oral oxycodone (non-intensive care unit). There were no significant oxyhemoglobin desaturations, irrespective of severity of OSAS or obesity (mean LSAT day 1, 94.8% [SD ± 2.4]; mean LSAT day 2, 95.5% [SD ± 1.6]). Complications included postoperative bleeding ( n = 4), infection ( n = 5), seroma ( n = 3), arrhythmia ( n = 4), angina ( n = 1), and loss of skeletal fixation ( n = 1). CONCLUSION: Intraoperative airway risks can be reduced by use of fiberoptic intubation in patients with increased neck circumference and skeletal deficiency. Patients with OSAS are at a significantly increased risk for hypertension. Nasal continuous positive airway pressure eliminated the postoperative risk of hypoxemia, which allowed the use of adequate parenteral or oral analgesics. (Otolaryngol Head Neck Surg 1997;117:648-52.)

Obstructive sleep apnea surgery: risk management and complications.

Hypoxemia, hypertension, airway obstruction, and death have been associated with surgery for obstructive sleep apnea syndrome (OSAS). Patient analysis was undertaken to identify potential factors that could affect risk-management outcome. One hundred eighty-two consecutively treated patients with OSAS undergoing 210 procedures were evaluated. Fifty-four factors were analyzed. Group characteristics included a mean age of 48.2 years, a mean respiratory disturbance index of 42.3, and a mean low oxyhemoglobin desaturation (LSAT) of 77.5%. Surgery included a combination of uvulopalatopharyngoplasty (162 patients; 77%) and maxillofacial procedures (173 patients; 82%). Patients with a respiratory disturbance index greater than 40 and an LSAT less than 80% (117 patients; 64%) were maintained on nasal continuous positive airway pressure. Thirty-nine patients (18.6% had difficult intubations. There was a positive correlation (p > 0.001) of difficult intubations, neck circumference (> 45.6 cm) and skeletal deficiency (Sella-Nasion-Point B < 75 degrees). All tubes were removed with the patient awake in the operating room with two transient episodes of airway obstruction. One hundred forty-eight of the patients (70.5%) required postoperative intravenous antihypertensive medications. Patients with a preoperative history of hypertension had a significantly increased risk (p > 0.01) of requiring intraoperative and postoperative intravenous antihypertensive medications. The mean hospital stay was 2.2 days (SD +/- 0.9). Analgesia was achieved with intravenous morphine sulfate or meperidine HCl (intensive care unit) and oral oxycodone (non-intensive care unit). There were no significant oxyhemoglobin desaturations, irrespective of severity of OSAS or obesity (mean LSAT day 1, 94.8% (SD +/- 2.4); mean LSAT day 2, 95.5% (SD +/- 1.6)). Complications included postoperative bleeding (n = 4), infection (n = 5), seroma (n = 3), arrhythmia (n = 4), angina (n = 1), and loss of skeletal fixation (n = 1). Intraoperative airway risks can be reduced by use of fiberoptic intubation in patients with increased neck circumference and skeletal deficiency. Patients with OSAS are at a significantly increased risk for hypertension. Nasal continuous positive airway pressure eliminated the postoperative risk of hypoxemia, which allowed the use of adequate parenteral or oral analgesics.

Pain and depression in patients with newly diagnosed pancreas cancer.

To evaluate the prevalence of pain and depression, their correlation, and their effect on quality of life in patients with recently diagnosed adenocarcinoma of the pancreas (PC). Cross-sectional pain and psychosocial distress were assessed using validated instruments, including the Memorial Pain Assessment Card (MPAC), Beck Depression Inventory (BDI), Hopelessness Scale (BHS), and Functional Living Index-Cancer (FLIC). Patients were evaluated before their first operation for PC or first treatment with chemotherapy at a large tertiary-care cancer center. One hundred thirty patients with proven PC were studied: 83 before their operation and 47 before their first chemotherapy treatment. At the time of study entrance, 37% of patients had no pain and an additional 34% had pain that was mild or less severe. Only 29% of patients had moderate, strong, or severe pain. Chemotherapy patients reported significantly more intense pain than did preoperative patients (P = .02). Symptoms of depression were assessed using the BDI and BHS scales. A substantial minority of patients (38%) had BDI scores > or = 15, which suggests high levels of depressive symptoms. There was a significant correlation between increasing pain and depressive symptoms among those who experienced pain. Quality of life was assessed using the Weekly Activity Checklist (WAC) and the FLIC. Compared with patients who had no pain or mild pain, patients with moderate or greater pain had significantly impaired functional activity (P = .03) and poorer quality-of-life scores (P = .02) when compared with those with lesser degrees of pain. There were significant correlations between increasing pain and depression and between pain and depressive symptoms and impaired quality of life and function. Our results indicate that moderate or severe pain and symptoms of depression are not as prevalent in recently diagnosed PC patients as is generally believed. However, one third have inadequate pain control despite the use of oral analgesics. These patients can be identified by the use of a simple self-report instrument (the MPAC card). Quality of life and function are adversely affected by moderate or greater levels of perceived pain intensity. A simple and rapid assessment is possible and can identify high-risk patients in need of intervention that may improve quality of life.

The outpatient vaginal hysterectomy

The purpose of our study is to report on our initial experience with the performance of vaginal hysterectomy on an outpatient basis. Between January 1990 and February 1992 10 patients underwent vaginal hysterectomies in a freestanding outpatient surgery center. All patients were discharged the same day within 8 hours of the starting time of surgery. Patients ranged in age from 32 to 52 years and had no major medical problems. Concomitant salpingo-oophorectomies, enterocele repairs, or both were also performed on 8 of the 10 patients. All patients had benign diseases, and the uteri weighed between 75 and 142 gm. There were no intraoperative complications, and 9 of the 10 patients had an uneventful postoperative course. Although postoperative pain control was not a problem, there was some degree of postoperative nausea during the first 24 hours associated with the use of various oral and transcutaneous analgesics. Nonetheless, all 10 patients were pleased with their surgical experience. This small pilot study adds to the growing body of literature that demonstrates the safety and feasibility of performing vaginal hysterectomy (together with certain concomitant procedures) in an outpatient setting.

Improved pain management with daily nursing intervention during radiation therapy for head and neck carcinoma

This study evaluated the response to a defined mouth care and analgesic treatment protocol for oropharyngeal mucositis in patients undergoing radiation therapy for head and neck carcinoma. Nineteen patients completed a 15 question pain survey before each radiation treatment. Patients were given instructions on the use of mouthwashes and a three-step analgesic protocol: acetaminophen, acetaminophen with codeine suspension, and oral morphine (20 mg/mL) for mild, moderate, and severe pain, respectively. Patients were seen daily by a radiation therapy nurse who reviewed the survey and prompt changes in the prescribed analgesic regimen were then made by a physician. Marked differences in control of pain related to radiation mucositis were observed when compared to patients from our prior study who used the same daily survey but had only sporadic nursing intervention and no analgesic protocol. Patients having daily nursing intervention reported fewer days of moderate/severe pain, had less pain throughout the day, and noted less disturbance in sleep, eating, and energy level. Weight loss of greater than 5 kg was noted in only three patients. Analgesics were used on 77% of treatment days and relieved all or most of the pain in 94% of these days. Daily review of a symptom survey by a radiation therapy nurse, combined with a well-defined strategy for mouth care, and analgesics results in improved pain management of radiation induced oropharyngeal mucositis because of prompt attention to patient needs. Future trials should incorporate defined strategies for oral care and analgesic use to control for possible bias in assessing efficacy.

Sleep and Comfort After Caesarean Section

To compare postoperative well-being after general and epidural anaesthesia, 58 women undergoing Caesarean section were divided into a general anaesthetic group receiving intramuscular opioid postoperatively (26), and an epidural group receiving morphine via the epidural route (32). The epidural group required less analgesia (p less than 0.01 at 0.5 and 8 hours, p less than 0.001 at 4 hours). There was no difference in the use of oral analgesics. At 1, 4 and 24 hours after delivery more patients in the general anaesthesia group described themselves as very comfortable (p less than 0.05). More in the epidural group had a very good night's sleep during each night studied. Patients in the epidural group were slower to use the ward toilet (p less than 0.01) and had more itching (p less than 0.001). Our conclusion is that patients progressed well in both groups.

Sleep and comfort after Caesarean section

To compare postoperative well-being after general and epidural anaesthesia, 58 women undergoing Caesarean section were divided into a general anaesthetic group receiving intramuscular opioid postoperatively (26), and an epidural group receiving morphine via the epidural route (32). The epidural group required less analgesia (p less than 0.01 at 0.5 and 8 hours, p less than 0.001 at 4 hours). There was no difference in the use of oral analgesics. At 1, 4 and 24 hours after delivery more patients in the general anaesthesia group described themselves as very comfortable (p less than 0.05). More in the epidural group had a very good night's sleep during each night studied. Patients in the epidural group were slower to use the ward toilet (p less than 0.01) and had more itching (p less than 0.001). Our conclusion is that patients progressed well in both groups.

Analgesics and risk of coronary and other death in middle-aged men in eastern Finland.

The association between oral analgesics and the risk of death from ischaemic heart disease (IHD), cardiovascular disease, disease other than IHD, and any disease was studied in a cohort of 3551 men aged 30-59 years, based on a random sample from the population of eastern Finland. A number of potential coronary risk factors were allowed for in multiple logistic models. On the basis of these data, a regular use of oral analgesics is associated with a decreased risk of death from IHD. The relative risk was 0.6 with 95% confidence interval (CI) of 0.2-0.9 for IHD death and 0.6 (95% CI = 0.4-0.9) for cardiovascular death. No significant association was found between oral analgesics and the risk of death from diseases other than IHD.