虚拟现实技术对脑卒中患者偏瘫上肢肱二肌和肱三头肌表面肌电的影响

目的分析虚拟现实技术(VR)用于脑卒中患者偏瘫上肢肱二肌、肱三头肌康复训练中的效果。方法收集脑卒中偏瘫上功能障碍患者60例,按康复治疗方法不同分为观察组和对照组,均给予常规康治疗,观察组另进行虚拟厨房上肢训练治疗,行前瞻性研究。两记录两组治疗前后患侧肘关节最大屈曲和伸展程度时肱二头肌、肱三头肌表面肌电图,计算肘关节屈伸最大等长收缩时力矩和协同收缩率(CR)。记录治疗前后两组改良Barthel指数分值。结果力矩比较:两组治疗后肘屈伸力矩均明显提高,治疗前后肘伸展力矩差值方面,观察组差值较对照组更大,差异均有显著性(P0.05)。CR比较:治疗后两组患者肘屈曲时肱二头肌和肱三头肌CR均明显降低;观察组肱三头肌CR改善率明显高于对照组,差异均有显著性(P0.05)。改良Barthel指数比较:治疗后观察组分值明显高于对照组,差异有显著性(P0.05)。结论在常规康复训练基础上开展虚拟现实技术厨房模拟康复训练能提高脑卒中上肢偏瘫患者患肢肘伸展力量,增强肘关节屈伸运动肌肉协调性,有利于提高患者日常生活能力。     

分级运动想象联合常规作业治疗对脑卒中后偏瘫患者上肢运动功能的影响

目的 观察分级运动想象（GMI）疗法联合常规作业治疗对脑卒中偏瘫患者上肢运动功能的疗效。 方法 将符合入选标准的30例脑卒中后偏瘫患者按随机数字表法分为对照组15例和GMI组15例。对照组患者给予常规药物、常规物理治疗和常规作业治疗（每日1 h），GMI组患者则在对照组常规药物、常规物理治疗方案的基础上，将常规作业治疗由每日1 h降为每日30 min，另增加每日30 min的分级运动想象疗法。于治疗前、治疗4周后（治疗后）分别采用上肢Fugl-Meyer评定量表（FMA-UE）、组块测试（BBT）、上肢和手Brunnstrom分期量表对2组患者的上肢运动功能恢复情况进行评估，同时采用表面肌电图检测2组患者患肘最大等长屈曲、伸展时肱二头肌、肱三头肌积分肌电值，并计算相应的共同收缩率（CR）。 结果 治疗后，2组患者的FMA-UE评分、上肢Brunnstrom分期、手Brunnstrom分期、BBT以及患肘屈曲时肱二头肌CR和患肘伸展时肱三头肌CR与组内治疗前比较，差异均有统计学意义（P<0.01），且GMI组治疗后的FMA-UE评分、上肢Brunnstrom分期、手Brunnstrom分期、BBT以及患肘屈曲时肱二头肌CR和患肘伸展时肱三头肌CR分别为（40.53±5.48）分、（3.67±0.72）分、（3.00±0.54）分、（4.47±1.13）个、（14.97±4.09）%、（29.42±6.04）%，与对照组治疗后比较，差异均有统计学意义（P<0.05）。 结论 分级运动想象疗法联合作业治疗可有效地改善脑卒中患者上肢运动功能。     

虚拟现实技术对脑卒中患者偏瘫上肢肱二、三头肌表面肌电的影响

目的:观察虚拟厨房上肢康复训练结合常规作业治疗对脑卒中恢复期患者偏瘫上肢肱二、三头肌表面肌电的影响.方法:将33例脑卒中恢复期偏瘫上肢功能障碍的患者随机分为治疗组(16例)和对照组(17例).对照组接受常规作业治疗每次40min,每日1次,每周5次,共3周.治疗组接受常规作业治疗和虚拟厨房上肢康复训练各20min,共40min/次,每日1次,每周5次,共3周.其余康复治疗如运动疗法和日常生活活动训练等两组均相同.两组患者分别于治疗前、治疗后在患侧肘关节屈曲、伸展最大等长收缩时记录肱二、三头肌的表面肌电图,计算肘关节屈伸力矩及相应的协同收缩率.结果:两组患者治疗后患肘屈曲、伸展力矩均较治疗前提高,肱二、三头肌的协同收缩率均较治疗前降低(P＜0.05);与对照组相比,治疗组患者患肘伸展力矩提高的幅度更大,肱三头肌协同收缩率降低的程度更明显(P＜0.05).结论:虚拟厨房上肢康复训练结合常规作业治疗能更好地增强脑卒中恢复期患者偏瘫上肢伸肘力量、改善肘关节屈伸运动的协调性.sEMG结合力矩测量能更全面评估偏瘫肢体功能状态.     

虚拟现实游戏训练对脑卒中患者偏瘫上肢功能恢复的影响

目的 探讨虚拟现实游戏训练对脑卒中患者偏瘫上肢功能恢复的影响。 方法 采用随机数字表法将30例脑卒中偏瘫患者分为治疗组（15例）及对照组（15例）,2组患者均给予常规药物治疗及物理治疗,治疗组在此基础上给予Wii（任天堂）虚拟现实游戏训练,对照组则辅以常规作业治疗。于治疗前、治疗2周后分别采用上肢部分Fugl-Meyer评定量表（FMA-UE）及上肢Brunnstrom分期量表对2组患者上肢运动功能恢复情况进行评定,同时采用表面肌电图检测2组患者患肘最大等长屈曲、伸展时肱二头肌、三头肌积分肌电值,并计算相应的共同收缩率（CR）。 结果 治疗前2组患者FMA-UE评分、Brunnstrom分期评分、患肘屈曲时肱二头肌CR及患肘伸展时肱三头肌CR组间差异均无统计学意义（P>0.05）;治疗2周后发现治疗组及对照组患者FMA-UE评分［分别为（33.5±12.6）分、（30.9±15.6）分］、Brunnstrom分期评分［分别为（4.1±1.0）分、（4.0±1.2）分］、患肘屈曲时肱二头肌CR［分别为（14.6±5.7）%、（13.7±6.0）%］及患肘伸展时肱三头肌CR［分别为（27.4±8.2）%、（30.3±9.5）%］均较组内治疗前明显改善（P<0.05）,且治疗后2组患者上述疗效指标组间差异仍无统计学意义（P>0.05）。 结论 Wii虚拟现实游戏训练在促进脑卒中患者偏瘫上肢运动功能恢复以及改善患肘屈伸运动协调性方面与常规作业治疗具有相同疗效。     

经络刮疗结合康复训练对脑卒中偏瘫患者痉挛上肢表面肌电图及动力学的影响

目的:探讨经络刮疗结合康复训练对脑卒中偏瘫患者上肢肱二头肌、肱三头肌表面肌电图及动力学的影响。方法:将80例脑卒中后偏瘫上肢肌张力增高患者按照随机数字表法分为综合组和西药组,每组各40例。西药组口服巴氯芬片治疗,综合组在口服巴氯芬片基础上对上肢阴经及阳经进行经络刮疗,治疗期间2组均接受相同的康复训练。经络刮疗和康复训练均每日1次,每周5次,连续4周。治疗前及治疗4周后,2组在患侧肘关节屈曲、伸展最大等长收缩时记录肱二头肌、肱三头肌肌肉收缩的积分肌电值,计算肘关节屈伸力矩及相应的协同收缩率。采用改良Ashworth量表、肘关节活动度及Fugl-Meyer测评法评价患侧屈肘痉挛上肢肱二头肌肌张力改善程度、肘关节活动度变化及运动功能恢复情况。结果:2组治疗后患肘屈曲、伸展力矩均高于治疗前(P0.05),肱二头肌、肱三头肌的协同收缩率低于治疗前(P0.05)。治疗后综合组患侧肘关节伸展力矩增加幅度大于西药组(P0.05),肱二头肌协同收缩率降低幅度大于西药组(P0.05)。治疗后2组患侧肱二头肌痉挛程度、肘关节自主活动度、上肢运动功能较治疗前明显改善(P0.05),且综合组患侧肱二头肌痉挛程度、肘关节自主活动度、上肢运动功能改善优于西药组(P0.05)。结论:经络刮疗结合康复训练能增强脑卒中偏瘫痉挛上肢伸肘力量,改善肘关节屈伸运动的协调性,降低患侧肱二头肌肌张力,增大患侧肘关节主动活动度和改善患侧上肢运动功能。     

机器人辅助训练对脑卒中患者上肢屈肌痉挛的疗效观察及表面肌电图分析

目的:研究机器人辅助训练对脑卒中上肢屈肌痉挛患者的治疗效果,分析其对患者表面肌电信号的影响。方法:选取2016年1月—2018年12月在本院康复医学科病房住院治疗的脑卒中上肢屈肌痉挛患者100例为研究对象,按照随机单盲法分为研究组和对照组,每组50例。对照组给予常规康复训练,研究组在对照组的基础上采用上肢康复机器人辅助训练。收集患者治疗前后日常生活活动能力(ADL)评分、简式Fugl-Meyer运动量表上肢部分(FMA-UE)评分、改良Ashworth痉挛评价量表(MAS)、肘关节主动伸展角度、肱二、三头肌的积分肌电值(iEMG)和协同收缩率(CR)水平。结果:两组患者治疗后ADL、FMA-UE评分显著高于治疗前(P0.05),且研究组显著高于对照组(P0.05);MAS评分显著低于治疗前(P0.05),且研究组显著低于对照组(P0.05)。两组患者治疗后肘关节主动伸展角度显著高于治疗前(P0.05),且研究组显著高于对照组(P0.05),研究组患者治疗前后关节伸展角度变值显著高于对照组(P0.05)。两组患者治疗后肘关节屈曲肱二头肌、肱三头肌及伸展肱三头肌iEMG水平显著高于治疗前,且研究组显著高于对照组(P0.05),肘关节伸展肱二头肌iEMG水平显著低于治疗前,且研究组显著低于对照组(P0.05);两组患者屈肘时的肱三头肌和伸肘时的肱二头肌CR值显著低于治疗前,且研究组显著低于对照组(P0.05)。结论:机器人辅助训练对脑卒中患者上肢屈肌痉挛有较好的治疗效果,可显著改善患者上肢功能障碍,缓解上肢屈肌痉挛,增加肘关节主动伸展角度,协调上肢系统张力平衡。     

多通道功能性电刺激对脑卒中上肢运动功能的疗效及表面肌电特征研究

目的:探讨多通道功能性电刺激对脑卒中患者上肢运动功能及表面肌电信号的影响。方法:选取2019年1月至2019年6月在无锡市同仁康复医院康复医学科住院的脑卒中患者44例,随机分为观察组(21例)和对照组(23例),两组患者均给予常规临床、护理及康复治疗,在此基础上,对照组患者接受手摇车训练,而观察组患者在进行手摇车训练的同时辅以多通道功能性电刺激治疗,均每日治疗1次,每周5次,共治疗4周。分别在治疗前和治疗4周后对患者患侧上肢肱二头肌、肱三头肌进行表面肌电图测试,并采用Fugl-Meyer评定量表上肢部分(FMA-UE)和改良的Barthel指数(modified Barthelindex,MBI)对所有患者进行上肢运动功能及日常生活活动能力评定。结果:治疗前两组患者上肢肱二、三头肌表面肌电均方根值(root mean square,RMS)、协同收缩率(co-contractionratio,CR)以及FMA-UE、MBI评分均无显著性差异(P0.05)。治疗4周后,两组患者上肢肱二、三头肌RMS值、CR值较治疗前均有所降低(P0.05),FMA-UE和MBI评分较治疗前均有所提高(P0.05),差异具有显著性意义。4周后观察组各评分值改善程度优于对照组(P0.05)。结论:多通道FES可以有效提高脑卒中患者上肢运动功能和日常生活自理能力,同时能有效降低脑卒中患者上肢的肌张力,值得临床推广应用。     

全身振动训练对亚急性期脑卒中患者上肢运动功能的影响

目的:观察并探讨全身振动训练对亚急性期脑卒中偏瘫患者上肢运动功能的影响。方法:选取2018年8月—2019年1月北京大学第三医院康复医学科住院治疗的亚急性期脑卒中偏瘫患者28例,随机分为试验组(n=14)和对照组(n=14)。试验组接受常规康复训练与全身振动训练,方案为常规康复训练每次45min,每日2次,全身振动训练每次30min,每日1次,每周5天,治疗周期为3周。对照组仅接受常规康复训练,每次60min,每日2次,每周5天,治疗周期为3周。治疗开始前采集所有患者的一般情况。治疗前,治疗3周后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE),Wolf运动功能测试(WMFT),以及表面肌电图(sEMG)测定的肘关节屈、伸最大等长收缩(MIVC)时肱二头肌、肱三头肌积分肌电值(IEMG)及由此计算的协同收缩率(CR)来评定患者偏瘫侧上肢运动功能。结果:治疗前,试验组与对照组患者在一般情况、FMA-UE评分、WMFT评分及肘关节屈、伸MIVC时,肱二头肌、肱三头肌CR均无显著差异(P0.05)。治疗3周后,试验组和对照组患者上肢FMA、WMFT评分较治疗前均显著提高(P0.05),肘关节屈、伸MIVC时肱二头肌、肱三头肌CR均较治疗前下降(P0.05)。治疗3周后,试验组患者FMA和WMFT评分明显高于对照组患者(P0.05),试验组患者肘伸展MIVC时肱三头肌CR显著低于对照组患者,试验组与对照组患者肘屈曲MIVC时肱二头肌CR无明显差异(P0.05)。结论:全身振动训练在提高亚急性期脑卒中患者上肢运动功能方面具有潜在优势。     

基于表面肌电探讨蝶形浴对脑卒中偏瘫患者上肢痉挛的影响

目的:基于表面肌电(sEMG)观察蝶形浴对脑卒中偏瘫患者上肢痉挛的影响。方法:采用随机数字表法将60例脑卒中偏瘫患者分为观察组和对照组各30例。2组患者均给予常规的康复治疗,观察组患者在此基础上进行蝶形浴治疗。分别于治疗前、治疗4周后采用表面肌电图记录肘关节屈曲最大等长收缩时肱二头肌与肱三头肌积分肌电值(IEMG)、改良Ashworth量表(MAS)来评估2组患者患侧肘关节及腕关节的肌张力大小,采用简易Fugl-Meyer上肢运动功能评分(FMA-U)评估2组患者的上肢运动功能。结果:治疗4周后,2组患者肘关节屈曲最大等长收缩时肱二头肌IEMG均较治疗前明显降低(均P0.05),且观察组更低于对照组(P0.05);肱三头肌IEMG均较治疗前明显增高(均P0.05),且观察组更高于对照组(P0.05);2组患侧肘、腕关节屈肌MAS评分均较治疗前下降(均P0.05),且观察组明显低于对照组(P0.05);2组患侧FMA-U评分均较治疗前明显提高(P0.05),且观察组明显高于对照组(P0.05)。结论:蝶形浴疗法可以有效地缓解脑卒中偏瘫患者的上肢痉挛,减轻因痉挛导致的上肢运动功能障碍,值得在临床推广应用。     

早期不同康复策略对脑卒中患者偏瘫侧上肢功能恢复的影响

摘要 目的：探讨脑卒中早期采取伸肌治疗策略与屈肌治疗策略对患者偏瘫上肢功能恢复的影响。 方法：选取符合入组标准的患者48例,随机分为伸肌治疗组和屈肌治疗组,两组均接受除上肢以外部位的常规康复治疗,伸肌治疗组对偏瘫上肢伸肌群（肱三头肌、前臂伸肌群）行电针、肌电生物反馈、手法快扣、运动想象等康复治疗;屈肌治疗组针对上肢屈肌群（肱二头肌、前臂屈肌群）行相同治疗。3周为1疗程,共进行4个疗程康复治疗。分别于治疗前、每疗程结束时进行肱二、肱三头肌的均方根值（RMS）、协同收缩率（CR）、Fugl-Meyer上肢功能（FMA-UE）、改良Barthel指数（MBI）评估。 结果：每个疗程结束后两组患者肱二、三头肌的RMS值、FMA-UE及MBI评分均显著好转（P＜0.01）（P＞0.05）;第四个疗程结束后伸肌治疗组的伸肘时CR值小于屈肌治疗组（P＜0.05）。 结论：两种早期康复策略对脑卒中患者的上肢肌力、功能及生活自理能力均有明显的治疗效果,但早期采用伸肌治疗策略能更有效地减轻上肢伸肘时的痉挛程度。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.