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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two concentrations of etidocaine (1 and 1.5%) and of pH-adjusted bupivacaine (0.5 and 0.75%, pH 6.8), all fortified with hyaluronidase, were compared as local anesthetics in regional ophthalmic surgery for cataract extraction. The series comprised 160 patients assigned randomly to four groups (n = 40). Each patient received one of the four anesthetics in a double blind manner. The technique used was an inferolateral intraconal injection (3 mL) followed by a medial extraconal injection (3 mL). Supplemental injections were given at 10 and 20 min, if needed. At 10 min, globe akinesia was satisfactory in both etidocaine groups and in the 0.75% bupivacaine group (78-80% of patients), but in only 37% of the 0.5% bupivacaine group. In lid akinesia, the 0.75% bupivacaine group gained the highest scores, but there was no significant difference between the groups. Perioperative analgesia was better in both bupivacaine groups, in which only 3 and 5 patients felt pain compared to 7 and 12 in the etidocaine groups (P < 0.05). Of these local anesthetics, pH-adjusted 0.75% bupivacaine is recommended for regional ophthalmic anesthesia.
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PMID:Comparison of regional ophthalmic anesthesia produced by pH-adjusted 0.75% and 0.5% bupivacaine and 1% and 1.5% etidocaine, all with hyaluronidase. 831 20

To relieve pain from local anesthetic injections, the authors tried lowering the skin surface temperature by spraying a commercially available cold spray immediately before the injections. A noncontact thermometer was used to measure the thermal change of the skin surface. An esthesiometer was applied to determine the surface perception of the skin. Our basic experiments indicated that there was a relationship between the thermal change and the perception. When the surface temperature dropped to 10 degrees C, there was a definite decrease in the perception. Based on these findings, the authors applied the spray to 100 patients undergoing cataract surgery prior to both akinesia and retrobulbar anesthesia at a distance of 10 cm from the skin surface for 2 seconds, to be immediately followed by the injections. We found the spray to be effective in decreasing the pain due to these injections. Furthermore, there has been no major complications of the spray.
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PMID:Use of cold spray for relieving pain from local anesthetic injections in ocular surgery. 848 14

Reports of complications associated with local anesthesia in ophthalmic surgery have increased conspicuously in recent years. Sub-Tenon's capsule anesthesia for anterior segment surgery avoids the risks of retrobulbar and peribulbar injections. This study compared sub-Tenon's and retrobulbar anesthesia. Patients undergoing various anterior segment surgery were randomly assigned to sub-Tenon's or retrobulbar anesthesia; 300 were operated with 1-quadrant sub-Tenon's anesthesia (1-QST) and the results were compared with 270 patients operated with retrobulbar anesthesia. Retrobulbar anesthesia consisted of a 2.5 ml injection of a 1:1 mixture of 2% lidocaine without epinephrine and 0.5% bupivacaine. Sub-Tenon's anesthesia involved direct transconjunctival infiltration of the same local anesthetic directly into the sub-Tenon's space, in the inferior-nasal quadrant, using a blunt 23-gauge cannula. Patients undergoing various anterior segment surgery procedures were randomly assigned to 1-QST or retrobulbar anesthesia; 300 patients were operated with 1-QST and the results were compared with 270 patients operated with retrobulbar anesthesia. Preinjection mean (+/- SD) IOP wer 12.9 +/- 3.7 mmHg in the retrobulbar and 13.4 +/- 3.2 mmHg in the 1-QST patients. Preoperative intraocular pressures were 8.7 +/- 3.0 mmHg in the retrobulbar and 9.2 +/- 3.2 mmHg in 1-QST patients. Pre- and postinjection IOP for retrobulbar and 1-QST patients were similar. Pain scores for delivery of the anesthetic, using a numerical rating scale, produced a median score of 1 for 1-QST and 2 for the retrobulbar technique. For the subsequent operative procedure, the median score was 1 for 1-QST and 2 for the retrobulbar patients. Complete akinesia was achieved in 41% with 1-QST and in 69% of retrobulbar patients. 1-QST patients with incomplete akinesia most often had lateral muscle function which did not interfere with the operation. We found the use of a blunt cannula to deliver anesthetic into the sub-Tenon's space as a simple, safe and effective alternative approach to traditional retrobulbar anesthesia in anterior segment surgery.
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PMID:One quadrant sub-Tenon's capsule anesthesia in anterior segment surgery. 882 84

Retro- und peribulbar anesthetic injections, the common techniques in cataract surgery, have persistently reported complications. Recently topical anesthesia has been mentioned as a possible alternative. The effectiveness of anesthesia, the acceptance on the part of the patients and the consequences of the lack of akinesia were analysed in a prospective study. We compared two groups of 27 patients. Patients in the first group had only topical anesthesia, while patients in the control group had a peribulbar injection. None of the patients included had such conditions as deafness or dementia or felt overanxious. Both methods were accepted very well by the patients. There were no significant differences in the improvement of visual acuity and the opinion of the patients about pain during the operation. The surgeon's assessment revealed a few cases of increased voluntary eye movements in the topical anesthesia group, but this did not affect the complication rate significantly. There was one case of vitreous loss in each group and in the peribulbar group one case of zonular defect. Topical anesthesia should be seen as an alternative to injection anesthesia.
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PMID:[Eyedrop anesthesia in cataract surgery]. 886 64

Diagnosis of Parkinsonism is made in two steps: 1. identification of the Parkinson syndrome, a combination of rest tremor, hypertonia, akinesia and postural disturbances; 2. then essentially on the basis of clinical observations, relation to Parkinson's disease. The main risks during the course with L-dopa treatment are, on the one hand, the appearance of akinetic changes and movement disorders, more common in the younger affected patients, and on the other hand, disorders that do not respond to L-dopa, especially postural and cognitive, that are favoured by old age. Anxiety, depression pain, autonomic disorders and insomnia increase the repercussions of the disease and complicate its management.
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PMID:[Diagnosis and course (under treatment) of Parkinson disease]. 920 68

This is a multicentric double blind comparison of the effects of standard and slow release levodopa + carbidopa formulations in patients with Parkinson's disease. Sixty four patients with simple fluctuations were included and 43 finished the study. The study had three phases: a) optimal dose findings phase with standard levodopa + carbidopa; b) open label, cross over study with the two formulations, and c) double blind, parallel investigation. The following results were obtained. There was not a difference in the severity of disability according to UPDRS, part 3, scores though the subjective impressions of patients were in favor of standard formulations. The Sustained release levodopa + carbidopa produced significant improvement of dystonia in off period, pain due to akinesia in off and the number of hours in off and the quality and latency of sleep. In addition there was a tendency in favor of slow release compounds for early morning akinesia, global effect and impression of the examining physician. Low protein diet improved the kinetics of levodopa and the clinical response with both formulations. The clinical usefulness of standard and slow release levodopa + carbidopa formulation should be weighted according to individual problems of patients with Parkinson's disease.
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PMID:[The effect of controlled release of DOPA and carbidopa on clinical response and plasma pharmacokinetics of DOPA in parkinsonian patients]. 923 23

Idiopathic Parkinson's disease (IPD) is a common and universal condition. Although its cause is still unknown, we now have some insights into pathogenetic mechanisms and genetic factors that may be important in causing the selective neuronal loss and presence of Lewy bodies that characterize its pathology. Clinically, as well as the classic features of akinesia, rigidity and often rest tremor, patients may present a wide range of other symptoms including pain, other sensory symptoms, impaired olfaction, personality change, mild executive cognitive deficits, dementia and depression, an extraordinary richness of symptoms and signs rendered even more extraordinary by the long-term effects of drug treatment. While there may be little difficulty recognizing typical cases of IPD, there has been, at least until recently, a considerable misdiagnosis rate in both atremulous (confusion with ageing, vascular disease, multiple system atrophy (MSA) or progressive supranuclear palsy (PSP)) and tremulous (confusion with essential tremor (ET), dystonic tremor, and MSA) forms. However, increasing awareness of the clinical features of all these conditions, together with adherence to exacting diagnostic criteria, is leading to improved diagnosis, which is crucial for patients (who want to know what the future holds for them), for their treatment (giving them the right drug and not the wrong one) and for research (since all the different diseases above have different aetiologies and pathology).
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PMID:Parkinson's disease: clinical features. 942 65

We have evaluated the effects of the volume and speed of administration of local anaesthetic during peribulbar anaesthesia. One hundred and forty patients scheduled for cataract surgery were randomly allocated to one of four groups of 35. Each patient received an injection of the same mixture of lignocaine, bupivacaine and hyaluronidase. Patients in group A were given 9 ml at a speed of 5 ml.min-1, group B were given the same volume at 12 ml.min-1, group C were given 13.5 ml at 5 ml.min-1 and group D were given 13.5 ml at 12 ml.min-1. A significantly higher incidence of satisfactory akinesia was found in group D, whose pain score at injection was no higher than for the other groups. Large volumes of local anaesthetic significantly affected intra-ocular pressure. The incidences of early and late ptosis or diplopia were not affected by either the rate of injection or the volume of local anaesthetic.
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PMID:The effects of volume and speed of injection in peribulbar anaesthesia. 965 24

Several symptom complexes in multiple sclerosis (MS) are found in unusual circumstances but are characteristic of the disease. Most of these are amenable to treatment and will be confronted by the physiatrist treating patients who have MS. This article begins by addressing paroxysmal symptoms such as trigeminal neuralgia, paroxysmal dysarthria and ataxia, parathesia and pain, paroxysmal itching, and akinesia. Seizures, adventitious movements, fatigue, and complications related to pregnancy also are addressed.
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PMID:Multiple sclerosis potpourri. Paroxysmal symptoms, seizures, fatigue, pregnancy, and more. 989 8

Patients with fibromyalgia sometimes have sign of a movement disorder in addition to sensory disturbances sometimes similar as those found in akinetic syndromes. Akinesia is due to disturbances in the functions of the cortico-thalamo-nigro-striatal system and associated areas. The reason of this dysfunction in Parkinson's disease is a decreased nigral dopaminergic efferent innervation due to a neuronal degeneration in the pars compacta of the substantia nigra. Changes in other neurotransmitters, like GABA or serotonin, and in receptors and second messengers also occur, with additional modulation due to therapy. The aetiology of nigral malfunction is in only rarely known. Drugs and mutations of some genes are examples which give much insight in the pathogenesis of movement disorders in general. In other akinetic disorders, like multisystem atrophy, corticobasal ganglionic degeneration, and progressive supranuclear palsy, more complex patterns of degeneration have been found. This pathological anatomical disturbances have typical clinical effects which can be studied physiologically and with imaging in vivo. Since basal ganglia play also a role in pain, a comparative study of their involvement in movement disorders and nociception seems to be fruitful, especially in devising new therapeutic strategies.
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PMID:Pathophysiology of akinetic movement disorders: a paradigm for studies in fibromyalgia? 1002 78


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