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

One hundred healthy parturients were divided at random into two demographically similar groups and were positioned for cesarean section either horizontally or flexed 5 to 10 degrees head up, with a 15 degrees lateral tilt. A Doppler ultrasound transducer was positioned over the fourth intercostal space parasternally. Initially, two patients received spinal, three general, and 95 epidural anesthesia. Two patients subsequently needed general for failed epidural anesthesia. Changes in Doppler heart tones (greater than 15 sec duration) indicative of venous air embolism (VAE) were identified 15 times in 11 patients--seven in supine and four in head-up patients (no statistically significant difference). Six awake patients (three horizontal, three head-up) developed chest tightness or pain during surgery, but only one episode correlated with VAE. No patient developed breathlessness. Moderate hypotension (greater than 10% decrease in systolic arterial pressure [SAP]) occurred in seven of 11 (63.6%) patients with, and in 26 (29.2%) of 89 patients without, VAE (P less than 0.001). More severe hypotension (SAP less than 90 mm Hg) due to bleeding occurred once. We conclude that a modest (5-10 degrees) head-up position does not influence the occurrence of VAE in patients having cesarean section. An 11% incidence of clinically insignificant VAE, although low, is still worrisome, as even small air bubbles in the circulation are potentially harmful, especially if the foramen ovale is patent. VAE during cesarean section should be anticipated and the anesthetic management planned accordingly.
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PMID:Incidence of venous air embolism during cesarean section is unchanged by the use of a 5 to 10 degree head-up tilt. 218 27

56 patients with carpal tunnel syndrome (CTS) with 84 hands affected were investigated. All patients were assessed clinically and electromyographically in order to find out whether there is a correlation between clinical signs and/or symptoms and the EMG data. A highly significant correlation was found between sensory deficit (hypoesthesia to touch and/or pain) and the amplitude of SAP and a significant correlation between motor deficits (weakness and/or atrophy) and distal motor latency.
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PMID:Clinical-electrophysiological correlations in the carpal tunnel syndrome. 395 37

We studied an AIDS patient who suffered from numbness, paresthesias and pain in the territories of different non-contiguous cutaneous nerves at different times. A transitory partial loss of touch and pinprick sensibility was also present in the same cutaneous areas. Sensory conduction velocities and SAP amplitudes were normal. The clinical picture was consistent with the Migrant Sensory Neuritis of Wartenberg. This rare neuropathy has never previously been described in patients affected by AIDS.
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PMID:Migrant sensory neuritis associated with AIDS: case report. 787 62

The investigators analyzed postoperative analgesia quality by randomizing 28 patients (ASA I-II) in two group. I group (14) received ketorolac 120 mg throughout a 24 hs observation period via a pump (20 mg initial bolus, 2 mg demand bolus, 5 min lock-out time 4 mg/h continuous infusion, 48 mg maximum dose not including initial bolus. II group (14 patients) were treated with ketorolac 30 mg im every 6 hs. During the study several parameters were recorded: MR, SAP, RR, SatO2 and pain level by noting' pts' filuing VAS. In the I group pain level dramatically dropped from 6.37 +/- 1.44 to 3.5 +/- 1.11 (p < 0.01) during the first 3 hrs. Pain level continued to decrease in a significant way up to 6 hs after the end of the surgical procedure (p < 0.01). Even in the II group patients the pain level drop in the first 3 hrs was significant (p < 0.01), never the less it did not show any further change throughout the following observation period. RR decreased from 19.7 +/- 3.7 to 15.9 +/- 3.2 (p < 0.01) in the first group, in the first 3 hrs, while in the II group patients lowered from 26.4 +/- 2.2 to 23.6 +/- 2.4 (p < 0.01) in the same time fraction. Results show a significant analgesic effect in both groups of patients in the first 3 hs. However pain control is more dramatic and stable up to the 6 hs in the patients of I group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Use of ketorolac in patient controlled analgesia (PCA) in postoperative pain]. 807 14

We divided 80 patients undergoing cataract surgery into two groups of 40: one control group and one propofol group to whom 1-1.5 mg/kg of propofol was administered before retrobulbar anesthesia. The following parameters were recorded before and after retrobulbar anesthesia: systolic and diastolic arterial pressure (SAP and DAP), heart rate (HR) and finally arterial oxygen saturation through pulse oximetry. Pain was also measured on the Scott-Huskisson visual analog scale. For patients in the control group a rise in arterial pressure over baseline values after 5 minutes (p < 0.01) was observed, while a decrease was found in the propofol group (p < 0.01). The rise after 5 minutes in the control group was significant when compared with the measurements for the propofol group (p < 0.01). The pain measure for the control group reached 5.53 +/- 1.54 on the Scott-Huskisson scale, but was 0 in the propofol group. Measurements on the pain scale correlated positively with diastolic arterial pressure 5 minutes after blockade in the control group (p < 0.05). The technique studied affords greater comfort for the patient, presents no special difficulties for the anesthesiologist performing the retrobulbar blockade, and causes no complications.
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PMID:[Propofol and retrobulbar anesthesia for cataract extraction]. 824 11

The authors report the initial experience with transarterial embolization of large hepatocellular carcinoma (HCC) with use of superabsorbent polymer microsphere (SAP-MS) particles. Six patients with nine HCCs (mean diameter, 8.2 cm) underwent 10 embolization procedures. Two patients underwent surgery later. In follow-up, tumor necrosis, postembolization syndrome, and laboratory data were assessed. Complete necrosis in three nodules, nearly complete necrosis in three nodules, and partial necrosis in three nodules were observed. Histologically, SAP-MS occluded intratumoral vessels tightly without ischemic damage of normal hepatic tissue. Postprocedural pain was minimal. No deterioration of liver function occurred. Our initial experience suggests that embolization with use of SAP-MS leads to extensive tumor necrosis of large nodular HCC, sparing use of chemotherapeutic agents.
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PMID:Transarterial embolization for large hepatocellular carcinoma with use of superabsorbent polymer microspheres: initial experience. 1235 28

In previous studies, we have shown that loss of spinal neurons that possess the substance P receptor (SPR) attenuated pain and hyperalgesia produced by capsaicin, inflammation, and nerve injury. To determine the role of SPR-expressing neurons in modulating pain and hyperalgesia, responses of superficial and deep lumbar spinal dorsal horn neurons evoked by mechanical and heat stimuli and by capsaicin were made after ablation of SPR-expressing neurons using the selective cytotoxin conjugate substance P-saporin (SP-SAP). Morphological analysis and electrophysiological recordings were made after intrathecal infusion of vehicle, saporin alone, or SP-SAP. SP-SAP, but not vehicle or SAP alone, produced an approximately 62% decrease in SPR-expressing neurons in the dorsal horn. Loss of SPR-expressing neurons diminished the responses of remaining neurons to intraplantar injection of capsaicin. Peak responses to 10 microg of capsaicin were approximately 65% lower in animals pretreated with SP-SAP compared with controls. Additionally, sensitization to mechanical and heat stimuli that normally follows capsaicin was rarely observed. Importantly, responses to mechanical and heat stimuli in the absence of capsaicin were not altered after SP-SAP treatment. In addition, nociceptive neurons did not exhibit windup in the SP-SAP-treated group. These results demonstrate that SPR-expressing neurons located in the dorsal horn are a pivotal component of the spinal circuits involved in triggering central sensitization and hyperalgesia. It appears that this relatively small population of neurons can regulate the physiological properties of other nociceptive neurons and drive central sensitization.
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PMID:Spinal neurons that possess the substance P receptor are required for the development of central sensitization. 1238 16

The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.
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PMID:Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy. 1240 99

The stress response to tracheal intubation may be obtunded by opioids given with induction of anesthesia. Tramadol is an opioid acting on mu-receptors and the monoaminergic pain modulating systems. This study examined vasomotor responses to tracheal intubation after equipotent doses of tramadol, nalbuphine and pethidine (3.0, 0.3 mg/kg(-1), and 1.5 mg/kg(-1), respectively), and placebo, given prior to induction of anesthesia in 118 healthy patients. Premedication and induction of anesthesia were standardized. Recordings of HR and SAP were made prior and subsequent to induction of anesthesia, and at 1, 3, 5 and 7 minutes after tracheal intubation. Prior to laryngoscopy and intubation, HR increased in all groups (p < or = 01, all comparisons), but least so after nalbuphine, whilst SAP remained unchanged after placebo, tramadol and pethidine, but fell after nalbuphine (p < 0.025). Maximum increases in HR (p < or = 0.005, all comparisons) and SAP (p < or = 0.02, all comparisons) occurred one minute after intubation. Maximum HR after placebo (108 SD 15 bpm), tramadol (107 SD 20 bpm), pethidine (113 SD 16 bpm) and nalbuphine (110 SD 26 bpm) was similar; with placebo HR remained faster than baseline until the seventh minute but had returned to baseline by the fifth minute with the opioids. Maximum SAP with tramadol (151 SD 26 mmHg) was similar to that with placebo (157 SD 20 mmHg), but was greater than after pethidine (136 SD 27 mmHg; p < 0.05) and nalbuphine (135 SD 19 mmHg; p < 0.02). With each test drug SAP returned to baseline by the third minute. It is concluded that, in these doses, 1) tramadol does not attenuate the chronotropic nor the inotropic response to tracheal intubation, and 2) pethidine and nalbuphine reduce only the inotropic response to airway instrumentation.
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PMID:Reducing cardiovascular responses to laryngoscopy and tracheal intubation: a comparison of equipotent doses of tramadol, nalbuphine and pethidine, with placebo. 1583 Jul 77

Not all neuropathic pain patients gain relief from current therapies that include the anticonvulsant, gabapentin, thought to modulate calcium channel function. We report a neural circuit that is permissive for the effectiveness of gabapentin. Substance P-saporin (SP-SAP) was used to selectively ablate superficial dorsal horn neurons expressing the neurokinin-1 receptor for substance P. These neurons project to the brain as shown by retrograde labelling and engage descending brainstem serotonergic influences that enhance spinal excitability via a facilitatory action on 5HT(3) receptors. We show the integrity of this pathway following nerve injury contributes to the behavioural allodynia, neuronal plasticity of deep dorsal horn neurons and the injury-specific actions of gabapentin. Thus SP-SAP attenuated the tactile and cold hypersensitivity and abnormal neuronal coding (including spontaneous activity, expansion of receptive field size) seen after spinal nerve ligation. Furthermore the powerful actions of gabapentin after neuropathy were blocked by either ablation of NK-1 expressing neurones or 5HT(3) receptor antagonism using ondansetron. Remarkably, 5HT(3) receptor activation provided a state-dependency (independent of that produced by neuropathy) allowing GBP to powerfully inhibit in normal uninjured animals. This circuit is therefore a crucial determinant of the abnormal neuronal and behavioural manifestations of neuropathy and importantly, the efficacy of gabapentin. As this spino-bulbo-spinal circuit contacts areas of the brain implicated in the affective components of pain, this loop may represent a route by which emotions can influence the degree of pain in a patient, as well as the effectiveness of the drug treatment. These hypotheses are testable in patients.
Pain 2005 Oct
PMID:Spinal-supraspinal serotonergic circuits regulating neuropathic pain and its treatment with gabapentin. 1615 May 46


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