Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty patients undergoing thoracotomy were given 2, 4, or 6 mg morphine epidurally in a double-blind, randomized study for postoperative analgesia. Administration at T12-L1 or L1-L2 resulted in a dose-related analgetic duration (514 +/- 118 min, 778 +/- 207 min, and 938 +/- 155 min; means +/- SEM, respectively, for the groups). For the three groups, peak plasma morphine concentrations (range 19-34 ng/ml) were reached within 15 min. The plasma curves had a similar appearance as after an intramuscular injection and pharmacokinetic calculations showed an elimination half-life (mean +/- SEM) of 173 +/- 24 min, 200 +/- 60 min, and 213 +/- 57 min for the groups, respectively. The morphine concentrations in the CSF were considerably higher compared with plasma (45-100 times the plasma concentration at 1 h, 100-250 times at 3 h, and 125-175 times at 5 h) but the elimination half-life of morphine in the cerebrospinal fluid (CSF) was similar to that in plasma. The lumbar approach was used with similar efficacy as reported for thoracic administration. Side effects were few and nonsignificant. The authors conclude that epidural morphine administration results in a dose-dependent analgesia, as well as concentrations in the CSF that are considerably higher than in plasma. With similar elimination half-lives for morphine in CSF and plasma, the long analgetic duration probably depends on the locally high morphine concentrations achieved. For safety purposes, one may use the lumbar approach to the epidural space even for thoracic pain without reducing the efficacy.
 ...
PMID:Pharmacokinetic aspects of epidural morphine analgesia. 685 84

The effects of 0.5% bupivacaine 1.5, 2 and 3 ml in 8% glucose was compared in a double-blind study involving 30 patients undergoing spinal analgesia. The time to the onset of maximum segmental spread of analgesia was approximately 15 min for all three volumes. Cephalad spread of analgesia was related to the volume used: 1.5 ml reached T10, 2 ml T8 and 3 ml T7. The duration of analgesia increased with increasing volume, 3 ml producing analgesia in T8-T12 for 1.5-2 h, and in the lumbar region for 2.5-3 h. Increasing the volume increased the extent of motor blockade and speeded up its onset. Significant decreases in arterial pressure were observed in the 2- and 3-ml groups. The changes in heart rate were moderate and not correlated with the amount of drug. Spinal headache occurred in two patients.
 ...
PMID:Spinal analgesia with hyperbaric bupivacaine: effects of volume of solution. 703 57

Continuous infusion of a 0.2% solution of bupivacaine via a peridural catheter in a rate of 0.2 ml/kg x h is sufficient to make a patient pain-free for any time required following upper abdominal or abdomino-thoracic surgery. The zone of analgesia extends segmentally from T4 to T12/L1 so that the patient can be mobilized. If necessary an insufficient blockade can be completed by bolus injection of 10 to 15 ml of 0.2% solution. Using this technique over a period of four days after surgery, serum concentrations of bupivacaine were measured in 20 patients. The following values were found (median, range): at the end of the operation 0.85, 0.26-1.72 mg/1, after 24 h 1.70, 0.58-4.04 mg/1, after 48 h 3.46, 1.22-7.62 mg/1, after 72 h 2.80, 0.73-12.15 mg/1 and after 96 h (end of the investigation) 2.39, 0.34-9.92 mg/1. Moderate excitation was sometimes observed, while the patient was in the recovery room (shivering, restlessness) but disappeared completely within 10 h. Later on no signs of intoxication were observed, even when serum bupivacaine concentrations exceeded 6 mg/1. During continuous epidural anaesthesia, when serum bupivacaine concentrations increase gradually this level does not seem to be toxic. We consider this method to be suitable for keeping a patient pain-free following upper abdominal surgery, provided that adequate monitoring is available.
 ...
PMID:[Serum bupivacaine concentrations in patients with continuous peridural anesthesia administered by thoracic catheter]. 714 16

A new technique for producing segmental subarachnoid analgesia in adult horses without causing complete loss of locomotor control is described. A 17-gauge Huber point (Tuohy) needle was used to place a catheter with a stylet into the subarachnoid space at the lumbosacral intervertebral space in 13 adult horses (weighing 500 +/- 60 kg, representing both sexes) and to advance the catheter craniad to the thoracolumbar area. The position of the catheter was confirmed radiographically. A 2% mepivacaine hydrochloride solution (1.5 ml, 30 mg) was injected through the catheter at a rate of 0.5 ml/60 s. Segmental analgesia, as determined by the horses' responses to superficial and deep muscular pinpricks, occurred within (onset) 5 to 10 minutes of injection and lasted (duration) 42.4 +/- 15 minutes (min-max, 25 to 68 minutes). Maximal thoracolumbar analgesia extended from spinal cord segments T12 to L3 on both sides of the spinal column. Subarachnoid injection of mepivacaine hydrochloride caused significant (P less than 0.05) increases in heart rate and subcutaneous temperature and decreases in respiratory rate and rectal temperature. Significant changes (P less than 0.05) were not observed in a control group of 7 horses after subarachnoidal injection of sterile water (1.5 ml). The surgical application of segmental subarachnoid analgesia was demonstrated in 1 horse. The benefits and potential complications of segmental subarachnoid analgesia in horses are discussed.
 ...
PMID:Segmental thoracolumbar spinal (subarachnoid) analgesia in conscious horses. 716 57

The concentration of procaine in the CSF of 10 adult nonpregnant cows was determined after epidural injection of 5% procaine hydrochloride solution. Samples of CSF were removed through a catheter introduced into the subarachnoid space at the lumbosacral intervertebral space and advanced craniad to the same level as the epidural injection site. The position and the location of the catheter and spinal needle were confirmed radiographically. Segmental analgesia was achieved 8 to 20 minutes after completing the procaine hydrochloride injection and extended between spinal cord segments T12 and L3 on one or both sides of the animal. The average duration of analgesia, as determined by response to superficial and deep muscular pinpricks at the L1 dermatome, was 81.3 +/- 22.8 minutes (min-max, 45-127 minutes). The average subarachnoid concentration of procaine 10 minutes after epidural injection was 120.4 +/- 42.9 microgram/ml. The highest average procaine concentration recorded was 160.7 +/- 63.7 microgram/ml at 25.0 +/- 6.7 minutes after injection. Average procaine concentration was 47.8 +/- 13.5 microgram/ml at cessation of analgesia. A similar concentration of procaine was recovered from the subarachnoid space during either unilateral or bilateral analgesia. Procaine was not found in arterial plasma after the epidural administration of procaine hydrochloride. Subarachnoid threshold concentrations of local anesthetic necessary to produce spinal analgesia were reached after repeated epidural injections, but not after a single administration. It is concluded that segmental epidural analgesia is principally due to anesthesia of dura-covered nerve roots within and outside the epidural space and is minimally, if at all, dependent on the production of analgesia of nerves within the subarachnoid space.
 ...
PMID:Appearance of procaine in spinal fluid during segmental epidural analgesia in cows. 733 26

To study post-operative analgesia with epidural midazolam, 30 patients who had undergone upper abdominal surgery were divided into two equal groups. When patients complained of pain, they were given either 6 microliters 0.25% bupivacaine (control group) or 6 microliters 0.25% bupivacaine + 0.05 mg kg-1 midazolam (midazolam group) epidurally at a single level between T7 and T12. Blood pressure and heart rate were similar in the two groups. Sedation was significantly greater in the midazolam group 10 min after administration. The area of analgesia was significantly larger in the midazolam group 10 and 30 min after administration and involved the entire spinal area and the head and face 10 min after administration in six patients. Amnesia was observed in 14 patients in the midazolam group but in only one in the control group. Epidural midazolam together with bupivacaine adds central analgesic, sedative, and amnesic effects to spinal analgesia and is useful for managing post-operative pain.
 ...
PMID:The post-operative analgesic action of midazolam following epidural administration. 758 66

The present study tested the hypothesis that patients receiving epidural bupivacaine before surgery would require less morphine postoperatively and/or report less intense pain than patients receiving epidural bupivacaine after incision but before the end of surgery. Forty-two patients (ASA class I-III) scheduled for lower abdominal surgery were randomly assigned to 1 of 2 groups of equal size and prospectively studied using a double-blind, placebo-controlled crossover design. Epidural catheters were placed in the T12-L1 or L1-L2 interspaces pre-operatively, the position of the catheter was confirmed with 3% chloroprocaine with epinephrine 1:200,000, and sensory testing was carried out until levels had receded to below T12. Group 1 received 15 ml of 0.5% epidural bupivacaine injected 35 min before incision followed by 15 ml of epidural normal saline 30 min after incision. Group 2 received 15 ml of epidural normal saline injected 37 min before incision followed by 15 ml of 0.5% epidural bupivacaine 30 min after incision. General anaesthesia was induced with thiopental (4-6 mg/kg) and maintained with N2O/O2 and isoflurane. Paralysis was achieved with pancuronium (0.1 mg/kg). Opioids were not used as pre-medication or during surgery. Postoperative analgesia consisted of patient-controlled (PCA) intravenous morphine. Visual analogue pain scores (VAS) (at rest and after standardized mobilization) did not differ significantly between the 2 groups but McGill Pain Questionnaire (MPQ) pain ratings were significantly lower in group 1 at the 24 and 72 h assessments. Group 1 used significantly less morphine than did group 2 between 12 and 24 h after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery. 770 14

One hundred and twenty-eight ASA I-III patients less than 40 yr of age, undergoing orthopaedic or trauma lower limb surgery, were allocated randomly to receive either continuous spinal anaesthesia (CSA) using a 32-gauge polyimide microcatheter with a permanent stylet (Rusch/TFX Medical, Duluth, GA, USA) or single-dose spinal anaesthesia (SDSA) with a 24-gauge x 103-mm Sprotte spinal needle (Pajunk, Germany). Plain bupivacaine (0.5%) was used as the local anaesthetic. The initial doses were 1 ml (5 mg) of CSA and 3 ml (15 mg) of SDSA, while the re-injection doses were 1 ml (5 mg) in the CSA group. SDSA was quicker to perform: mean 4.4 (SD 1.6) min compared with 6.2 (2.6) min for CSA (P < 0.01). Times to onset and surgical anaesthesia were also significantly greater in the CSA group (P < 0.01). The quality of the block was better in the SDSA group (P < 0.05), but was associated with greater haemodynamic instability (P < 0.05). The segmental level of analgesia was significantly lower in the CSA group (median T10 (range T12-T8)) than in the SDSA group (T9 (T11-T5)) (P < 0.05). There were no significant differences in the incidence of postoperative complications, with two mild spinal headaches in both groups. We conclude that CSA using a microcatheter in young patients is difficult to perform and affords no advantages over SDSA with a small gauge atraumatic needle.
 ...
PMID:Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients. 788 Jun 57

Thoracic epidural analgesia combined with chronic beta-adrenergic blocker medication may cause cardiac depression. We investigated the cardiovascular and myocardial metabolic effects of a T1-T12 epidural block in 18 patients (age < 65 yr, ejection fraction > 0.5), receiving chronic beta-adrenergic blocker medication and scheduled for aortocoronary bypass surgery. After randomization into a light or deeper general anesthetic group, the cardiovascular and myocardial metabolic effects of a subsequent general anesthesia induction were investigated. Thoracic epidural analgesia induced a moderate decrease in mean arterial pressure, coronary perfusion pressure, free fatty acids, and myocardial consumption of free fatty acids. General anesthesia with thiopental (2-4 mg/kg) and a low fentanyl dose (5 micrograms/kg) increased heart rate, coronary perfusion pressure, and coronary vascular resistance, whereas mean pulmonary arterial pressure and pulmonary capillary wedge pressure decreased. After thiopental (2-4 mg/kg) and a high fentanyl dose (30 micrograms/kg), mean arterial pressure and left ventricular stroke work index decreased. We conclude that a T1-T12 epidural block in well sedated, beta-adrenergic blocked patients does not induce clinically significant cardiovascular effects. Induction of general anesthesia was well tolerated, but the light general anesthetic could not prevent an increase in heart rate and coronary vascular resistance, whereas the deeper anesthetic induced slight myocardial depression. No effect on the atrioventricular conduction, as measured by the PQ-time, was noted.
 ...
PMID:The influence of thoracic epidural analgesia alone and in combination with general anesthesia on cardiovascular function and myocardial metabolism in patients receiving beta-adrenergic blockers. 810 48

The purpose of this study was to determine the clinical efficacy and safety of ropivacaine as a local anesthetic for spinal anesthesia. Forty patients between the ages of 18 and 75 yr, scheduled for minor lower limb surgery, were studied. They were randomly allocated to receive either 3 mL glucose-free 0.5% (15 mg) or 0.75% (22.5 mg) ropivacaine in a double-blind fashion. The subarachnoid puncture was performed with a 26-gauge Quincke-point needle at the L3-4 interspace with the patients in the sitting position. The onset of analgesia to pinprick was similar with both concentrations. The median (range) upper level of analgesia obtained with the 0.5% solution was T11 (L4-T5) and was T10-11 (L4-T4) with the 0.75% solution. The duration of analgesia at T12 (P < 0.01) and the total duration of analgesia (P < 0.002) were longer in the 0.75% group. In addition, the area under the number of blocked segments versus time curve was larger with the 0.75% ropivacaine solution (P < 0.001). The incidence of complete motor block of the lower limbs was higher (P < 0.02) and the total duration of motor block longer (P < 0.002) in the 0.75% group. No unexpected adverse events were registered. We conclude that subarachnoid injection of glucose-free ropivacaine solutions results in a variable spread of analgesia, mostly accompanied by a good quality of motor block, in particular with the 0.75% solution.
 ...
PMID:Spinal anesthesia with ropivacaine: a double-blind study on the efficacy and safety of 0.5% and 0.75% solutions in patients undergoing minor lower limb surgery. 819 69


<< Previous 1 2 3 4 5 6 7 Next >>