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

Spinal compression related to the formation of an epidural abscess after epidural blockade is a rare but serious complication. We report the case of a male patient in whom a thoracic epidural catheter was implanted to provide analgesia after trauma involving fracture ribs. The patient developed an epidural abscess within one week of implantation. Delay in diagnosis led to persistent neurogenic bladder symptoms in spite of aggressive treatment. We review causal factors, mechanisms of formation, pathogenesis, diagnosis and management, as well as possible relation between injury and abscess formation. We also emphasize the importance of adequate vigilance as well as rapid diagnosis and adoption of therapeutic measures in order to avoid permanent sequelae such as paresis, sensory deficits or mechanical sphincter dysfunction.
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PMID:[Epidural abscess secondary to the implantation of a thoracic catheter]. 964 56

Sedation and analgesia will be required in the mechanically ventilated pediatric trauma patient. Adequate provision of both has a number of beneficial physiologic and psychologic effects. There are a number of categories of sedatives available for use. To provide optimal management and avoid adverse sequellae, an understanding of the pharmacology of these agents should guide their use in this group of patients, who are likely to have variable pharmacokinetic responses and therapeutic goals. Neuromuscular blockade is warranted in only a select population of mechanically ventilated ICU patients. Given newer ventilator technology and modes, it is certainly possible to achieve patient-ventilator synchrony with the use of sedation alone. Neuromuscular blockade is associated with a number of possible adverse effects, including prolonged weakness or paresis, and prohibits ongoing clinical assessment. When the use of this therapy is deemed necessary, it is again essential to understand the pharmacodynamics and pharmacokinetics of the available agents to avoid potential complications.
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PMID:Paralyzation and sedation of the ventilated trauma patient. 1158 7

A total of 2,624 groin operations were performed in 2,202 infants and children aged 6 months-14 years during the last 4.5 years. Preventive analgesia was used in all operations, and included ilioinguinal and iliohypogastric nerve block combined with inguinal canal infiltration. In 6 patients transient postoperative quadriceps muscle paresis (QMP) was noted. They required bed rest and monitoring for a few hours, and complete spontaneous recovery was noted in all cases. The aim of this study was to examine the incidence of transient QMP following regional nerve block and to discuss models of possible prevention.
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PMID:Quadriceps paresis in pediatric groin surgery. 1195 84

Herpes zoster (HZ) results from recrudescence of varicella zoster virus latent since primary infection (varicella). The overall incidence of HZ is approximately 3/1000 of the population per year rising to 10/1000 per year by 80 years of age. Approximately 50% of individuals reaching 90 years of age will have had HZ. In approximately 6%, a second attack may occur (usually several decades after the first). Patients with HZ can transmit the virus to a non-immune individual causing varicella. HZ is not contracted from individuals with varicella or HZ. Reduced cell-mediated immunity to HZ occurs with ageing, explaining the increased incidence in the elderly and from other causes such as tumours, HIV and immunosuppressant drugs. Diagnosis is usually clinical from typical unilateral dermatomal pain and rash. Prodromal symptoms, pain, itching and malaise, are common. The most common complication of HZ is postherpetic neuralgia (PHN), defined as significant pain or dysaesthesia present >or= 3 months after HZ. PHN results from damage and secondary changes within components of the nervous system subserving pain. Some motor deficit is common; severe and long-lasting paresis may rarely accompany HZ. More than 5% of elderly patients have PHN at 1 year after acute HZ. Predictors of PHN are, greater age, acute pain and rash severity, prodromal pain, the presence of virus in peripheral blood as well as adverse psychosocial factors. Therapy for acute HZ is intended to reduce acute pain, hasten rash healing and reduce the risk of PHN and other complications. Antiviral drugs are close to achieving these aims but do not entirely remove risk of PHN. Oral steroids show no protective effect against PHN. Adequate analgesia during the acute phase may require strong opioid drugs. Nerve blocks and tricyclic antidepressants (TCAs) may reduce the risk of PHN although firm evidence is lacking. PHN requires thorough evaluation and development of a management strategy for each individual patient. Initial therapy is with TCAs (e.g., nortriptyline) or the anticonvulsant gabapentin. Topical lidocaine patches frequently reduce allodynia. Strong opioids are sometimes required. Topical capsaicin cream is beneficial for a small proportion of patients but is poorly tolerated. NMDA antagonists have not proved beneficial with the exception of ketamine. Transcutaneous Electrical Nerve Stimulation (TENS) may be effective in some cases. HZ is a common condition. Severe complications such as stroke, encephalitis and myelitis are relatively rare whereas sight threatening complications of ophthalmic HZ are more common. PHN is common, distressing and often intractable. Good management improves outcome.
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PMID:Management of herpes zoster (shingles) and postherpetic neuralgia. 1501 24

This investigation was designed to evaluate sequential spinal epidural analgesia with a needle through needle technique for pain relief in labour. The spinal injection was made using a Becton Dickinson 29 gauge Quincke point needle. Bupivacaine 1 mg, sufentanil 5 microg and adrenaline 25 microg (2 ml) were injected intrathecally. Analgesia was maintained using bupivacaine 12.5 mg, sufentanil 10 microg and adrenaline 12.5 microg in a 10 ml bolus given through an epidural catheter in the epidural space. This dosage was also used for the test dose. Pain relief was obtained in less than ten minutes and lasted for a mean of 134 min. Of the 620 parturients in the investigation, 500 had a mean dose of 4.3 mg bupivacaine per hour. Hypotension and paresis were of no concern. Patient satisfaction was excellent, 85% of the parturients being very satisfied and 10% satisfied.
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PMID:Sequential spinal epidural analgesia for pain relief in labour: an audit of 620 parturients. 1563 99

The study was undertaken to evaluate the effectiveness and safety of ropivacaine used via long-term epidural infusion and to define the optimum doses of the agent in the intra- and postoperative period. The parameters of hemodynamics, the adequacy of anesthesia, and the consumption of the agent were explored in 53 patients (ASA III-IV) aged 68 +/- 1.4 years operated on for abdominal cancer. Following 15 and 25 min of the injection of a bolus dose of ropivacaine, the occurrence of sensory block II was observed in 60 and 95% of the patients, respectively. After injection of ropivacaine in a bolus dose (56 +/- 3.4 mg), there was a 20% lowering of mean blood pressure and a 17% reduction in heart rate as compared with the baseline values. Maintenance infusion was made at a rate of 15-25 (20 +/- 1.9) mg/h. The total consumption was 126 +/- 13 mg. Bradycardia was noted in 4 (7.5%) cases; 7 (13%) patients required additional administration of phentanyl. The latter was used in a dose of 100 microg in 87% of the patients only prior to tracheal intubation. For postoperative analgesia, 0.2% ropivacaine was infused at a rate of 6-10 ml/h. Increasing its dose up to 12-14 ml/h resulted in hypotension and the occurrence of the signs of motor block. Postoperative analgesia was effective in 89% of cases when the agent was infused at rate of 8.8 +/- 0.9 ml/h and the hemodynamic parameters were stable. Postoperative intestinal paresis was abolished in 85.8% of patients after an average of 52 +/- 2.7 hours. Long-term epidural infusion of ropivacaine may be regarded as an effective component of anesthesia at abdominal surgery in elderly patients with severe comorbidity. The method allows one to completely refuse the use of narcotic analgesics in most cases both during a surgical intervention and in the postoperative period, which creates good conditions for an early activation of patients and for a reduction of postoperative complications.
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PMID:[Use of continuous epidural infusion of ropivacaine as a component of an anesthesiological appliance and postoperative analgesia in elderly patients in cancer surgery]. 1631 46

A prospective and randomized study was conducted on 50 full term parturients undergoing labour analgesia at Panna Dai Hospital, R.N.T. Medical College, Udaipur. The parturients were allocated in two groups: group BF (n = 25) received an epidural injection of bupivacaine (0.15%; 15 mg) + Fentanyl (0.0002%); 2 microg/ml); group BEF (n = 25) bupivacaine (0.15%; 15 mg) + Fentanyl (0.0002%; 2microg/ml) + Epinephrine (1.7 microg/ml; 1:600,000). Subsequent top up (same as bolus) was administered at VAS > or = 3. Comparison between the two groups showed no significant difference in onset of analgesia, number of top up doses, degree of motor block and parturients acceptance. The difference in duration of analgesia with addition of epinephrine (93.00 +/- 29.00 min : BEF group; V/S 86.00 +/- 27.00 Min : BF group) did not show any statistical significance between the two groups. Ambulation was achieved in 100% of parturients from both study groups. The incidence of spontaneous delivery was 92% in each group. Parturients in group BEF demonstrated a higher incidence of side effects like nausea and vomiting (4% v/s 0%); hypotension (4% v/s 0%); paresis (8% v/s 0%) and retention of urine (12% v/s 8%) as compared to BF group. To conclude, the addition of epidural epinephrine (1:600,000) to bupivacaine and fentanyl does not affect the duration or quantity of labour analgesia.
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PMID:Epidural for labour analgesia--bupivacaine + fentanyl vs bupivacaine + fentanyl + epinephrine. 1638 Dec 66

The current approach to the anesthetic procedure and postoperative intensive therapy after esophageal resection for esophageal carcinoma, as well as characteristic perioperative pathophysiological events are presented. The contributory factors of severe postsurgical morbidity are considered too. Esophagectomy is an extented procedure which includes laparotomy, thoracotomy and often cervicotomy, and carries a great surgical stress with a huge fluid shift. It is mostly performed in the aged population with a certain co-morbidity: malnutrition, compromized immune status, respiratory and cardiovascular diseases. Standardization of esophageal resection and reconstructive techniques together with the optimal perioperative management significantly reduce operative mortality. Preoperatively, the patients' nutritive, respiratory and cardiac status should be improved. Intraoperatively, beside adequate depth of anesthesia which enables the optimal metabolic response to surgical stress, the invasive hemodynamic monitoring with insertion of pulmonary artery catheter is of great importance. The aim is to ensure adequate tissue perfusion and oxygenation avoiding pulmonary overhydration at the same time. Postoperatively, important role has epidural analgesia, allowing proper breathing and coughing and routine usage of fiberbronchoscopy for clearance of pulmonary secretion. After resection there are several conditions which contribute to cough and swallow disturbances: bilateral vagotomy, the absence of upper and lower esophageal sphincters, transient aperistalsis of the substitute, sometimes a transient vocal cord paresis. All of these make patients prone to regurgitation and aspiration of duodenal and gastric juice. Currently, the pulmonary complications are the leading problems after this procedure, so their prevention and early treatment are the key tasks for the clinicians.
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PMID:[Anesthesia and perioperative management of patients with resection for esophageal carcinoma]. 1658 36

A 2% lignocaine solution infused at a dose of 2 mg/kg at the lumbosacral site gave excellent analgesia in 28 vasectomy operations and in 33 of 38 (87%) Caesarian operations at a dose of 4 mg/kg. Failure of the anesthetic technique in 4 sheep (6% of all operations) was associated with poor positioning of the ewe and incorrect identification of the epidural space. One fatality was recorded and was considered to result from lignocaine overdosage and the probable pooling of blood in the splanchnic vasculature. Pelvic limb paresis persisted for 2 to 4 h post epidural injection in all ewes, but no permanent paralysis was encountered. Lumbosacral epidural anesthesia gave excellent analgesia for vasectomy, and was indicated for Caesarian surgery when a dystocia was associated with severe vaginal prolapse or the delivery of a fetal monster. Further work is needed to find an analgesic preparation which has a shorter duration than the 2% lignocaine solution.
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PMID:Application of lumbosacral spinal anesthesia for ovine Caesarian surgery and for vasectomy under field conditions. 1672 94

This case describes a patient who developed a complete right hemiparesis with ptosis of eyelid, trigeminus and facial paresis following a routine epidural analgesia for labor. A subdural deposit of the local anaesthetic might be the cause of these symptoms. The pathogenesis of these symptoms as well as the diagnoses and treatment of the condition is discussed.
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PMID:[A rare complication of labor epidural analgesia]. 1856 19


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