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

Pulsed dye laser is a new treatment for port-wine stains, congenital lesions in the cutaneous vascular plexus. We report our anesthetic experience with paediatric outpatients treated in the dermatology clinic. From April to November 1993, 48 ASA 1 children were anaesthetised for a total of 105 consecutive laser treatments. The youngest was eight months old, the oldest was 12 yrs old and most of the sessions (43%) were done for children aged from two to four years. Each received acetaminophen (10 mg.kg-1 p.o.) before treatment. A propofol infusion was chosen for anaesthesia to achieve early discharge and to reduce the incidence of postoperative emesis. The infusion was adjusted to maintain blood pressure within 20% of baseline and to keep the child immobile. The dose was progressively reduced during the procedure from 400 micrograms.kg-1.min-1 to 100 micrograms.kg-1.min-1. Fentanyl (2 micrograms.kg-1 i.v.) was added for analgesia. Respiration was spontaneous through a nasopharyngeal airway (air in oxygen 40%). Anaesthesia proceeded uneventfully in all cases and lasted for 15-30 min (63% of treatments), 30-45 min (28%) or 45-60 min (9%) according to the size of the lesion. The mean stay in the recovery room was 25.1 min and none of the patients experienced emesis. Our experience shows that general anaesthesia with propofol supplemented with fentanyl offers a rapid onset and awakening, a painless treatment and an immobile child. It is a safe solution to alleviate pain from repeated painful procedures even in small children under two years of age.
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PMID:Propofol for pulsed dye laser treatments in paediatric outpatients. 792 22

Forty-five patients undergoing circumcision were allocated randomly to one of three study groups to compare topical analgesia with dorsal nerve block using the midline or lateral approach. Pain scores, side effects and analgesic requirements were recorded after surgery. Patients who received topical analgesia required significantly more fentanyl and had higher pain scores at the 15-min observation period after operation. Fentanyl requirements and pain scores were similar in patients who received a dorsal nerve block using either the midline or lateral approach. The incidence of side effects after surgery was similar in all three groups.
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PMID:Post-circumcision analgesia: comparison of topical analgesia with dorsal nerve block using the midline and lateral approaches. 777 44

Epidural opiate administration is routinely used by many anaesthesiologists involved in obstetric anaesthesia. Epidural injection of a local anaesthetic combined with an opioid generates a more rapid onset of more profound analgesia with little motor blockade. Thus pain relief lasts longer than after either drug alone. A combination of dilute concentrations of bupivacaine and opioids lowers the risk of systemic local anaesthetic toxicity significantly. Fentanyl was the first opioid widely used as an adjunct to local anaesthetics for labour analgesia. An initial dose of fentanyl 50 micrograms combined with 0.25% or 0.125% bupivacaine can produce good initial analgesia for most laboring parturients. A continuous infusion of 0.125% or 0.0625% bupivacaine with 1 microgram.ml-1 fentanyl at 10-12 ml.h-1 will maintain good pain relief throughout parturition. No adverse effects on either the mother or the neonate have been attributed to this technique. Recently, sufentanil was introduced in obstetric analgesia. Sufentanil appears to induce a faster onset of more profound, long lasting analgesia with extremely low concentrations of bupivacaine than that with fentanyl. The reduction of the total amount of bupivacaine is correlated with a significant decrease in motor blockade and instrumental deliveries. There were no adverse maternal or fetal effects and umbilical cord levels were too low to be detected.
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PMID:[Opiates for epidural analgesia: for or against?]. 808 46

The effectiveness of fentanyl and ketorolac in providing analgesia for day-case gynaecological procedures was evaluated in 55 healthy volunteers in a single blinded fashion. Fentanyl (1 mcg/kg iv) and ketorolac (30 mg im) were administered immediately following induction of anaesthesia. Anaesthesia was standardized with propofol, nitrous oxide and enflurane. Outcome variables assessed were pain, additional analgesic requirements, and incidence of postoperative nausea and vomiting. All variables were recorded at 15 minutes, 2 hours and 24 hours postoperatively. There was no significant difference between the 2 groups with respect to any of the measured variables. Both drugs were ineffective as sole analgesic agents in half of their respective groups. It may be that a combination of these drugs, providing a multireceptor approach to analgesia, will prove to be more effective.
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PMID:Ketorolac versus fentanyl for gynaecological day-case surgery. 817 63

The analgesic effects of fentanyl (4 micrograms/kg) and medetomidine (10 micrograms/kg) in 1 mL saline injected epidurally were measured in 15 cats. The response to an electrical cutaneous stimulus from a constant current generator was used as the index of analgesia. The stimulus was applied to a forelimb before epidural injection, and at 15, 30, 60, 90, 120, 180, 240, and 300 minutes post-injection (PI). The hindlimb was tested 5 minutes later. One mL saline only was used to control for volume of injection and saline. Medetomidine significantly increased the pain threshold for the hindlimb at 20 to 245 minutes PI compared with the preinjection level. Fentanyl significantly increased the pain threshold at 20 minutes PI only compared with preinjection levels. Medetomidine significantly increased the pain threshold of the forelimb at 15 to 120 minutes PI compared with the preinjection levels. Fentanyl did not significantly increase the pain threshold of the forelimb. Administration of medetomidine produced emesis in 12 of 15 cats in an average of 6.4 minutes PI (range, 3 to 11 minutes) and mild sedation in all cats. Injection of fentanyl produced no visible side effects in any of the cats.
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PMID:The analgesic effects of administering fentanyl or medetomidine in the lumbosacral epidural space of cats. 819 74

This study examined analgesic efficacy and adverse effects of buprenorphine and fentanyl for the postoperative pain relief by continuous epidural infusion. Fifty patients after upper or lower abdominal surgeries were assigned to two groups and buprenorphine and fentanyl were epidurally administered postoperatively. Buprenorphine (B) group received bolus injection of B 0.1mg + saline 8 ml and continuous infusion of B 0.8 mg+saline 92 ml (2 ml.h-1). Fentanyl group received bolus injection of F 0.1 mg+saline 6 ml and continuous infusion of F 0.6 mg+saline 84 ml (2 ml.h-1). There was no significant difference between the two groups in the analgesic efficacy, which became lower from 2 to 12 hours postoperatively. However, compared with buprenorphine group, the incidence of nausea or vomiting and dizziness was significantly less in the fentanyl group (11 vs. 4 cases and 7 vs. 1 cases). These results imply that the major site of action of epidurally administered fentanyl is the spinal cord. In contrast, analgesic effect of epidural buprenorphine appears to be enhanced by the supraspinal action. We conclude that fentanyl is superior to buprenorphine for postoperative pain relief by continuous epidural infusion.
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PMID:[Comparison of buprenorphine and fentanyl for postoperative pain relief by continuous epidural infusion]. 830 22

Treatment of postoperative pain is often insufficient. It normally consists of systemic application of an analgesic drug or a regional technique of analgesia. Fentanyl-TTS may be a new approach for postoperative pain therapy. Fentanyl is incorporated into a transdermal system; after application to the skin continuous release of therapeutic doses is achieved for a period of 72 h. Serum peak levels are obtained 8-16 h after application; the serum half-life is about 16-21 h because of the dermal depot. Fentanyl-TTS was administered in several clinical studies for therapy of postoperative pain. The efficacy of this new form of application could be demonstrated. For the first 12 h the patients needed supplementary doses of analgesic drugs in the same range as the placebo groups because of the lag time of fentanyl-TTS. In the following 12 h the need for supplementary analgesics was significantly reduced. After removal of the patch, the need for analgesics was still reduced for 12 h. In 21 of 341 patients respiratory depression occurred under therapy with fentanyl-TTS; no respiratory depression was observed in the placebo groups. Thus, respiratory depression might occur in up to 9% of postoperative patients treated with fentanyl-TTS. Other adverse effects were nausea (62%), vomiting (26%), sedation (22%), urinary retention (11%), headache (5%), and dizziness (8%). Local reactions under the patch were erythema (39%) or pruritus (9%). These phenomena disappeared within a few hours. The pharmacokinetics of fentanyl-TTS have two major drawbacks: during the first 12-15 h the patients need supplementary analgesics, usually opioids.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fentanyl-TTS for postoperative pain therapy. A new alternative?]. 831 89

Iontophoresis is a process which enhances skin permeation of ionized species by using an electrical field as driving force. The aim of the present study was to investigate whether transdermal iontophoresis of fentanyl or sufentanil could induce therapeutic plasma levels and antinociceptive effect. Fentanyl and sufentanil were introduced in an acidic buffer (acetate buffer 0.01 M at pH 5) at 40 micrograms/mL. A platinum electrode was clamped in an hydrophilic foam soaked with the drug solution and linked to the anode. A cathodic foam reservoir was filled with saline solution. The device was applied on the abdominal skin of hairless rats and direct current (0.17 mA/cm2) was applied for 1 h. Opioid plasma concentrations were monitored. In the experimental conditions used, iontophoresis strongly increased transdermal permeation of the drugs as compared to diffusion. A 1.5 h Tmax was observed. The maximal plasma levels after 1.5 h were 29.3 +/- 14 ng/mL for fentanyl and 29.1 +/- 14 ng/mL for sufentanil. The plasma level of the narcotics decreased slowly after iontophoresis was terminated. Iontophoretic transdermal permeation of fentanyl and sufentanil in rats induced analgesic effects as measured by the tail-flick test. These effects lasted for about 4 h. Thus, transdermal iontophoresis with a miniaturized device is effective for the controlled and pulsatile or sustained delivery of synthetic opiates for pain management in humans. As compared to classical patches, it could reduce the lag time before reaching steady state and allow variable drug release rate.
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PMID:In vivo iontophoresis of fentanyl and sufentanil in rats: pharmacokinetics and acute antinociceptive effects. 831 48

There is no standard therapy in the management of postoperative pain control following corrective cardiac surgery of congenital heart disease. Assessment in the preverbal age is difficult. In a randomized study we compared a combined treatment of fentanyl and midazolam, given as continuous infusion versus single dose application. A pain assessment score was used to measure the effectiveness of analgosedation in addition to recording nurseries observations. Fentanyl and midazolam are an appropriate combination for postoperative pain treatment. Continuous application is considered to be more effective concerning basic anxiety, cumulative dosage and to avoid volume overload in infants and young children, following cardiac surgery; overdosage was not observed.
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PMID:[Analgosedation with fentanyl/midazolam after correction of congenital heart defects]. 856 37

Eleven patients with cancer pain in a palliative care and chronic pain service required cessation of morphine due to unacceptable opioid side effects. In this retrospective study fentanyl was evaluated as a second-line subcutaneously infused opioid. Starting doses ranged from 100 to 1000 micrograms/24 h, and the duration of fentanyl infusion was 3-70 days. The clinically derived mean relative potency of fentanyl to morphine infusions was 68:1 (SD +/- 23; range: 15-100), and we now recommend cautious dose conversion at an approximate equivalence of 150-200 micrograms fentanyl for 10 mg morphine in non-opioid naive chronic cancer pain patients. All patients demonstrated an improvement in the adverse effect(s) for which the change in opioid was undertaken. Adequate pain relief was achieved in all but 1 patient with mixed nociceptive and neuropathic pelvic pain for whom an epidural infusion of a local anaesthetic/opioid mixture was required. Fentanyl was changed to the more potent synthetic opioid sufentanil in 2 patients for whom the fentanyl dose necessitated too large a volume for the portable syringe driver in use. The clinically derived sufentanil to fentanyl relative potencies were 24:1 and 16:1, respectively. This achieved good analgesia and maintained the favourable side-effect profile seen with fentanyl. Subcutaneous infusion appears to be a safe and viable route of fentanyl delivery, and provided effective analgesia with a low incidence of adverse effects in this small selected group of patients who were intolerant of subcutaneous morphine. We suggest a trial of subcutaneous fentanyl for selected patients who have intractable adverse effects on morphine, and it is now the second-line infusable opioid in our service. Further prospective evaluation of the role of these two synthetic mu opioid agonists in palliative care practice is warranted, as part of an evolving picture of variation in opioid side-effect profile seen with different drugs within the class.
Pain 1995 Nov
PMID:Subcutaneous fentanyl and sufentanil infusion substitution for morphine intolerance in cancer pain management. 862 93


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