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

Two groups, each consisting of 20 parturients, were given a continuous infusion of 0.25 per cent bupivacaine into the epidural space for pain relief, after test and loading doses. The analgesic effect was registered during labor. After delivery the course of the catheters in the epidural space was investigated radiologically. In the first group long catheters (mean 16.5 cm from the skin surface) and in the second group short catheters (mean 10.5 cm) were used. The medial approach in the epidural space was varied between the first and second lumbar interspaces. The relationship between the position of the catheter tip and the degree of analgesia was also studied. In two mothers with fetus mortuus ante partum, the spread of a radiopaque dye solution was followed during labor. Through the force of gravity and the mothers position, the spread of solution covered three segments within 30 minutes. It was concluded, that slow infusion of local anesthetic solution gives satisfactory pain relief if the catheter is inserted into the first lumbar interspace to a depth of 10--12 cm from the skin surface ending close to the Th12 level. Gradual raising of the mother from the supine to the semirecumbent position and regular change of sides during mini-infusion is important for an even spread of the analgesic solution and analgasia.
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PMID:Continuous mini-infusion of bupivacaine into the epidural space during labor. Part I: Radiographic visualization of the epidural catheters. 28 8

Obstetric analgesia was accomplished by segmental continuous blockade in 225 women. The technique involved automatic pump infusion of 0.25 per cent bupivacaine solution into the epidural space at a rate of 5 ml per hour after initial doses of 2 and 5 ml bupivacaine. If the analgesia was insufficient one or two single injections of 5 ml of bupivacaine were added. Statistical evaluation of the results could be carried out for 218 women, 158 of whom were nulliparae and 60 multiparae. Fully satisfactory analgesia was achieved in 96 per cent of the nulliparae and 88 per cent of the multiparae in the first stage of labor. In the second stage of labor 46 per cent of the mothers were given pudendal blockade to maintain statisfactory analgesia. The positioning of the patient in the first stage of labor from supine to semirecumbent was of importance to spread the analgesic agent caudally, to the sacral nerve roots, and to control the pain due to stretching of the vagina and perineum. In the total material 17 per cent of the neonates were delivered by vacuum extraction. When the infusion into the epidural space was started in early labor, the incidence of vacuum extraction was 9 per cent, as compared with 38 per cent when it was started at 6 cm cervical dilatation or later (p less than 0.01). 9.8 per cent of the neonates were delivered by cesarean section. Fetal head malposition occurred in 8.7 per cent. A drop in blood pressure was noted in 7 per cent of the women. The condition of the newborn was unaffected by the analgesia. The mini-infusion system minimized the risk for infection. The danger in case of accidental intravascular injection was reduced, due to slowly administered bupivacaine. At the maternity department this technique has created a positive attitude towards epidural blockade, as midwives and doctors have found it safe and easy.
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PMID:Continuous mini-infusion of bupivacaine into the epidural space during labor. Part III: A clinical study of 225 patients. 28 10

One investigator at each of 4 institutions followed the requirements of a core protocol designed to evaluate propoxyphene napsylate (50, 100 and 150 mg), fenoprofen calcium (200, 400 and 600 mg) and their combination (50/200, 100/400 and 150/600 mg) in patients reporting postpartum pain. Placebo and aspirin (650 mg) were included as control medications. Analyses were based on subgrouping which isolated individually the interactions between medications and the following factors: dose-observation criteria, the investigator-observer-institution differences, the intensity of pain at the time the medication was given, and postepisiotomy-wound compared to uterine-cramp pain. Each of these factors influenced the absolute scores for analgesia significantly, but had no significant influence on the relative rankings of the medications. The analgesia scores for individual patients in each subgroup were transformed to ridits and then pooled. A linear increase in effectiveness occurred in response to increasing doses of propoxyphene, fenoprofen, and their combination in this dose range. The dose responses were essentially parallel. The combination was more effective than either drug alone.
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PMID:A multicenter study for analgesia involving fenoprofen, propoxyphene [alone or in combination] with placebo and aspirin controls in postpartum pain. 29 Jul 26

The hypothesis that perceived pain intensity can influence placebo analgesia was tested. One hundred and seven subjects rated their pain from from 0 to 10 on a visual analog scale after a standard wisdom tooth extraction. The expected course of such postoperative pain in the absence of therapy or placebo is a steady increase; this was confirmed by blind administration of the placebo. When placebos were given intravenously in view of the patients, some (placebo nonresponders) reported that their pain increased, whereas others (placebo responders) reported that their pain either decreased or remained the same over the next 60 min. A placebo response was more likely to occur if the pain rating 5 min prior to placebo administration (initial pain) was greater than 2.6. Furthermore, placebo responders with initial pain above this 2.6 level reported significantly greater mean analgesia than those with lower initial pain. Indeed, responders with initial pain less than 2.6 reported no change in pain during the 60 min after administration of a placebo. When their initial pain level was greater than 2.6, they reported a steady decline in pain over this period. However, above the 2.6 level there was no obvious relationship between the magnitude of the placebo analgesia and the initial pain.
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PMID:Role of pain in placebo analgesia. 29 Oct 20

One hundred four patients with moderate to severe postoperative pain participated in a double-blind study comparing butorphanol/acetaminophen with oxycodone/acetaminophen and placebo with respect to analgesic effectiveness and incidence of side effects. Pain was rated by the patients and an observer; sums of these data were calculated. Side effects, their severity and their relationship to the drug were recorded. Both active medications provided statistically significant levels of analgesia as compared with placebo. Analgesia produced by both combinations of drugs was statistically similar until 4 hours postdrug. From 4 to 6 hours postdrug, butorphanol/acetaminophen was significantly more analgesic. Both active medications produced analgesia within 0.5 hours, showing a peak effect at 1 to 2 hours and lasting for 6 hours. The incidence of side effects was minimal and statistically equivalent for each treatment group.
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PMID:A comparison of analgesic effectiveness of oral butorphanol/acetaminophen, oxycodone/acetaminophen and placebo in hospitalized postsurgical patients. 29 51

The effect of electrostimulation of the mesencephalic grey matter and of the dorsal nucleus raphe on physiological pain produced by nociceptive stimulation (compression of the tail or the skin on the limb by a clamp) and on pathological pain (the pain syndrome of spinal origin) were studied in experiments on albino rats. Pathological pain was induced by creating a generator of pathologically enhanced excitation in the dorsal horn of the spinal cord by local disturbance of the inhibitory mechanisms with the aid of tetanus toxin. It was shown that electrostimulation of the indicated areas abolished both physiological and pathological pain. A conclusion was drawn that analgesia produced by electrostimulation of certain structure of the brain was connected not only with augmentation of the descending inhibition in the spinal cord as in the case of physiological pain caused by peripheral nociceptive stimulation (as shown by several authors), but also with the block of excitation at the supraspinal level. This mechanism should play a decisive role in analgesia realization in the pain syndrome of central origin, both under experimental and natural conditions.
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PMID:[Analgesia following electrostimulation of midbrain nuclei of rats with a pain syndrome of spinal origin]. 30 29

Peripheral transcutaneous electrical stimulation has been used in an attempt to relieve the pain associated with fractured ribs. Sixty-two per cent of the patients considered their pain to be greatly relieved by this electro-analgesic technique and a further 28% gained some relief. Pain was assessed by means of a visual analogue scale. In most of the patients there was a clinical improvement in their condition, the degree of which correlated well with the pain relief. This trial indicated that transcutaneous electro-analgesia is a useful technique for producing analgesia in patients suffering from acute trauma, without some of the side-effects inherent in more conventional forms of therapy.
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PMID:Management of acute traumatic pain by peripheral transcutaneous electrical stimulation. 30 94

Low-frequency (1.6-2.2 Hz) and weak-intensity electrical stimulation in the spinal extradural space produced complete to partial pain relief in a majority of patients (22 of 25) who suffered from intractable pain. Also it produced analgesia or hypoalgesia over a wide area of the body surface in 19 of the 25.
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PMID:Low-frequency, weak extradural stimulation in the management of intractable pain. 30 6

Patients with chronic pain in one limb, who experienced pain reduction with transcutaneous neurostimulation, were examined for sensory perception in that limb before and during electrical analgesia. Contralateral limbs and normal subjects served as controls. Sensory stimuli were quantified, a range of stimuli were presented and data were analyzed according to sensory decision theory. Results showed that, compared to controls, painful limbs show considerable impairment in sensory sensitivity. With transcutaneous neurostimulation, however, sensitivity is improved towards normal, whereas electrical stimulation slightly impairs perception in normal limbs. These results suggest that electrical analgesia involves both peripheral small-fiber blockade and large-fiber stimulation; the latter is more noticeable in the normal limb, but the former effect is predominant when pain reduction occurs in a painful limb.
Pain 1978 Aug
PMID:Changes in somatic sensitivity during transcutaneous electrical analgesia. 30 30

31 patients suffering from intractable pain associated with chronic low back syndrome, terminal cancer, and other disorders have been studied after an average 6 months' treatment by electrical stimulation of the spinal cord applied via electrodes inserted through a Tuohy needle into the epidural space. As judged by three different subjective rating methods, epidural stimulation successfully relieved otherwise intractable chronic pain in from 23 to 26 of the 31 patients. Reported improvements in the ability to perform various everyday activities, and elimination of drug usage by many patients, corroborate this finding. The side effects of stimulation, both as reported subjectively and as measured objectively by sensory testing, were not clinically significant. Spontaneous electrode displacements, leading to loss of analgesia and requiring minor surgery for repositioning, were encountered frequently, as were lead wire failures necessitating replacement. The partially implanted, externally powered stimulation system presently in use also suffers from problems of reliability and convenience to the patient.
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PMID:Chronic dorsal column stimulation via percutaneously inserted epidural electrodes. Preliminary results in 31 patients. 30 10


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