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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case is reported of a persisting leakage of cerebrospinal fluid (CSF) occurring after removal of a subarachnoid analgesia kit. The kit had been inserted in a 79-year-old man who had severe perineal cancer pain. Fifteen months later, after a second episode of meningitis, the kit was removed. The leakage was noticed a few hours after removal of the kit. Biological parameters confirmed the fluid was most certainly CSF. Despite making the patient lie prone, water restriction and a compressive dressing, the leakage was still present three days later. A blood patch, and the epidural injection of biological glue, were of no avail. The leakage was only stopped by tying off the fistula with a ligature. The actiology and treatment of skin CSF fistulae after puncture of the dura mater are discussed.
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PMID:[Persistent leakage of cerebrospinal fluid after removal of a device implanted for subarachnoid analgesia]. 141 83

A large number of opioids and nonopioids have been administered epidurally and intrathecally in the hope of providing segmental analgesia without serious adverse effects. However, neurotoxicity data are generally unavailable for many of these drugs. The present study evaluated the behavioral, motor, electroencephalographic, and histopathologic changes following intrathecal injection of large and small doses of butorphanol, sufentanil, and nalbuphine in sheep. Thirty-two sheep (20-32 kg) were anesthetized and catheters placed intrathecally after hemilaminectomy. The large doses of butorphanol, sufentanil and nalbuphine were 0.375 mg/kg (4.4-5.2 ml), 7.5 micrograms/kg (3.6-4.8 ml) and 0.75 mg/kg (1.5-2.4 ml), and the small doses were 0.075 mg/kg (0.9-1.1 ml), 1.5 micrograms/kg (0.7-0.9 ml) and 0.15 mg/kg (0.38-0.5 ml), respectively. The opioids were administered intrathecally every 6 h for 3 days and the above-mentioned parameters studied. Five sheep received intrathecal saline (1.1 or 5.2 ml) and served as controls. Histopathologic changes were evaluated by a neuropathologist blinded to the study protocol. Irrespective of dose, intrathecal injection of butorphanol was associated with severe behavioral responses such as agitation, rigidity, vocalization, and restlessness, as well as prolonged or irreversible hindlimb paralysis. Electroencephalography showed increased cortical activity or seizure activity. One sheep died because of severe respiratory depression that did not respond to naloxone. Spinal cord histologic changes consisted of suppurative meningitis and myelitis as well as neuronal changes such as spongiosis and chromatolysis. Large doses of intrathecal sufentanil were associated with similar though somewhat less severe responses. The behavioral and motor changes following the small dose of intrathecal sufentanil were of mild to moderate nature. Following intrathecal nalbuphine, the above-mentioned changes were similar to those seen in control animals. We conclude that butorphanol in doses of 0.075 and 0.375 mg/kg intrathecally and sufentanil 7.5 micrograms/kg intrathecally are neurotoxic in sheep.
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PMID:Behavioral and histopathologic effects following intrathecal administration of butorphanol, sufentanil, and nalbuphine in sheep. 138 69

Spinal analgesia, a new method for relieving refractory cancer pain, was tested in 19 patients. A catheter was installed in the subarachnoid (17 cases) or peridural (2 cases) space and connected to a subcutaneous site of injection. The success rate at 10 days was 68%. In 11 patients pain was relieved throughout the course of the malignant disease, with doses that did not exceed 6 mg in 7 patients and 10 mg in the remaining 4 patients. The most severe complications were leakage of the cerebrospinal fluid in 1 case, meningitis after 18 months of injection in 1 case and displacement of the catheter in 3 cases.
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PMID:[Refractory cancer pain. Subarachnoid or epidural administration of morphine]. 295 74

We report on a patient suffering severe pain following a long-standing sacral chordoma in whom management of therapy and pain was extremely difficult. Because orally administered morphine was observed to be ineffective in the early stages of treatment, we tried to achieve pain relief by using epidural morphine. This was also unsatisfactory. Intrathecal infusion of morphine and bupivacaine through a catheter inserted at the L2-L3 level was also found to be ineffective; only a segment block was observed. A structural anomaly of the spine was suspected and confirmed by myelography, showing metastasis at L3. Pain relief improved when an infusion of morphine+bupivacaine was employed through a catheter placed at the L4-L5 level below the blockage. A major problem which continued throughout the course of the disease was the daily occurrence of episodes of unbearable sharp pain that required addition of midazolam to the local anesthetic/opioid subarachnoid infusion. The patient received this mixture through an intrathecal port during the last 13 months of life, a gradually increasing dose being necessary. Periods of analgesia were followed by occasional crises of intense sharp pain suggesting incomplete relief. No serious complications or meningitis occurred. This case emphasizes the difficulty in managing pain in this type of cancer.
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PMID:Difficult management of pain following sacrococcygeal chordoma: 13 months of subarachnoid infusion. 789 30

Among the most difficult pain management problems are those associated with advanced head and neck cancer, and those in which pain is midline, bilateral, or diffuse. The authors report effective control of intractable pain in 52 patients by injection of small doses of morphine via an Ommaya or a Cordis reservoir into the lateral cerebral ventricle. The technique is safe and effective. The reservoir is usually inserted under local analgesia so the method of pain relief is available to patients in whom general anesthesia would be difficult or contraindicated. The doses of morphine required to maintain analgesia remain remarkably low. Tolerance reported by other authors has not been a problem when preoperative assessment of the patient has been thorough. Maximum survival time has been 75 wk and another patient has lived 65 wk. Complications included two colonized reservoirs, one dislodged ventricular catheter, three blocked catheters, and one postoperative meningitis. For patients with diffuse midline or bilateral pain, or intractable pain associated with advanced head and neck cancer, the use of intraventricular morphine should be considered when satisfactory pain relief is not achieved with oral morphine or continuous subcutaneous infusion.
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PMID:Intraventricular morphine for intractable pain of advanced cancer. 796 73

We report two cases of meningitis which developed after combined spinal-extradural procedures for obstetric analgesia. The first case was thought to be caused by aseptic or chemical meningitis and the second was a case of bacterial meningitis in a patient who also received an extradural blood patch. It is important that meningitis is considered as a differential diagnosis in patients who present with headache after spinal anaesthesia and that antibiotic therapy is selected to cover unusual organisms.
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PMID:Meningitis after combined spinal-extradural anaesthesia in obstetrics. 771 96

Epidural analgesia (EA) is the best technique to obtain pain relief during labour. But the needle, the catheter and the local anaesthetics (LA) are 3 reasons to cause maternal complications. In France we do not know the exact number of EA performed every year and it is very difficult to appreciate the incidence of maternal complications. Therefore, it is necessary to know it and try to reduce the incidence of some of them. Maternal complications after EA are classically: 1. caused by catheter or needle: massive subarachnoid injection, toxic intravenous injection with convulsions and/or cardiac arrest; 2. secondary to infectious problems: meningitis or epidural abscess; 3. due to LA with the very rare anaphylactoid reactions; 4. due to prolonged neurologic complications with epidural and subdural haematomas, subarachnoid cysts or arachnoiditis. These complications are rare: 1/4,700 in the largest series of literature, involving more than 500,000 EA. In France, we tried to quantify maternal complications among nearly 300,000 EA performed over a period of 5 years. The overall incidence of serious complications was 1/4,005 EA. The most frequent are accidental dural puncture (1/156), massive subarachnoid injections (1/8,010) and convulsions (1/9,011). The incidence of these 3 complications must be reduced by better training, material or attention during bolus injection of LA.
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PMID:[Epidemiology of complications of obstetrical epidural analgesia]. 808 39

Spinal anaesthetics can induce histopathologic lesions and regional haemodynamic alterations in the spinal cord. There are numerous causes of neurologic lesions, including direct trauma of the spinal cord and nerve roots during puncture or catheter insertion, compromised spinal cord perfusion and direct neurotoxic effect. Histopathologic lesions are localized either in meninges (meningitis or arachnoiditis) or in neuraxis (myelitis or axonal degeneration). Neurotoxicity can result from decrease in neuronal blood supply, elicited by high concentrations of the solutions, long duration exposure to local anaesthetics, and the use of adjuvants. They have been implicated in the occurrence of cauda equina syndrome after continuous spinal anaesthesia using hyperbaric solution of lidocaine and tetracaine given through small diameter catheters. Selective spinal analgesia is induced by spinal opioids without motor blockade except for meperidine. Complications occurred in patients after high doses of morphine, which were related to one of its metabolites, morphine-3-glucuronide. Preservative-free opioid solutions are to be preferred for spinal anaesthesia. There is no report of neurotoxicity neither in animal studies, nor in humans, using spinal clonidine. In order to reduce the incidence of neurotoxicity, some safety rules should be followed. The lowest efficient dose of local anaesthetics must be given. Incomplete blockade should not necessarily lead to a reinjection. Large volume of hyperbaric lidocaine or repeated injections of such solutions must be avoided as well as preservative-containing solutions. The administration of new compounds by the spinal route must be supported by data of spinal neuropharmacology and the lack of neurotoxicity must have been previously checked with animal studies.
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PMID:[Neurotoxicity of intrathecally administrated agents]. 903 58

We report a case in which the signs of a malignant meningitis could have been confused with complications of an in-dwelling epidural catheter which was being used for analgesia. This confusion could have had disastrous implications for the patient's pain relief. We also discuss some of the issues and problems surrounding the use of in-dwelling epidurals in terminal care patients.
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PMID:Epidural complications and a case of malignant meningitis. 951 72

We report a case of Streptococcus salivarius meningitis following combined spinal-epidural analgesia for labour. Although rare, bacterial meningitis following combined spinal-epidural anaesthesia is being increasingly described. We review the previously reported cases and discuss the possible aetiological causes and the aseptic precautions likely to reduce the incidence of infectious complications.
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PMID:Bacterial meningitis following combined spinal-epidural analgesia for labour. 979 29


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