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

For a period of five days serum levels of antidiuretic hormone (ADH) have been investigated postoperatively in a group of 20 patients with upper abdominal surgery. In addition serum electrolytes (Na+, K+) and plasma osmolality have been controlled regularly. Patients in group A (n = 10) received Fentanyl epidurally (0.1-0.2 mg diluted with 0.9% saline solution) for treatment of postoperative pain, whereas in group B (n = 10) systemic opiate therapy was performed by intramuscular application of piritramide (Dipidolor, 15-25 mg). There was a significant increase in ADH in all patients, whereas serum electrolytes (Na+, K+) and plasma osmolality stayed within normal range. ADH-levels in group A (epidural opiate), however, were significantly lower than mean values in group B (systemic opiate application). The postoperative increase in ADH is interpreted as a reaction to stress and trauma, being less pronounced, when epidural opiate therapy is performed for postoperative pain treatment.
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PMID:[Plasma-antidiuretic hormone level as indicator of postoperative stress (part II) (author's transl)]. 732 45

A continuous epidural infusion of fentanyl was used for control of postoperative pain in a series of 30 patients who had received an epidural anaesthetic for general surgical procedures. Fentanyl was originally administered at a maximal rate of 50 micrograms/hr but later reduced to 25 micrograms/hour or less. Satisfactory analgesia was provided in 24 patients, who required no other form of analgesia whatsoever. Three patients derived significant analgesia from the infusion, but did require occasional small supplementary doses of opiates. Three patients derived little or no benefit from the procedure. The only noticeable side effect was nausea and vomiting, which was less of a feature with the weaker solution. The method was used on general surgical wards with no extra demands being made on nursing staff. Many nursing procedures and physiotherapy could be carried out more conveniently than usual in the postoperative period.
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PMID:Continuous epidural infusion of fentanyl for postoperative analgesia. 744 84

Fentanyl citrate is administered intramuscularly at increasing doses to patients suffering from an intense pain in the facial or trigeminal nerves territory. Fentanyl induces a very intense analgesia which develops during the hour following the administration. The intensity and the duration of the effect are dose related. Compared to that of morphine chlorhydrate, in the same conditions, the analgesia induced by fentanyl citrate is much less intense than expected: fentanyl seems to be only 25 times more potent than morphine. Furthermore, the observed duration of action of fentanyl makes it impossible to be still classified with the short time acting analgesics: with equianalgesic doses, morphine and fentanyl have the same time of initiation and the same duration of action. As observed, the time of the clinically useful analgesia is longer than 3 hours after injection of 0.006 mg/kg of fentanyl or of 0.150 mg/kg of morphine.
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PMID:[Comparison between the analgesic effects of fentanyl and morphine in conscious man (author's transl)]. 745 45

Fentanyl citrate or morphine chlorhydrate are injected intramuscularly at increasing doses to patients suffering from intense pain in the facial or trigeminal nerves territory: --fentanyl = 0.0015, 0.003, 0.006 mg/kg; --morphine = 0.100, 0.150, 0.200 mg/kg. The clinically observed side-effects are noted at regular time during the three hours following the injection. Fentanyl induces a drop in ventilation similar in duration to that of morphine, but it is more intense. Fentanyl induces less vomiting, but more euphoria than morphine and the sedation is the same in frequency and intensity with both drugs. The only difference of clinical importance concerns the cardio-vascular effects: morphine induces a constant, dose-related hypotension as that of fentanyl, at equianalgesic doses, is negligible.
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PMID:[Comparison between the side-effects of fentanyl and morphine in conscious man (author's transl)]. 745 46

This study made a longterm (72 hours) evaluation of the efficacy and possible side-effects of transdermal delivery of fentanyl (TTS-system) for post-operative pain relief. The study was double-blind, placebo-controlled with either a TTS-system delivering fentanyl 100 micrograms.h-1 and rescue analgesic on demand or a placebo system and analgesic on demand. Analgesic consumption, pain, general satisfaction, respiratory rate, and levels of SpO2 and tcCO2 (pulse oximetry and transcutaneous CO2 measuring) were evaluated. Recruitment was stopped after enrolment of 24 patients, on safety grounds. The Fentanyl group was more satisfied with postoperative pain relief (P = 0.008); they had a lower analgesic demand (P < 0.05) but also a lower respiratory rate (P < 0.05) and a higher level of tcCO2 23 hours after application (P < 0.05). There were three cases (25%) of increased PaCO2 (> 6.5 kPa) in the Placebo group but without low PaO2 levels, sedation or bradypnoea. Conversely, there were three cases (33%) in the Fentanyl group with bradypnoea (< 10 breaths/minute), two without influence on PaO2 or PaCO2, but one (no. 24) with bradypnoea, heavy sedation, a marked decrease in PaO2 (5.8 kPa) and increased PaCO2 (7.5 kPa). These findings terminated the study. The 100 micrograms transdermal fentanyl system is agreeable to the patients, but apparently too potent for routine postoperative pain relief due to a risk of respiratory depression. Respiratory frequency can not be relied upon as sole indicator of insufficient respiration.
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PMID:Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl. 748 44

The transdermal route of drug delivery has been used for the effective administration of therapeutic agents for more than a decade. The most important consideration in selecting a drug for transdermal delivery is the potential for improving therapeutic efficacy. The development of a transdermal fentanyl system provided an opportunity to add fentanyl to the armamentarium of strong opioids available for the treatment of cancer pain. The transdermal route of administration has advantages over both the oral and parenteral routes. In addition, patient and caregiver factors allow improved acceptance of and compliance to strong opioids and therefore improved analgesic outcome. Four transdermal fentanyl systems are available, providing delivery rates ranging from 25-100 micrograms/h; higher rates can be achieved by multiple system application. The system releases fentanyl continuously for 3 days when applied to the skin. Concentrations of fentanyl in the blood are measurable within a few hours of system application. Fentanyl serum concentrations increase gradually, generally levelling off after 12-24 h and remaining relatively constant for the remainder of the 3-day period. Steady state serum concentrations are reached by the second application. Clinical trials have established the efficacy and safety of transdermal fentanyl for the treatment of cancer pain. Transdermal fentanyl is not licensed for the treatment of acute pain, e.g. postoperative pain, and should not be prescribed for this purpose.
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PMID:Transdermal fentanyl therapy: system design, pharmacokinetics and efficacy. 760 33

This study examined midazolam and midazolam plus fentanyl in a placebo-controlled, double-blind clinical trial. It tested the hypothesis that combined drug therapy results in significantly poorer safety but no difference in efficacy compared to the single drug approach. Subjects were among 207 mildly anxious young adults having their third molars removed. Fentanyl had a significant depressant effect on respiration. Fifty of 79 (63%) subjects who received a midazolam-fentanyl combination became apneic, while only two of 78 (3%) who received midazolam alone were apneic (Fisher's Exact Test, P < 0.001). Two subjects (2.5%) in the combination group and none in the midazolam alone group had oxygen saturations drop below 90%. About twice as many subjects in the combination group had end-tidal carbon dioxide (EtCO2) levels greater than 25% above baseline. While these results are consistent with those for apnea, contingency analyses of the oxygen saturation and EtCO2 results were not statistically significant. Subjects in the combination group were more than four times as likely to have excellent versus good, fair, or poor sedation at a given level of intraoperative pain, and behavioral (movement and verbalization) but not cognitive measures of anxiety were attenuated.
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PMID:The safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl. 764 89

The effects of intravenous midazolam (0.75, 1.5, and 3 mg/70 kg) were examined and compared to that of fentanyl (0.1 mg/70 kg; positive control) and saline on pain induced by a cold pressor test. Both sensory and affective components of the pain response were assessed, as there is some evidence that benzodiazepines reduce the affective component. Healthy volunteers (three females, nine males) were enrolled in a prospective, double-blind, randomized, cross-over trial in which mood and psychomotor performance were also examined. Five minutes and 135 min postinjection, subjects immersed their forearm in ice-cold water for 3 min while assessments of pain were recorded. During the first immersion, subjects reported significantly lower pain intensity and bothersomeness ratings after having been injected with fentanyl, relative to the saline and midazolam conditions, which did not differ significantly from each other. Fentanyl and midazolam had prototypical mood altering and psychomotor impairing effects. We conclude that midazolam in our laboratory setting at the doses and route of administration studied had no effects on either the sensory or affective components of the pain experience.
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PMID:A dose-response study of the effects of intravenous midazolam on cold pressor-induced pain. 786 18

Fentanyl 50 micrograms, bupivacaine 50 mg and two mixtures containing fentanyl 50 micrograms and bupivacaine 25 mg or 12.5 mg (0.25 and 0.125%), respectively, in a volume of 10 ml were administered via thoracic extradural catheters to 24 patients after major abdominal surgery. All patients received all four treatments, in a randomized order, so that each patient received one of the 24 possible combinations of the four treatments. Pain relief was assessed by a linear analogue pain scale and the Prince Henry Hospital pain score. The duration of pain relief, effects on ventilatory frequency, heart rate, arterial pressure and central venous pressure were also recorded. Mean reductions in the analogue pain scale for fentanyl, bupivacaine, and fentanyl in 0.25% and 0.125% bupivacaine were 80 (SEM 5) %, 87 (4) %, 86 (5) % and 77 (5) %, respectively (ns). Pain scores decreased by 62 (6) %, 83 (5) %, 77 (6) % and 72 (6) %, respectively (ns). Mean arterial pressure decreased to 90 (2) %, 70 (2) %, 81 (2) % and 82 (3) %, respectively, of pretreatment values. In this respect, bupivacaine alone was significantly different from the three other treatments (P < 0.001). Hypotension (reduction in arterial pressure greater than 25% of pretreatment mean arterial pressure) was also more frequent after bupivacaine alone (P < 0.01). Effects on ventilation, heart rate and central venous pressure did not differ between the four treatments.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of extradural fentanyl, bupivacaine and two fentanyl-bupivacaine mixtures of pain relief after abdominal surgery. 788 Jul 3

A questionnaire was sent to the pharmacies of 88 Finish hospitals with surgical departments to inquire about the consumption of opioids during 1990. Another questionnaire was sent to 480 members of the Finnish Society of Anaesthesiologists to ask how they administer opioids to adult patients. Answers were received from 95% of hospitals and 67% of anaesthetists. Dextropropoxyphene was the most common oral opioid and oxycodone was the most common parenteral opioid used in Finland. Parenteral opioids were consumed almost totally in the hospitals. The anaesthetists reported oxycodone to be the opioid of choice for premedication, postoperative pain and sedation of critically ill patients. Fentanyl was the opioid most commonly used intravenously during balanced anaesthesia and in epidural administration. Epidural opioids were administered by 77% of anaesthetists and patient-controlled analgesia (PCA) technique mostly for intravenous administration by 19%. Only 10% of Finnish anaesthetists were actively involved in the management of chronic pain; the methods they use are discussed. The majority of anaesthetists were satisfied with the currently available opioids.
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PMID:Opioids in anaesthesia: a questionnaire survey in Finland. 791 67


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