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

Back pain is a common symptom in association with pregnancy. This article reviews the pathogenesis of back pain during pregnancy (gestational back pain) and of new onset postpartum back pain. The studies implicating epidural analgesia and postpartum back pain are discussed. Possible physiological mechanisms contributing to gestational back pain are outlined. Guidelines are provided for the prevention and symptomatic management of the back pain syndromes of pregnancy.
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PMID:Back pain and pregnancy: a review. 878 3

Back pain and minor neurological symptoms are commonly experienced postpartum, often being attributed to non-specific causes such as maternal obstetric factors, or the use of epidural analgesia. We report a case in which neurological problems associated with a prolapsed intervertebral disc occurred after epidural analgesia in labour and a normal vaginal delivery.
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PMID:Prolapsed intervertebral disc after epidural analgesia in labour. 879 23

A woman's experience of unrelenting back pain with a fetus in an occipitoposterior position and the escalating interventions culminating in a cesarean birth is every midwife's nightmare. Intrathecal analgesia is a relatively simple and rapid method to provide maternal relaxation and relief from severe back labor. This article describes the use of intrathecal opioid analgesia in labor complicated by failure to progress in first-stage labor due to persistent occipitoposterior position of the fetus. Intrathecal analgesia has the advantage of being inexpensive and providing rapid onset of adequate pain relief for the first stage of labor. It does not cause motor blockade, so it allows the mother to be mobile and feel the urge to push. Consequently, there is no associated risk of an increased need for forceps or vacuum-assisted delivery. The authors note a decreased incidence of operative delivery for fetal occipitoposterior position with the use of intrathecal narcotics.
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PMID:Use of intrathecal analgesia in a rural hospital. Case studies. 882 19

Postpartum back pain may occur in up to 44% of women after childbirth. The increasing use of epidural analgesia during labour over the past 35 years has led many women and some doctors to attribute postpartum back pain to this. Such suggestions, if unfounded, may undermine parturients' confidence in epidural analgesia. However, the outcome of recent, randomized studies clearly shows that epidural analgesia does not cause back pain.
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PMID:Do epidurals cause back pain? 883 45

A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.
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PMID:Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine. 898

The pharmacology, pharmacokinetics, efficacy, adverse effects, and dosage and administration of tramadol are reviewed. Tramadol is a synthetic analogue of codeine that binds to mu opiate receptors and inhibits norepinephrine and serotonin reuptake. It is rapidly and extensively absorbed after oral doses and is metabolized in the liver. Analgesia begins within one hour and starts to peak in two hours. In patients with moderate postoperative pain, i.v. or i.m. tramadol is roughly equal in efficacy to meperidine or morphine; for severe acute pain, tramadol is less effective than morphine. Oral tramadol can also be effective after certain types of surgery. Tramadol and meperidine are equally effective in postoperative patient-controlled analgesia. In epidural administration for pain after abdominal surgery, tramadol is more effective than bupivacaine but less effective than morphine. In patients with ureteral calculi, both dipyrone and butylscopolamine are more effective than tramadol. For labor pain, i.m. tramadol works as well as meperidine and is less likely to cause neonatal respiratory depression. Oral tramadol is as effective as codeine for acute dental pain. In several types of severe or refractory cancer pain, tramadol is effective, but less so than morphine; for other types of chronic pain, such as low-back pain, oral tramadol works as well as acetaminophen-codeine. Common adverse effects of tramadol include dizziness, nausea, dry mouth, and sedation. The abuse potential seems low. The recommended oral dosage is 50-100 mg every four to six hours. Tramadol is an effective, if expensive, alternative to other analgesics in some clinical situations.
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PMID:Tramadol: a new centrally acting analgesic. 907 93

A 35-year-old man presented with a painful skin necrosis after a deep ventrogluteal injection of diclofenac and dexamethasone for treatment of severe back pain. Immediately after the injection, the patient felt a strong pain just above the injection site. In the following days a remarkable necrosis developed in the upper gluteal region. Topical therapy with antiseptics and a topical corticosteroid cream plus analgesia with tramadole revealed no improvement of the symptoms. We excised the necrotic area. Within 1 day, the patient was without pain.
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PMID:Embolia cutis medicamentosa. 915 1

We investigated the efficacy and complications of microcatheter spinal anesthesia (CSA) in comparison to a combined spinal-epidural technique (CSE) using plain bupivacaine 0.5%. Sixty trauma patients randomly received either CSA using a 22-gauge Sprotte needle and a 28-gauge microcatheter or CSE after insertion of a 22-gauge epidural catheter through an 18-gauge Tuohy needle followed by dural puncture with a 25-gauge pencil-point needle inserted through the backeye of the Tuohy needle. An initial subarachnoid bolus of 2 mL of plain bupivacaine 0.5% was injected. If analgesia did not reach T12 within 20 min, supplemental bupivacaine was injected either intrathecally or epidurally up to a maximum of 5 mL in the CSA group or 16 mL in the CSE group. Mean arterial blood pressure, heart rate, and analgesic levels were recorded. On postoperative Day 4, patients were interviewed for postanesthetic complaints. Technical problems were more frequent in the CSE group than in the CSA group (47% vs 13%). Performance of anesthesia was faster (8 +/- 3 vs 15 +/- 8 min) and the total dose of bupivacaine lower (3.2 +/- 1.0 vs 9.7 +/- 5 mL) in patients who received CSA. The incidence of hypotension did not differ significantly. However, more patients in the CSE group were treated for bradycardia (4 vs 0). The number of patients suffering from postdural puncture headache was comparable in both groups, but there were more patients with lower back pain in the CSE group (8 vs 2). In conclusion, our data suggest that microcatheter CSA is not associated with an increased rate of complication in patients with lower limb fractures.
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PMID:Comparison of continuous spinal with combined spinal-epidural anesthesia using plain bupivacaine 0.5% in trauma patients. 921 25

Ropivacaine is a new, long-acting local anaesthetic, prepared as a single enantiomer (the S form). Ropivacaine has a pKa of 8.07, a protein binding of approximately 94%, but a lower lipid solubility than bupivacaine. Extensive animal toxicological studies have shown a lower propensity for cardiotoxicity with ropivacaine than with bupivacaine. Studies in sheep have shown that the systemic toxicity of ropivacaine is not enhanced by gestation. Studies in human male volunteers have shown that ropivacaine is associated with at least 25% less CNS and cardiovascular adverse effects than bupivacaine following use of intravenous infusions of either drug at a rate of 10 mg/min, to a maximum dose of 150 to 250 mg. With its lower toxicity, especially cardiovascular toxicity, and less intense motor blockade, ropivacaine may have advantages over bupivacaine in epidural pain relief during labour. In general, comparative studies have shown ropivacaine and bupivacaine to have similar efficacy, but ropivacaine has a greater degree of separation between motor and sensory blockade than bupivacaine when it given epidurally for epidural pain relief during labour (as intermittent doses or continuous infusion) or for caesarean section. A significantly lower rate of instrumental deliveries and significantly higher neurological and adaptive capacity scores in neonates at 24 hours were noted for following epidural relief during labour with ropivacaine in a meta-analysis of 6 studies comparing this agent with bupivacaine. Ropivacaine is also of great interest when used as an epidural infusion for postoperative analgesia. There are a few studies evaluating epidural infusions of ropivacaine 0.1%, 0.2% or 0.3% (10 ml/h for 21 hours) after upper or lower abdominal or orthopaedic surgery, and epidural infusion of ropivacaine 0.2% (6 to 14 ml/h) after orthopaedic surgery. The studies show that ropivacaine provides postoperative pain relief in a dose-related manner with minimal or a low degree of dose-related motor blockade. Recommended doses of ropivacaine given epidurally to control postsurgical pain or labour pain are 20 to 40 mg as a bolus with 20 to 30 mg as a top-up with an interval > or = 30 minutes. Alternatively, ropivacaine 2 mg/ml (0.2%) can be given as a continuous epidural infusion at a rate of 6 to 14 ml/h (lumbar) or 4 to 8 ml/h (thoracic). Epidural ropivacaine 0.2% provides a good level of analgesia with minimal motor block, but the effects of a combination of ropivacaine and an opioid administered epidurally could have potential and need to be investigated. Preoperative or postoperative subcutaneous wound infiltration, during cholecystectomy or hernia repair, with ropivacaine 100 to 175 mg has been shown to be more effective than placebo and as effective as bupivacaine in reducing wound pain. The adverse effects associated with epidural administration of ropivacaine include hypotension, nausea, bradycardia, transient paraesthesia, back pain, urinary retention and fever. In comparative studies of ropivacaine and bupivacaine, the 2 drugs appear to be associated with a similar incidence of similar types of adverse effects excluding cardiovascular and CNS toxicities which are lower with ropivacaine. In conclusion, ropivacaine is effective for pain relief during labour and in the postoperative period. Ropivacaine is associated with less cardiovascular and CNS toxicity than bupivacaine and provides a greater degree of dissociation between sensory and motor effects producing less intense motor blockade and more rapid recovery to full patient mobilisation.
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PMID:Preliminary risk-benefit analysis of ropivacaine in labour and following surgery. 924 93

In one year three patients were operated on for spinal haematomas following thoracic epidural analgesia. All three patients experienced back pain and developed progressive paraparesis, one in connection with insertion of the catheter and two after its removal. A spinal block was visualized using MRI in two patients and myelography in one. The patients were operated on with posterior decompression. In two patients an epidural haematoma was evacuated. Both patients recovered neurologic function, one completely. The third patient, who had a subarachnoidal hemorrhage and an intramedullar haematoma, remained paralytic.
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PMID:[Intraspinal hematoma after thoracic epidural analgesia]. 948 20


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