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

The effects of intrathecal midazolam and fentanyl on electrical current threshold for pain were measured using stimulating electrodes in the neck and tail of rats with chronically implanted lumbar subarachnoid catheters. This involved the measurement of the minimum current (50 Hz 2 ms pulses 0-5 mA), which made the rat squeak when applied alternately to electrodes at each skin site. The responses measured in milliamperes were expressed as a number of times control readings. Equieffective doses of both midazolam and fentanyl produced a significant increase in electrical threshold for pain in the tail (mean +/- SEM 3.14 +/- 0.51 and 2.89 +/- 0.35: P less than 0.05; Wilcoxon sum rank test) in the absence of any change in the neck (mean +/- SEM 1.28 +/- 0.13 and 0.96 +/- 0.12, NS), thus demonstrating a spinal effect. Fentanyl caused a significant simultaneous increase in tail flick latency (mean +/- SEM 67.8 +/- 20.1%, P less than 0.05), but midazolam did not (mean +/- SEM 4.22 +/- 2.76%, NS). Intraperitoneal injections of naloxone (0.25 mg/kg) blocked the response to fentanyl in both tests and did not affect the response to midazolam. Intraperitoneal flumazenil (5 mg/kg) blocked the midazolam antinociceptive effect but did not affect the response to fentanyl in either test. Tail withdrawal in response to non-noxious stimulation was preserved in all animals with spinal analgesia, indicating that myelinated afferent and efferent pathways were still functioning. Righting reflex, coordination, motor power, and alertness were also preserved in the presence of both drugs. Both drugs caused spinally mediated antinociceptive effects that were qualitatively different.
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PMID:Intrathecal midazolam and fentanyl in the rat: evidence for different spinal antinociceptive effects. 271 11

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 micrograms/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.
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PMID:Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system. 272 46

According to our results, permanent epidural anaesthesia was significantly superior to systemic opioid treatment in patients with serial rib fractures. The main advantages were not only continuous pain relief despite the fact that the nonepidural control group required more than twice the dosage of morphine derivatives; also, the respiratory and pain-related recovery time was reduced. Another advantage was the selective effect (due to the local application) on respiratory pain and therefore on respiration as a whole. Deep breathing and expectoration were easier, so that the use of respirators and other artificial breathing aids could be avoided or at least reduced in duration in some cases. This makes the method particularly suitable for use in the management of polytraumatized patients. The standard dose was a mixture of 3.3 mg morphine and 37.5 mg bupivacaine (= 1/3 ampoule morphine + 15 ml Carbostesin 0.25%) every 12 h. When morphine was temporary contraindicated (frequently the final diagnosis in the case of an "acute abdomen" delayed the administration of morphine) the use of bupivacaine alone provided a satisfactory result for a certain time (we never observed tachyphylaxis). Additional systemic pain relievers were only necessary when the patient was suffering from pain caused by other injuries beyond the area of effectiveness of the epidural catheter (the only obvious disadvantage of the local application technique). On the other hand, epidural anaesthesia enabled us to treat a patient's lower-leg fracture by interlocking nailing, while adding only 0.01 mg fentanyl (= 2 ml Fentanyl Janssen) and 1.2 mg flunitrazepam (Rohypnol).
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PMID:[Catheter epidural analgesia in serial rib fractures]. 272 9

In a prospective, randomized double-blind study carried out on 255 parturients, fentanyl 80 micrograms (n = 81), morphine 4 mg (n = 83) or placebo (n = 85) was added to 0.25% bupivacaine administered extradurally for pain relief during labour. Fentanyl increased the mean duration of bupivacaine analgesia by 30% and did not reduce the rate of inadequate pain relief. Morphine did not increase the mean duration of bupivacaine analgesia significantly, but increased the rate of inadequate pain relief. It was concluded that morphine 4 mg added to extradural 0.25% bupivacaine was of no value.
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PMID:Controlled trial of extradural bupivacaine with fentanyl, morphine or placebo for pain relief in labour. 275 19

Fentanyl (1 microgram/kg body weight) was administered intravenously and via a lumbar epidural catheter (in random order) on 2 separate occasions to 6 patients with chronic pain associated with non-terminal disease states. Frequent blood samples were collected from an indwelling intravenous catheter and CSF samples were collected via spinal needles inserted in the cervical (C7-T1 interspace) and lumbar (L3.4 interspace) regions at 0, 5, 10, 20, 30 and 45 min after fentanyl administration. The concentration of fentanyl in blood and CSF samples were quantified by a sensitive and selective gas-liquid chromatography assay. Visual analogue pain scores (VAPS) were recorded every 5 min for the first hour. Coded syringes (one containing the appropriate fentanyl dose while the other contained an equivalent volume of saline) allowed the investigator administering the fentanyl and assessing VAPS to remain blinded as to which route of administration actually contained the fentanyl. There was minimal vascular uptake of fentanyl following epidural administration. Similarly, the permeation of fentanyl into cervical and lumbar CSF following intravenous administration was minimal and erratic such that only 4 of the 60 CSF samples had detectable fentanyl concentrations. In contrast, there was a rapid penetration of fentanyl across the dura mater following lumbar epidural administration. There was significantly fentanyl in lumbar CSF samples by 10 min in 5 patients, and by 20 min in all 6 patients. The mean maximum lumbar CSF concentration was 19.1 ng/ml, while the time associated with these maximum concentrations was 22.5 min. The mean maximum cervical CSF fentanyl concentrations were 10% of the lumbar CSF concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1989 Sep
PMID:Pharmacokinetics of fentanyl in lumbar and cervical CSF following lumbar epidural and intravenous administration. 281 36

The effects of 3.0 mg.kg-1 fentanyl on cerebral and peripheral hemodynamics alone and when combined with subanesthetic doses of pentobarbital (4.0 mg.kg-1), were studied in 11 unanesthetized, newborn lambs, in whom catheters had been previously inserted. After a control period, drugs were administered at 20-min intervals by intravenous bolus injection. Group 1 animals (n = 5) received fentanyl, pentobarbital, and naloxone (0.01 mg.kg-1), whereas Group 2 animals (n = 6) had the order of fentanyl and pentobarbital reversed. All animals responded to pain (withdrawal to tail clamping) and appeared conscious (eyes open, alert to sound) when either fentanyl or barbiturate was given alone. The combination of drugs, however, produced complete unresponsiveness. All of these effects were reversed by naloxone. Cardiac output did not change after either fentanyl or pentobarbital was administered individually but decreased significantly (29% in Group 1, 21% in Group 2) after administration of the combination of both. Mean arterial pressure and heart rate were unchanged. Cerebral blood flow, oxygen (O2) transport, and O2 consumption did not change after either administration of fentanyl or pentobarbital alone but decreased significantly after both (22%, 30%, 19%, respectively, in Group 1 and 35%, 40%, 38%, respectively, in Group 2). The decrease in cerebral O2 transport nearly paralleled the decrease in cerebral O2 consumption such that the ratio, the fractional O2 extraction, increased slightly. Fentanyl decreased kidney blood flow alone (24%) and in combination with pentobarbital (25%), although pentobarbital did so only when combined with fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Interaction of fentanyl and pentobarbital on peripheral and cerebral hemodynamics in newborn lambs. 232 93

Intravenous administration of 0.8 microgram/kg and 1.1 micrograms/kg fentanyl in low back pain patients reduced both sensory intensity and unpleasantness visual analogue scale (VAS) responses to experimental pain evoked by graded 5-sec nociceptive temperature stimuli (45-51 degrees C) as well as VAS-sensory and VAS-affective responses to clinical pain. Fentanyl produced similar decreases in VAS-sensory responses to experimental and clinical pain. Fentanyl produced nearly equal reductions in VAS-sensory and VAS-affective responses to experimental pain but greater reductions in clinical pain VAS-affective as compared to clinical pain VAS-sensory responses. This interaction of type of pain (experimental versus clinical) and pain dimension (sensory versus affective) results from either a steeper sensory intensity-unpleasantness relationship for clinical pain as compared to experimental pain or additional selective influences of opiates on affective factors uniquely related to clinical pain. These results indicate that low to moderate doses of opiates reduce both sensory and affective dimensions of pain and strongly suggest that changes in pain affect occur mainly as a direct consequence of reductions in pain sensation intensity.
Pain 1986 Feb
PMID:A simultaneous comparison of fentanyl's analgesic effects on experimental and clinical pain. 293 58

17 patients undergoing cholecystectomy in non-opiate general anaesthesia received tramadol (n = 7) or fentanyl (n = 10) for immediate postoperative pain relief using the on-demand analgesia computer (ODAC). Heart rate, blood pressure, and respiratory rate were monitored at half-hourly intervals during the 6-h trial period. Arterial blood was withdrawn at hourly intervals for blood gas analyses and beta-endorphin plasma level assays. Fentanyl and tramadol serum levels were determined prior to each on-demand bolus injection during the first 2 h of the study. At the end of the trial period, the quality of analgesia was assessed retrospectively using a visual analog scale. Mean opiate consumption was 0.53 +/- 0.1 mg for fentanyl and 412 +/- 11.6 mg for tramadol, resulting in an equipotency ratio of about 1:980 (relating to body wt., consumption/h, and pain score). No correlation was found between body wt.-based opiate requirements and pain score. Heart rate increased slightly but significantly under both opiates. Fentanyl produced a significant drop in mean arterial pressure by a maximum of 16%, while tramadol left mean arterial pressure unchanged. Respiratory rate, which was elevated initially, dropped significantly in both groups. Arterial pO2 and pCO2 were within the normal range throughout the observation period, reflecting the absence of respiratory side effects. Opiate blood levels showed major inter- and intraindividual variations (minimal and maximal levels for fentanyl ranged from 0.44-3.44 ng/ml, for tramadol from 272-1,900 ng/ml) and were thus poor predictors of the quality of analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of fentanyl and tramadol in pain therapy with an on-demand analgesia computer in the early postoperative phase]. 294 72

Opioids remain the drugs of choice for the treatment of severe pain. In recent years several new potent opioids have become available for clinical use. These newer drugs are generally safer than the older morphine-like compounds and their differing pharmacological and pharmacokinetic properties allow the physician to choose an appropriate drug according to the clinical situation and need of an individual patient. These drugs are classified according to their activity at the opioid receptors. The opioid agonists produce their pharmacological effect by an almost exclusive action at mu-receptors. The agonist-antagonist group are kappa-receptor agonists and either competitive antagonists at the mu-receptor or weak mu-agonists. The use of the potent opioid agonists, because of their potential for causing respiratory depression, is restricted to hospitals. Fentanyl, the oldest drug of this class, is extensively used as a supplement to general anaesthesia, or in high doses as a 'complete' anaesthetic for patients undergoing cardiac surgery. Alfentanil and sufentanil are newer fentanyl derivatives. Alfentanil is unique in having a very short elimination half-life. This is a particular advantage during short operations and for day-case surgery. For longer operations alfentanil can be given as a continuous infusion to supplement nitrous oxide anaesthesia. Sufentanil is about 10 times more potent than fentanyl and is more rapidly eliminated. Initial reports suggest that it may be more effective than fentanyl as an anaesthetic supplement and that recovery may be more rapid. Both sufentanil and alfentanil are also used in cardiac anaesthesia. The newer agonist-antagonist opioids, butorphanol, nalbuphine and buprenorphine, have largely replaced pentazocine in clinical practice. Unlike pentazocine, they cause a low incidence of dysphoric side effects. Like the pure agonists, they cause respiratory depression; however, in contrast to the pure agonists this is not dose related, reaching a 'ceiling' as dose increases. The risk of dependence is also less, so that these drugs are safer for the treatment of chronic pain. Additionally, it is particularly worth noting that buprenorphine and nalbuphine cause minimal cardiovascular changes, and are safe and effective drugs for treatment of pain associated with myocardial infarction. Buprenorphine, which is effective parenterally, orally and sublingually, has a prolonged duration of action (up to 12 hours after a single dose).
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PMID:Which potent opioid? Important criteria for selection. 295 11

The French technique of anaesthesia by electrostimulation described in 1972 by Cara and coworkers, consists of transcranial electrostimulation by means of a high frequency current combined with administration of a neuroleptic drug, a benzodiazepine, a curare and nitrous oxide with oxygen. Fentanyl is also given by some authors. In order to assess the benefit of such electrostimulation, this study compared two randomized groups of ten patients, scheduled for abdominal and pelvic surgery. Both groups received the same drugs (i.e. droperidol, flunitrazepam, pancuronium and nitrous oxide with oxygen), whereas patients in group I were also submitted to electrostimulation. This study describes and discusses the clinical behaviour of patients and the hormonal reactions before, during and after surgery. In both groups, operative conditions were satisfactory. Recovery and onset of spontaneous ventilation were rapid and no patient had an unpleasant recall of the operation itself. However, most of them complained of postoperative pain. Electrostimulation did not reduce the quantity of drugs required during and after surgery. In both groups, circulatory activity was significantly increased. In group I, the arterial pressure and the heart rate were significantly higher than in group II during and after surgery. The hormonal reactions showed that in both groups adrenocorticotrophic hormone, growth hormone and antidiuretic hormone increased during surgery. Adrenocorticotrophic hormone concentration was higher in group I during the operation. The serum levels of cortisol decreased before surgery in group I and rose in both groups during and after laparotomy; prolactin increased before surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Electro-drug anesthesia. Clinical and hormonal effects of transcranial electrostimulation]. 299 Feb 60


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