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

Continuous lumbar epidural analgesia (L.E.A.) is considered to be the most effective technique for providing pain relief during labour and delivery. A prospective randomized study of 52 patients with pre-eclamptic toxemia in labour was carried out to investigate various aspects of the use of L.E.A. in view of the considerable disagreement concerning its effect. The results were compared to a control group (n = 52) receiving i.v. infusion of Hydralazine (Apresoline) and MgSO4 according to Zuspan recommendations. The results were evaluated statistically. The incidence of neonatal jaundice was higher in the control group (P less than 0.005). Maternal postpartum complications were similar in both groups. There were fewer forceps deliveries in the control group (P less than 0.05). The decrease in systolic BP after L.E.A. is well documented up to 120 min after the first injection of Marcaine (P less than 0.001-0.025), while after 120 min, by which time the Marcaine effect has finished, the systolic BP rises again (time for topping up). The decrease in the average diastolic BP as compared to the control group is statistically significant (P less than 0.001-0.01) until 180 min after initiation of the L.E.A. After that, the average diastolic BP rises again, unless Marcaine is topped up. Our results favour L.E.A. as the obstetric analgesic method of choice in cases of severe pre-eclampsia.
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PMID:Lumbar epidural analgesia in hypertensive patients during labour. 372 Oct 47

The modifications of the threshold for vocalization induced by pressure on the paws (both hind paws and both forepaws) were monitored at different times (15 min-96 h) following intraplantar injection of the polysaccharide carrageenin in the rat. During the first 2 h following the carrageenin injection, a decrease in vocalization threshold was observed not only for the right, injected hind paw, but also, in some rats, on paws distant from the inflamed plantar region, especially the right forepaw. This hyperalgesic effect was suppressed by locally administered Xylocaine into the right hind paw. During the 4 days following the injection, the number of rats hyperalgesic in the injected paw progressively declined. Twenty-four hours after the carrageenin injection, only a few rats still presented a clear hyperalgesia in the non-injected paws.
Pain 1987 Jan
PMID:Local and remote modifications of nociceptive sensitivity during carrageenin-induced inflammation in the rat. 382 99

We have examined the severity and duration of reflex inhibition of quadriceps activation after arthrotomy and meniscectomy, its relationship with pain, and the effect of local anaesthesia on this relationship. Fourteen men, on completion of medial meniscectomy by arthrotomy, received either 10 ml (B10 group) or 15 ml (B15 group) of 0.5% bupivacaine hydrochloride ('Marcaine Plain') into the knee, or no injection (control group). Reflex inhibition of quadriceps was measured as the percentage reduction, from the ipsilateral preoperative value, in the integrated surface electromyogram recorded during maximal voluntary isometric contractions with the knee in extension. Pain during each contraction was recorded on a linear analogue scale. Unoperated limbs showed no evidence of quadriceps inhibition. In the operated limbs, at 1-2 h post-operatively, controls had both severe inhibition (median = 62%) and severe pain on attempting a maximal quadriceps contraction. The B10 group had similar inhibition but less pain (P less than or equal to 0.005, Wilcoxon 2-sample, 1-tailed test). In the B15 group both inhibition (P less than or equal to 0.05) and pain (P less than or equal to 0.01) were less than in the controls. These effects of bupivacaine had been lost by 4-5 h post-operatively. At 3-4 days, inhibition was still severe (median = 75%) in all three groups of patients but pain was only mild or absent. At 10-15 days, median inhibition was still 35%, but there was little or no pain. We conclude that postmeniscectomy inhibition is not simply due to perceived pain but is due, at least in part, to stimuli from the knee.
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PMID:Reflex inhibition of the quadriceps after meniscectomy: lack of association with pain. 383 24

In order to reduce pain by injection, a frequently used topical anaesthetic is Xylocaine 5% ointment. This preparation, however, has certain limits in effectiveness. A new topical anaesthetic formulation, EMLA (Eutectic Mixture Local Anaesthetics), has been developed. Promising local anaesthetic properties on intact skin made it interesting to investigate the clinical usefulness of EMLA on mucous membranes and to find a suitable time of application. 30 volunteers, 20-40 yr, took part in the study. In two experimental double blind series, the topical anaesthetic effect was compared for EMLA 5% cream, Xylocaine 5% ointment, placebo cream, dry EMLA emulsion in cellulose discs and placebo discs. Application times were 2 and 5 minutes for the first three preparations, 2 minutes for the cellulose discs. The application areas were the alveolar mucosa in the lower buccal fold and the palatal mucosa. The pain by insertion of 27 or 30 gauge dental needles through the mucosa was registered. Xylocaine 5% and EMLA 5% reduced pain perception compared to placebo. For both Xylocaine 5% and EMLA 5% an application time of 2 minutes was found to be enough to produce a high degree of mucosal analgesia in the lower buccal fold. In the palatal area, however, the pain was not totally blocked by any of the investigated preparations but after 5 minutes of application EMLA showed a higher degree of analgesia. EMLA 5% creams was poorly localized at the applied area while the cellulose EMLA discs seemed to be more useful. No side effects were noticed.
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PMID:Experimental studies of new topical anaesthetics on the oral mucosa. 386 34

Twenty-two patients with malignant pericardial effusion were seen at the Toronto General Hospital between 1979 and 1984. Under ECG monitoring, an indwelling Kifa catheter was inserted into the pericardial sac and then connected to a Hemovac system and allowed to drain for 12 to 24 hours. Xylocaine hydrochloride, 100 mg, was first instilled intrapericardially, followed by tetracycline hydrochloride, 500 to 1,000 mg, dissolved in 20 mL normal saline. The catheter was clamped for one to two hours and then allowed to drain into the Hemovac. This procedure was repeated every 24 to 48 hours until the net drainage was less than 25 mL/24 hours. Nine men and 13 women were treated (median age, 55 years). The primary malignancy included lung in 15 patients, breast in two patients, and carcinoma of the stomach, ovary, pleural mesothelioma, chronic granulocytic leukemia, and adenocarcinoma of unknown primary in one patient each. Twenty patients received one to five instillations of tetracycline. In one patient the catheter could not be inserted into the pericardial sac, and in one patient the catheter clotted before tetracycline instillation. Minor complications included transient arrhythmia in two patients, postinjection pain in four patients, and self-limited temperature elevation greater than 38.5 degrees C in two patients. fifteen patients had good control of their malignant pericardial effusion for more than 30 days (median survival, 160 days; range, 38 to 275 days). Three patients died before 30 days without evidence of effusion, and no patient surviving longer than 30 days developed recurrent effusion or pericardial constriction. Intrapericardial tetracycline instillation is a safe and efficacious treatment for malignant pericardial effusion and should be considered the first treatment modality in this situation.
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PMID:Tetracycline sclerosis in the management of malignant pericardial effusion. 406 15

A retrospective study of 67 patients in whom Morton's neuroma had been diagnosed showed that 78% were women. The average age was 58 years (range, 19-85 years). Pain in the forefoot, which worsened with walking, was relieved by removal of shoes. The presence of local interdigital tenderness led to the diagnosis. Modification of shoes was helpful in two patients. The other 65 patients received a series of interdigital Xylocaine-steroid injections at one- to three-week intervals, which immediately relieved the pain in 30% of the patients and gave partial relief in 50%. At a two-year follow-up examination, 80% of the patients indicated complete relief of pain or had only slight pain. Surgical excision was indicated in those who failed to respond to the injections. Of 11 patients, surgical excision successfully relieved pain in four, effected partial relief in four, and failed in three. As a result of this retrospective study of patients with Morton's neuroma, the authors recommend therapeutic injections prior to surgery.
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PMID:Morton's interdigital neuroma. Indications for treatment by local injections versus surgery. 620 Feb 64

Segmental epidural blocks by double catheters which were inserted in the thoracolumbar (Th12-L1) and lower lumbar region (L4-L5) were performed in eleven primiparas to investigate the correct pain pathways of labor and the sensory innervation of uterus. It is generally believed in Japan that the sensory nerves of the cervix of uterus enter the cord through the sacral segments (s2,3,4) and the uterine body through the thoracic segments (Th11, Th12). 5 ml dose of 0.5% bupivacaine (Marcaine) was used to the upper catheter (Th12-L1) during the first stage of labor. Segmental spread of analgesia was on average Th9.4-L1,6 and the duration was 1 hr 57 min +/- 34 min. Seven cases (64%) had no pain up to the full dilatation of cervix and four cases (36%) complained of the pain in the pudendal nerve region (S2,3,4) at the 8 cm dilatation of cervix due to the lower engagement of the fetal head. These findings suggest that not only the pain impulses during the first stage of labor which are resulted from the uterine contraction and the dilatation of the cervix enter the cord through Th10.Th11.Th12.L1 segments and no relation to sacral nerves.
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PMID:[Clinical analysis of the pain pathways of labor (author's transl)]. 626 93

Two local anesthetics, Duranest 1% (etidocaine HCl) and Sensorcaine 0.5% (bupivacaine HCl), were tested against each other in dose-related blocks of the fifth ray. This study was conducted under double-blind cross-over conditions using 24 healthy volunteers. It was found that 4 ml. of either agent was sufficient to anesthetize the fifth ray area in all but 4.2% of the injections and 8 ml. of etidocaine always accomplished complete fifth ray anesthesia. Also, 4 ml. of etidocaine was found to have a more rapid onset and longer duration than the same volume of bupivacaine, 6.3 vs. 8.3 min. onset, and 487 vs. 449 min. duration, respectively. Pain and burning upon injection of either bupivacaine or etidocaine was encountered in 70% of the subjects tested. Residual pain was noted in some of the subjects given etidocaine after complete resolution of sensory anesthesia. Residual pain was not noted in any of the subjects given bupivacaine. Etidocaine was found to have a more rapid onset and a longer duration than bupivacaine or a lidocaine-bupivacaine mixture, and was thus found to be a superior agent in the subjects tested.
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PMID:A double-blind crossover study comparing two doses of Duranest (etidocaine) 1% with a fixed dose of Sensorcaine (bupivacaine) 0.5% utilizing infiltration regional blocks of the fifth ray. 652 Mar 49

Three local anesthetic agents (Xylocaine 2%, Xylocaine 2% with epinephrine 1:50,000, and Marcaine 0.5 with epinephrine 1:200,000) were injected intraorally using an intraligamentary injection technique. The study used a double-blind design and electrical tooth pulp stimulation to examine the duration of pulpal anesthesia. Patterns of recovery from each drug, subjective discomfort associated with each drug, pain of injection, and pain in comparison with local infiltration were also measured. The extent and duration of adjacent soft tissue anesthesia were recorded. Xylocaine 2% with epinephrine 1:50,000 produced the longest pulpal anesthesia. The decay pattern of this particular drug was less abrupt than that of the two others. No difference in discomfort or pain was found across the various drugs. There was no significant difference in pain at injection when intraligamentary anesthesia was compared with local infiltration. Post-injection pain was slightly lower with local infiltration. The extent of soft tissue anesthesia was significantly related to vasoconstrictor levels in the drugs. The study shows that duration of pulpal and soft tissue anesthesia can be tightly controlled by the operator and tailored specifically to planned dental procedures.
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PMID:Intraligamentary anesthesia: a double-blind comparative study. 658 88

Thirty-one patients undergoing thoracotomy were prospectively randomized to receive (1) no nerve blocks (n = 12), (2) placement of percutaneous catheters for intermittent nerve blocks with bupivacaine (Marcaine) (n = 10), or (3) bupivacaine nerve blocks intraoperatively (n = 8). One patient refused postoperative evaluation and was not included in this study. All patients received similar preoperative, intraoperative, and postoperative medications. Comparison of preoperative and postoperative arterial blood gases, assessments of pain and alertness, and chest roentgenograms showed no statistical advantage for any group. Analgesic requirements and pulmonary functions (functional residual capacity, tidal volume, minute ventilation peak flow, or forced expiratory volume) did not differ among the groups. Statistically significant differences were seen in mean respiratory rate and forced vital capacity. These differences, however, indicate that bupivacaine either by intraoperative use or by intermittent percutaneous administration did not improve postoperative increases in respiratory rate or decreases in forced vital capacity.
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PMID:Evaluation of bupivacaine nerve blocks in the modification of pain and pulmonary function changes after thoracotomy. 677 74


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