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)

Local analgesia can be produced by transcutaneous electrical stimulation of peripheral nerves. This is used in the treatment of chronic pain states. Its clinical effectiveness depends on two points; namely (1) the stimulation has to be perceptible, and (2) paresthesias elicited by TNS must be localized in the area of pain. To verify this in healthy subjects we produced an experimental pain by radiant heating of the skin and tested the analgesic effect of TNS. TNS stimuli parameters (duration, amplitude and frequency) were determined so that double blind conditions were given. Stimulation with small rectangular pulses showed the best analgesic effect especially at a stimulation rate of 100 Hz. The stimulation of various nerves showed that most of the analgesic effects depend on spinal level mechanisms but probably long loop effects are involved.
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PMID:TNS-evoked long loop effects. 31 54

In four patients with intractable pain from metastatic cancer, application of current through electrodes placed on the anterior surface of the cord produced analgesia and pain relief below the level of implant without the development of paresthesias. Application of current through electrodes placed on the dorsal columns in these patients also relieved pain, but to a lesser degree and with the development of associated paresthesias. In one patient, application of current from anterior electrodes to posterior electrodes produced a zone of dissociated sensory loss. While it is simpler to implant electrodes over the dorsal columns, the anterior location may be superior when currents are to be applied for the pain relief in the lower lumbar and sacral dermatomes.
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PMID:A comparison between anterior and posterior spinal implant systems. 80 54

Intravenous regional anesthesia for the treatment of fractures and dislocations of the upper extremity is a very effective, consistent and safe form of analgesia which requires low doses of lidocaine and can be performed in an emergency room using a regular blood pressure cuff. Dosage should be related to body weight and the blood pressure cuff should be maintained at higher than systolic pressure for a minimum of 15 minutes after the lidocaine is injected. Release of the tourniquet should be staged as described. Ninety-one per cent of 77 patients had excellent analgesia following the IVRA. Eight per cent had fair results, but this was still adequate to perform the reduction with only minimal but definite discomfort to the patient. Only one patient failed to respond to the IVRA technique. Other advantages such as muscle relaxation during the anesthetic and rapid full return of sensation after cuff release, permit ease of reducion and early anticipation of cast discomfort or pressure pain from sharp edges of plaster. Unpleasant long term side effects of axillary block anesthesia, such as persistent paresthesia have not been seen.
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PMID:Intravenous regional anesthesia for closed treatment of fractures and dislocations of the upper extremities. 95 82

The aim of this study was to evaluate the utility of the brachial plexus block using an axillary route employing the technique in which the needle is inserted into the sheath at an angle parallel to the neuro-vascular bundle with a sole modification: using a G22 spinal needle and without evoking paresthesia. The results obtained show that this method ensures an improved and more widespread analgesia. The flexibility and small size of the G22 spinal needle allow traumas to the axillary guaina and brachial plexus to be reduced to a minimum. In addition its length enables the anesthetic solution to be diffused around the first rib, including the axillary and musculo-cutaneous nerves, thus ensuring e total sensory and motor block of the upper limb.
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PMID:[Brachial plexus block by the axillary route. Cannulation of the neurovascular sheath with a G22 spinal needle. Our experience with 100 cases]. 129 4

Electric stimulation of the thalamic sensory relay nucleus (Vc) has an analgesic effect on deafferentation pain, however, the analgesic effect differs from patient to patient. Electrode position and state of the substrate stimulated are considered important factors influencing the analgesic effect. In order to determine the best position for the stimulating electrodes, we recorded somatosensory evoked potentials (SEPs) from stimulating electrodes implanted in the Vc and compared thalamic SEPs with the analgesic effect of Vc stimulation. The subjects were thirteen patients with deafferentation pain, four patients with thalamic lesions, seven patients with suprathalamic lesions and two patients with infrathalamic lesions. We inserted the electrode array into the Vc stereotactically, and fixed it so that stimulation-induced paresthesia would cover the painful frea. The electrode array consisted of the four contact points of four electrodes spaced at 2 mm intervals within 10 mm from the tip. Using bipolar combinations of the four electrodes (twelve combinations in all), we stimulated the Vc for about half an hour with each combination. We then rated the degree (%) of analgesia as 100% when pain disappeared and 0% when there was no change. Thalamic SEPs elicited after stimulation of the contralateral median nerve were recorded from all four contact points simultaneously. The latencies, amplitudes and recorded positions of large early positive components (P1) followed by large negative components (N1) with latencies between 10 and 20 msec were then analyzed and compared with the best electrode combination for optimal pain relief and with the degree of analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Correlation between the analgesic effect by thalamic relay nucleus stimulation and somatosensory evoked potentials recorded from thalamus]. 152 May 64

The effects of interscalene block were studied on 109 patients undergoing upper extremity elective orthopaedic surgery. Blocks were performed in a non-randomized manner with three different techniques, the site where anaesthetic solution was injected being the main distinguishing mark. The anaesthetic solution was injected into the interscalenic compartment both in the case of patients where classic technique had been carried out and in the group where the nerve stimulator had been used. In the "double needle" technique group, on the contrary, the anaesthetic solution was injected close to the vertebral column. The spread of analgesia involves the caudal portion of the cervical plexus and the cranial portion of the brachial plexus, but with the cervical plexus is almost certain to be involved, the brachial is not. Block outcome was related to the surgical procedure (surgery or orthopaedic manipulation), the site of surgery, paraesthesia elicitation, prolonged surgery and height, weight, age and sex of patients. Results also different according to the technique used. When the anaesthetic solution was injected close to the vertebral column analgesic cover was more widespread and lesser amounts of anaesthetic needed. When the block was performed within the interscalenic compartment, the analgesic cover was usually restricted to the area supplied by the primary superior trunk of the brachial plexus. The different results were explained by the presence of fibrous sheaths within the interscalenic compartment limiting spread of the anaesthetic, which are absent close to the vertebral column. Therefore two types of interscalene block were postulated: an intrascalene or troncular block within the interscalenic compartment and a radicular or paravertebral block close the vertebral column.
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PMID:[How many interscalene blocks are there? Reflections on 109 cases studied with various techniques]. 158 62

Systemic application of lidocaine in rats suppressed ectopic impulse discharge generated both at sites of experimental nerve injury and in axotomized dorsal root ganglion (DRG) cells. ED50 for DRGs was significantly lower than for the injury site. Lidocaine doses effective at blocking ectopic discharge failed to block the initiation or propagation of impulses by electrical stimulation, and only minimally affected normal sensory receptors. This selectivity may account for the effectiveness of systemic local anesthetics and other drugs that share the same mechanism of action (notably certain anticonvulsants and antiarrhythmics), in the management of neuropathic paresthesias and pain. In addition, it may account for the prolonged analgesia sometimes obtained using regional local anesthetic block.
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PMID:Systemic lidocaine silences ectopic neuroma and DRG discharge without blocking nerve conduction. 158 45

Upper abdominal and thoracic surgeries require efficient pain management. The complications of postoperative analgesia include respiratory depression and--when choosing the epidural route--possible damage to the spinal cord by infection, trauma, or bleeding. Therefore, thoracic epidural analgesia may appear to be too risky and is frequently cancelled although many studies have shown its excellent efficacy. Controlled studies comparing thoracic epidural analgesia to lumbar epidural analgesia or intravenous analgetic regimens with special regard to the patient's outcome are contradictory. To make the preoperative decision on the method of pain control more rational, we studied catheter-related complications from 2056 thoracic epidural catheters used for intra- and postoperative analgesia retrospectively (n = 1002) and prospectively (n = 1054) over a 5 1/2-year period. In all patients the thoracic epidural catheter was inserted preoperatively using local anaesthesia, in most cases by the paramedian approach between level T 5/6 and T 8/9. During the clinical course of all patients there were no clinical signs of any epidural bleeding or infection. Neurological complications caused by the epidural catheter did not occur. Seven patients (0.035%) experienced radicular pain that disappeared after removal of the catheter or interruption of the puncture, respectively. A primary perforation of the dura mater was noticed in 0.5% of cases retrospectively and 1.23% prospectively. Respiratory depression following epidural application of 0.3 mg buprenorphine was seen in 1 patient (0.05%). Continuous analgesia with local anaesthetics and/or opioids applied epidurally by a thoracic catheter was performed on the peripheral ward (n = 829, 40%) if close monitoring of the neurological status as well as rapid diagnosis of any painful paraesthesia or paraplegia was possible.
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PMID:[The integration of thoracic epidural anesthesia into anesthesia for intra-abdominal surgery]. 161 16

The process of nociception, the anatomy of the epidural space, and the placement of the epidural catheter are reviewed, and the pharmacology and pharmacokinetics, analgesic efficacy, and potential adverse effects of epidurally administered narcotics and local anesthetics are discussed, as well as patient monitoring standards and solution preparation guidelines for these agents. The epidural space is located between the dura mater (the outer-most membrane surrounding the spinal cord) and the vertebral canal. The site of catheter placement is determined by the dermatomes corresponding to the site of desired analgesia. The primary factors that differentiate epidural narcotics are related to their pharmacokinetic profiles. Morphine, which is hydrophilic, has a slower onset of action and a longer duration of analgesia than lipophilic compounds such as fentanyl; morphine also results in less segmentalization (the degree to which analgesia is limited to discrete dermatomal segments corresponding to the level of the epidural narcotic injection) than is seen with lipophilic compounds. Studies have shown that epidural narcotics provide superior pain relief compared with systemic narcotics. Common adverse effects associated with therapeutic doses of intraspinal narcotics include itching, nausea and vomiting, urinary retention, and sedation; respiratory depression is uncommon after epidural administration of narcotics. The most bothersome adverse effect encountered with analgesic doses of local anesthetics is paresthesia. Solutions for epidural administration must be sterile and preservative free. Epidural administration of narcotics and local anesthetics seems to provide better pain relief than conventional methods but may be associated with more bothersome adverse effects.
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PMID:Epidural analgesia. 174 84

The epidural space was located in 32 obstetric patients using loss of resistance to air, while in a further 35 saline was used. The incidence of paraesthesia was 56% in the air group and 57% in the saline group. There was no significant difference between the groups in terms of other complications or in the quality of analgesia provided.
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PMID:Paraesthesia with lumbar epidural catheters. A comparison of air and saline in a loss-of-resistance technique. 227 36


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