Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective, randomised, double-blind study was designed to determine whether topical application of 2% lignocaine is effective in decreasing analgesic drug requirements during and after circumcision surgery. General anaesthesia with halothane and nitrous oxide 60-70% in oxygen was administered via a facemask and a Bain system. Administration of halothane was stopped after removal of the foreskin; lignocaine (2%) or placebo was applied topically as drops to the surface of the penis to two groups of patients. Halothane was restarted if the anaesthesia was ineffective. The intra-operative consumption of halothane was significantly less (p less than 0.05) in the treated group as compared with the placebo group (0 and 17, SEM 3, % x minute). The treated group required significantly less (p less than 0.002) pethidine after operation (5 and 10 patients), and the pain-free period was significantly longer (p less than 0.01) (41, SEM 6 and 6, SEM 2 minutes) as compared with the placebo group.
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PMID:A new method of analgesia for relief of circumcision pain. 292 31

To determine whether pain or discomfort could be provoked by adenosine in skeletal muscle and, if so, whether it was dependent on the vasodilatation produced by adenosine, eight male volunteers were given intra-arterial bolus injections of adenosine and glyceryl trinitrate into the forearm. Local pain was assessed on a scale rate, forearm blood flow was measured by venous occlusion plethysmography, and blood was sampled simultaneously from the deep vein of the same arm. Five different doses of adenosine, ranging between the maximum tolerable and the lowest producing pain or discomfort, were given intra-arterially in random order and repeated in reverse order. Glyceryl trinitrate was given intra-arterially in increasing doses from 1 to 20 micrograms. Pain or discomfort began 12(1)(SEM) s after administration reached its maximum after 17(1) s, and disappeared after 40(2) s. Pain or discomfort appeared 8(1) s (p less than 0.001) after the first recorded increase in forearm blood flow, whereas maximum pain or discomfort preceded maximal forearm blood flow by 5(1) s (p less than 0.001). The flow remained increased after the disappearance of pain or discomfort. The effects of adenosine on pain or discomfort and vasodilatation were dose dependent. Glyceryl trinitrate provoked a similar increase in flow to that with adenosine without producing pain or discomfort. Arterial occlusion for 5 min at rest or forearm exercise with arterial occlusion increased forearm blood flow to the same extent as the maximum dose of adenosine. In addition, ischaemic work slightly increased the plasma concentration of adenosine. The pain or discomfort after ischaemic work was not considered different from the adenosine provoked pain or discomfort by four of the subjects. It is concluded that the symptoms did not appear to be dependent on vasodilatation and therefore adenosine may contribute to ischaemic pain or discomfort.
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PMID:Adenosine injection into the brachial artery produces ischaemia like pain or discomfort in the forearm. 314 48

The influence of nifedipine on left ventricular ejection fraction, infarct size, and infarct expansion was studied in a prospective, double blind, randomised, placebo controlled trial in 132 patients with low risk acute myocardial infarction of less than 12 hours duration, defined by an initial left ventricular ejection fraction greater than 35% and clinical Killip class of less than or equal to II. Sixty four patients were assigned to nifedipine 120 mg/day and 68 to placebo. Treatment was started on average (SEM) 8.0 (0.2) hours after onset of pain and continued for six weeks. Gated blood pool scans, thallium scans, and cross sectional echocardiograms were performed before treatment and at 10 days. There were no significant differences between the two groups in age, sex, cardiac risk factors, or use of other medications. Mean (SEM) global left ventricular ejection fraction was not different before treatment (nifedipine group 53 (2%), placebo group 55 (2%) and did not differ at 10 days (nifedipine group 54 (2%), placebo group 52 (2%). There were also no differences in regional wall motion or regional ejection fractions. Thallium defects quantified by computer analysis were similar in both groups before treatment (nifedipine 7.8 (0.7), placebo 7.9 (0.7)) and at 10 days (nifedipine 5.3 (0.7) placebo 5.3 (0.7)). In the subgroup of patients with transmural infarction who had good quality echocardiograms and serial studies (n = 30), there was no difference in mean (SEM) baseline infarct segment lengths between the two groups (nifedipine 70 (4) mm, placebo 65 (4) mm); however, the nifedipine group demonstrated no significant change in infarct segment length between the initial and 10 day studies ( + 0.6 (3) mm) while there was a significant increase in the infarct segment length in the placebo group (+ 7.8 (4) mm). The infarct segment length increased by >/= 1 cm in seven (47%) placebo patients but in only one (7%) nifedipine patient. The nifedipine group had a significant initial 10% decrease in mean arterial pressure whereas there was no change in the in the placebo group; this blood pressure difference persisted for 10 days. Thus although the early administration of nifedipine has no detectable effect on clinical outcome and infarction size, it may reduce early infarct expansion via an afterload reduction mechanism in patients with transmural infarction. These initial results must be interpreted with caution and need to be confirmed in a larger trial.
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PMID:Nifedipine in acute myocardial infarction: an assessment of left ventricular function, infarct size, and infarct expansion. A double blind, randomised, placebo controlled trial. 328 78

Morphine derivatives are the most frequently used analgetic substances in obstetrics today. Nevertheless, nausea, vomiting, weariness, and somnolence are common side effects of these drugs. Moreover opiates exhibit a depressive effect on ventilatory activity. As many studies have demonstrated tramadol, a new analgetic substance amongst the opiates does not show a depressive effect to such a high degree. In this prospective randomized trial we compared the efficacy as well as the safety of 100 mg tramadol and 100 mg pethidine in 40 women asking for pain relief during labour. The duration of labour was slightly but not statistical significantly shorter in the pethidine group. An analgetic effect could be observed in the pethidine as well as the tramadol group by both the pregnant women and the attending physician about 10 min after application lasting for about 2 hours. Concerning the side effects tramadol highly contrasted with pethidine. There were less cases of weariness and somnolence and the ventilatory frequency of the newborn babies tended to be higher than in the pethidine group. The serum levels of tramadol in umbilical and maternal veins demonstrated values of 0.83 +/- 0.15 (mean +/- SEM; quotient). The results of this study seem to establish an analgetic effect of tramadol similar to pethidine but with less side effects.
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PMID:[Obstetrical analgesia with tramadol--results of a prospective randomized comparative study with pethidine]. 333 63

The effects of adding 0.2 mg preservative-free morphine sulfate in 0.2 ml solution to hyperbaric spinal bupivacaine were evaluated in a double-blind randomized prospective study of 34 patients undergoing elective repeat cesarean section. In the control patients (n = 17), 0.2 ml saline instead of morphine was added to bupivacaine. The intrathecal morphine significantly improved intra- and postoperative analgesia, e.g., 82% of patients given morphine compared with 41% of the control patients did not require analgesic supplementation to the spinal anesthesia during surgery; postoperatively, the former patients did not request additional analgesia for 27 +/- 0.7 hours (mean +/- SEM) compared with 2 +/- 0.3 hours in the control patients. Neonatal condition was not adversely affected by this small dose of morphine administered 11 +/- 1 minutes before delivery. Combining 0.2 mg morphine with hyperbaric spinal bupivacaine for cesarean section is a safe and effective method of improving intraoperative pain relief and providing adequate prolonged postoperative analgesia.
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PMID:Combined intrathecal morphine and bupivacaine for cesarean section. 335 72

In a randomized double-blind study the effect of the addition of adrenaline to extradural diamorphine was assessed in 54 patients after Caesarean section. Patients received extradural diamorphine 5 mg in saline 10 ml with or without adrenaline 1 in 200,000 for postoperative pain relief. Analgesia was profound and of rapid onset in both groups. Duration of analgesia was greater in the adrenaline group (time to next analgesia 12.51 +/- 0.94 h, mean +/- SEM), than in the saline group (9.87 +/- 0.98 h) (P = 0.057). Analgesia was also more consistent in the adrenaline group, with 77% of patients having more than 8 h of good analgesia compared with 48% in the saline group (P less than 0.05). Plasma morphine concentrations, measured in 12 patients, were lower, although not significantly so, in the adrenaline group and mean time to peak concentration markedly delayed. No serious side effects were observed, but there was a higher incidence of vomiting in the adrenaline group.
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PMID:Effect of the addition of adrenaline to extradural diamorphine analgesia after caesarean section. 337 47

The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five-point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given. If sensory analgesia decreased more than five segments from the initial level or if the pain score reached 2 (moderate pain), the patient was removed from the study. Initial levels of sensory analgesia after loading doses of 21.8 +/- 0.5 and 19.3 +/- 0.8 ml bupivacaine 0.5% were similar (T3.8 +/- 0.3 and T3.8 +/- 0.5) in the surgical and chronic pain patients, respectively (mean +/- SEM). Of the surgical patients, only 4 of the 30 (13%) maintained the initial level of sensory analgesia, and a pain score below 2 throughout the study compared with 7 of the 12 patients with chronic pain (58%) (P less than 0.01). Mean duration of sensory blockade was significantly longer (P less than 0.005) in the patients with chronic pain than in surgical patients (13.1 +/- 1.2 and 8.5 +/- 0.7 hours, respectively). Thus, surgical injury hastens regression of sensory analgesia during continuous epidural bupivacaine infusion. The underlying mechanism remains to be determined.
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PMID:The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion. 339 60

In a prospective randomized study, 20 patients with term pregnancies underwent induction of labor with either continuous or pulsed (every 8 minutes) intravenous oxytocin infusion. There were no significant differences with respect to induction-labor interval, induction-delivery interval, cesarean section rates, need for pain relief and Apgar scores. Sixty percent of patients receiving continuous oxytocin infusion developed uterine hyperstimulation but only 10% receiving pulsed oxytocin did so. However, the difference was not significant. The mean +/- SEM total amount of oxytocin given by continuous infusion was 4237 +/- 1066 mU which was 70% more than by pulsatile infusion (2454 +/- 808 mU). The highest rate of oxytocin infused was significantly lower by pulsatile administration (5.2 +/- 0.8 mU/min) than by continuous infusion (9.2 +/- 1.8 mU/min, p = less than 0.05). Our study demonstrates that pulsed administration of oxytocin every 8 minutes is as effective and safe as continuous intravenous infusion of oxytocin for induction of labor, requires less oxytocin with therefore, a wider margin of safety and is consistent with the pulsatile release of oxytocin during normal labor.
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PMID:Pulsatile oxytocin for induction of labor: a randomized prospective controlled study. 340 78

Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0.17 (mean +/- SEM). Postoperatively, two patients maintained the initial level of sensory analgesia and low pain score throughout the 16-hour study. In these two patients epidural blood flow remained constant after the initial increase. Flow increased further to 10.3 +/- 0.8 ml/min per 100 g tissue (P less than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may be an important factor contributing to differences in rates of regression of sensory analgesia.
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PMID:Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine. 341 89

The effects of a continuous epidural administration of fentanyl on pain and on ventilation were studied in eight patients scheduled for orthopedic surgery of the knee. In each subject, epidural fentanyl was given by a bolus dose of 1 microgram.kg-1, followed by a continuous infusion of 1 microgram.kg-1.h-1 over 18 hours. Ventilatory measurements were performed during quiet breathing and during CO2 stimulation tests before surgery. After surgery measurements were made before epidural administration of fentanyl; 1, 2, 5, 18 hours after the start of epidural fentanyl infusion; and 6 hours after its discontinuation. Adequate pain relief was achieved in all patients during fentanyl administration. No significant change in ventilation was noted during quiet breathing. The slope of the ventilatory response to CO2 (VE/PaCO2) decreased significantly from 1.46 +/- 0.2 to 0.75 +/- 0.1 L.min-1.mm Hg-1 (mean +/- SEM; P less than 0.05) one hour after the onset of fentanyl administration, and remained stable throughout the infusion. Eighteen hours after the onset of epidural fentanyl infusion, VE/PaCO2 was still 0.76 +/- 0.14 L.min-1.mm Hg-1. At the end of fentanyl administration, plasma fentanyl levels measured in six patients had progressively increased from 0.42 +/- 0.02 ng.ml one hour after the onset of the infusion to 1.54 +/- 0.19 ng.ml at the end of the infusion. These results suggest that a continuous epidural administration of fentanyl is a technique of analgesia that can provide adequate pain relief but which is associated with ventilatory depression. However, with the doses used in this study, the ventilatory depression remained moderate and of no demonstrable clinical consequence.
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PMID:Ventilatory effects of continuous epidural infusion of fentanyl. 342 1


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