Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ropivacaine exhibits less cardiotoxicity and causes less motor block than bupivacaine when used in equianalgesic doses. This makes ropivacaine potentially well suited for epidural infusion for postoperative analgesia. The aim of this study was to determine which of three concentrations of epidurally administered ropivacaine infused for postoperative analgesia would attenuate intravenous opioid analgesia requirements while also minimizing motor block. Forty ASA I-III patients, having major lower abdominal surgery, completed the study. They were randomly assigned to one of four treatment groups: Group S, control, epidural saline (n = 10); Group 1, epidural 0.1% ropivacaine (n = 10); Group 2, epidural 0.2% ropivacaine (n = 10); and Group 3, epidural 0.3% ropivacaine (n = 10). The study was double-blind. Initial epidural analgesia was established with 0.5% ropivacaine, and then general anesthesia induced for surgery. Once in the recovery room, epidural infusions were commenced at 10 mL/h and maintained at that rate for 21 h. Intravenous patient controlled analgesia (PCA) morphine was used as required by the patients for supplemental analgesia. Total PCA morphine use was more over the 21-h period in Group S than all the ropivacaine groups, being significantly so for Group 2 (median values: Group S, 43.3 mg; Group 1, 18.7 mg; Group 2, 7.5 mg; Group 3, 19 mg; for Group 2, P = 0.03). Visual analog scale (VAS) scores on coughing were significantly lower (i.e., less pain) than control for all ropivacaine groups after 4 h of infusion and also for Groups 2 and 3 after 8 h of infusion. (Median VAS (mm) on coughing at 8 h: Group S = 70, Group 1 = 56, Group 2 = 32, Group 3 = 0; for Groups 2 and 3, P < 0.05 compared to Group S). There was a dose-related increase in the amount of motor block, with Group 3 having significantly more motor block than all other groups at 4 and 8 h.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery--a dose finding study. 748 88

Ropivacaine is a new local anaesthetic with advantages that suggest an important role in the provision of postoperative analgesia. The main aim of this study was to investigate the dose-response relationship of extradural infusion of ropivacaine. We studied 36 ASA I-III patients undergoing upper abdominal surgery during general anaesthesia and extradural block (catheter insertion at T6-9) using 0.5% ropivacaine in a randomized, double-blind study. After surgery nine patients each received an extradural infusion of either ropivacaine 0.1%, 0.2%, 0.3% or saline at a rate of 10 ml h-1 for 21 h. All patients had access to i.v. morphine via a PCA device. The ropivacaine groups consumed significantly less morphine over the 21-h infusion period than the saline group (medians: saline 75 mg; 0.1% ropivacaine 32 mg; 0.2% ropivacaine 39 mg; 0.3% ropivacaine 13 mg) (P < 0.05). Pain (VAS scores) at rest was significantly lower in all ropivacaine groups than in the saline group after 4 h of infusion (medians: saline 45 mm; 0.1% ropivacaine 15 mm; 0.2% ropivacaine 12 mm; 0.3% ropivacaine 0 mm). Pain on coughing was significantly less in all ropivacaine groups than in the saline group after 4 h infusion (medians: saline 67 mm; 0.1% ropivacaine 44 mm; 0.2% ropivacaine 33 mm; 0.3% ropivacaine 0 mm) and for 0.2% and 0.3% ropivacaine at later times. Motor block was negligible throughout the infusion. Patient satisfaction was higher in the 0.2% and 0.3% ropivacaine groups than in the two other groups.
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PMID:Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery. 865 17

To assess the efficacy and safety of wound instillation of ropivacaine, when administered via a patient-controlled elastometric pump, 50 term parturients undergoing cesarean delivery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard spinal anesthetic was administered. After the surgery, a multihole 20-gauge epidural catheter (B. Braun, Melsungen, Germany) was placed above the fascia such that the tip was sited at the point that demarcated 50% of the length of the surgical wound. Thereafter, the catheter was connected to the elastometric pump. According to a computer-generated randomization schedule, the pump was filled with either ropivacaine 0.2% (Ropivacaine Group) or an equal volume of sterile water (Control Group). Postoperatively, patient-controlled analgesia was administered via the elastometric pump. During the first 6 postoperative hours, a coinvestigator administered "rescue" morphine (2 mg, IV). Thereafter, "rescue" dipyrone (1 g) was administered on patient request. In a subset of 10 patients, blood ropivacaine levels were assessed. Compared with the Control Group, significantly fewer patients in the Ropivacaine Group received "rescue" morphine (92% vs. 48%, respectively) (P<0.01). The total "rescue" morphine administered during the first 6 postoperative hours was 2+/-3 mg vs. 10+/-5 mg (P<0.01) for the Ropivacaine and Control Groups, respectively. Patient-generated resting pain scores were similar between the groups. However, pain scores generated after coughing and leg raise were significantly (P<0.04) less in the Ropivacaine Group. More patients in the Ropivacaine Group than in the Control Group described their analgesia as good or excellent. In the subset of patients (n = 10) studied, unbound ropivacaine blood levels were below the toxic threshold (600 ng/mL). However, blood ropivacaine accumulation was noted. All patients stated that the elastometric pump was easy to use. Ropivacaine wound instillation via an elastometric pump is a simple technique that provides safe and effective analgesia after cesarean delivery.
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PMID:The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery. 1109 95

Transverse rectus abdominis musculocutaneous (TRAM) flap surgery is a complex procedure characterised by an extensive wound site. We present a pilot study with 17 patients receiving continuous wound instillation with ropivacaine or isotonic saline. Patients undergoing TRAM flap surgery were included in the study and randomised to the ropi group or the control group. Two catheters were placed subcutaneously before wound site closure. At the end of surgery patients received a single shot dose of 20 ml ropivacaine 0.2% or isotonic saline. After surgery the continuous instillation of ropivacaine or isotonic saline was commenced at an infusion rate of 10 ml/h per catheter. The perfusion of the TRAM flap was measured intraoperatively and postoperatively over 48 h. Pain scores, patient satisfaction, and the quality of recovery score were also assessed postoperatively over 48 h. Ropivacaine plasma levels were quantified 24 and 48 h after start of infusion. Pain scores at rest and on coughing were lower for the ropi group and reached significance in the first 8h at rest (P=0.007). Patient satisfaction, quality of recovery score, and adverse events were also comparable between the groups. Patients of the ropi group had bowel movement earlier than the control group (P=0.003). No differences were seen in the flap perfusion. Ropivacaine plasma levels were within therapeutic range. Our data show a trend that continuous wound instillation of ropivacaine 0.2% increases pain relief after TRAM flap surgery with earlier bowel movement than intravenous opioid patient controlled analgesia (IV-PCA) alone. A does of 960 mg of ropivacaine daily did not result in toxic plasma concentrations. Ropivacaine 0.2% did not show a vasoconstrictor effect.
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PMID:Postoperative analgesia and flap perfusion after pedicled TRAM flap reconstruction - continuous wound instillation with ropivacaine 0.2%. A pilot study. 1838 65

Wound infusion with local anesthetics has been used for postoperative pain relief with variable results. This randomized, controlled, double-blind clinical trial examines the effect of ropivacaine infusion on pain after laparoscopic cholecystectomy. A total of 110 patients were randomly assigned to 2 groups. After induction of anesthesia a 75-mm catheter was inserted subcutaneously and connected to an elastomeric pump containing either 0.75% ropivacaine (ropivacaine group) or normal saline (control group) for 24 hours postoperatively. Before skin closure, each hole was infiltrated with 2 mL of 0.75% ropivacaine or normal saline according to randomization. Pain at rest, pain during cough, and analgesic consumption were recorded in the postanesthesia care unit and at 2, 4, 8, 24, and 48 hours postoperatively. Analgesic requirements and pain scores were recorded 1 and 3 months after surgery. The ropivacaine group reported less pain during cough (P=0.044) in the postanesthesia care unit (P=0.017) and 4 hours postoperatively (P=0.038). Ropivacaine wound infusion had no effect on late and chronic pain.
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PMID:Perioperative Continuous Ropivacaine Wound Infusion in Laparoscopic Cholecystectomy: A Randomized Controlled Double-blind Trial. 2667 80