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)

Compartment syndrome can be difficult to diagnose in a child, with delays in diagnosis leading to disastrous outcomes. Thirty-six cases of compartment syndrome in 33 pediatric patients were treated at the authors' institution from January 1, 1992, to December 31, 1997. There were 27 boys and 6 girls, with nearly equal upper and lower extremity involvement. Approximately 75% of these patients developed compartment syndrome in the setting of fracture. Pain, pallor, paresthesia, paralysis, and pulselessness were relatively unreliable signs and symptoms of compartment syndrome in these children. An increasing analgesia requirement in combination with other clinical signs, however, was a more sensitive indicator of compartment syndrome: all 10 patients with access to patient-controlled or nurse-administered analgesia during their initial evaluation demonstrated an increasing requirement for pain medication. With early diagnosis and expeditious treatment, >90% of the patients studied achieved full restoration of function.
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PMID:Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. 1152 Oct 42

Ethanol effects on the central nervous system have been well investigated and described in recent years; modulations, by ethanol, of several ligand-gated and voltage-gated ion channels have been found. In this paper, we describe a shortening of action potential duration (APD) by ethanol in approximately equal to 40% of small diameter neurons in rat dorsal root ganglia (DRG). In these neurons, designated as group A neurons, we observed an ethanol-induced increase in whole-cell outward-current. As iberiotoxin, a specific blocker of large-conductance calcium-activated K+ channels (BK(Ca) channels), blocks the effects of ethanol, we investigated the interaction between these channels and ethanol in outside-out patches. Open probability of BK(Ca) channels was increased 2-6 x depending on the concentration (40-80 mM approximately equal to 2-4 per thousand v/v) of ethanol. Functional consequences were a prolongation of the refractory period, which was reversible after addition of iberiotoxin, and reduced firing frequency during ethanol application. In contrast, another type of neuron (group B) showed a prolonged APD during application of ethanol which was irreversible in most cases. In 90% of cases, neurons of group A showed a positive staining for isolectin B4 (I-B4), a marker for nociceptive neurons. We suggest that the activation of BK(Ca) channels induced by clinically relevant concentrations of ethanol, the resulting modulations of APD and refractory period of DRG neurons, might contribute to clinically well-known ethanol-induced analgesia and paresthesia.
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PMID:Ethanol reduces excitability in a subgroup of primary sensory neurons by activation of BK(Ca) channels. 1170 54

We present the cases of three patients scheduled for shoulder surgery under cervical epidural anesthesia with 0.75% ropivacaine. The technique was successful and surgery proceeded uneventfully in all three cases. The total doses of ropivacaine infused were 67, 90 and 109 mg. Premedication with intravenous atropine is recommended. Cervical epidural anesthesia offers several advantages over general anesthesia and other regional techniques for shoulder surgery: postoperative analgesia, lower total dose of the local anesthetic and single needle insertion with no need to elicit paresthesias or muscle movements. This technique brings about hemodynamic and respiratory changes in function of the extension and intensity of the block. Extent of the blockade to the upper thoracic sensory segments causes a total or partial sympathetic block with decreased heart rate, blood pressure and cardiac output. Limiting the initial and subsequent doses to restrict the sensory blockade to the surgical area will reduce hemodynamic complications. Ropivacaine provides an effective sensory block and a restricted motor block, reducing the probability of the restrictive pulmonary syndrome associated with cervical epidural anesthesia.
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PMID:[Cervical epidural anesthesia with 0.75% ropivacaine in shoulder surgery]. 1189 46

In the era of cost containment in our health care system the demand is made of increasing outpatient surgery e. g. for carpal tunnel syndrome. To show the possibilities of carpal tunnel release performed under outpatient conditions we analysed 925 consecutive cases during 1. 1. 1981 to 30. 4. 2001. A tourniquet was used in all cases. In 814 cases we used axillary plexus anaesthesia. 107 surgical interventions were done under local anesthesia. Two of these patients could not tolerate the tourniquet. Analgesia was complete in all but two cases. In two cases revision due to after bleeding was necessary. There were no further complications seen. The mean time for return to work was 21.3 days (min: 14, max: 36 days). The mean follow-up for these patients was 36 months. Numbness and paresthesias were relieved in 98 %, pain was relieved in 90 %, motoric weakness was relieved in 95 % of the hands. The overall satisfaction rate was 94 %. Carpal tunnel release can be performed safely and unexpensively under outpatient conditions.
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PMID:[Experiences with 925 outpatient operations of carpal tunnel syndrome]. 1193 87

Angiostrongylus cantonensis is a parasite that causes eosinophilic meningitis and has been reported to be present on most Pacific islands. Rats are the principal host and several species of land snails the intermediate host. Important paratenic hosts are fresh water shrimp and fish. Modes of transmission include ingestion by man of raw fish, snails and fresh leafy vegetables contaminated by snail slime trails containing larvae. The parasitic worms are neurotropic in man, and the diagnosis should be considered in any adult or child, who presents, in endemic areas or areas with suitable intermediate hosts, with severe unrelenting headache, paresthesias, or a cranial nerve palsy. Eosinophils in the cerebral spinal fluid suggest the diagnosis. Simple analgesia is sufficient for mild cases. Treatment of those with severe symptoms remains controversial. Glucocorticoids, lumbar puncture to reduce intercranial pressure and antihelminthic agents have been used.
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PMID:Human infections with Angiostrongylus cantonensis. 1201 20

This report highlights transient Horner's syndrome and trigeminal nerve palsy following labor epidural analgesia. A 29-year-old primigravida had a lumbar epidural catheter placed for analgesia in labor. The analgesia was maintained by infusion of a dilute local anesthetic/opioid mixture and turned off after achieving complete cervical dilation. Approximately 1 hour after delivery she complained of heaviness in her left eyelid, and was noted to have left-sided ptosis and paresthesia within the distribution of the ophthalmic and maxillary divisions of the trigeminal nerve, which resolved over the next 2 hours. There were no other neurologic changes. Horner's syndrome and cranial nerve palsies can occur as a consequence of epidural analgesia for labor.
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PMID:Horner's syndrome and trigeminal nerve palsy after lumbar epidural analgesia for labor and delivery. 1247 90

Epidural analgesia is often considered optimal postoperative analgesia for certain surgical procedures. Ropivacaine is a new local anesthetic that is less toxic than its homologue, bupivacaine. Epidural infusions usually comprise a local anesthetic, an opioid, or a combination of the two to improve analgesic efficacy and reduce unwanted side effects. All 210 patients undergoing lower abdominal or lower extremity surgery received epidural analgesia infusions at 7 mL/hour, 105 with 0.1% ropivacaine and 105 with 0.1% ropivacaine plus 1 microg/mL fentanyl. Pain score and side effects (hypotension, nausea, vomiting, pruritus, paresthesia, urinary retention and motor block) were measured at 0, 0.5, 1, 3, 6, 12, and 24 hours. There was no statistical difference in patient profile between the groups. Pain relief scores were similar in the two groups in the first hour after the drugs were given. However, pain relief was significantly better in the ropivacaine/fentanyl group after the first hour and this difference lasted for the remaining time. There was no significant difference in adverse events between the two groups during 24 hours of assessment. In conclusion, the quality of analgesia was significantly improved by the addition of fentanyl 1 microg/mL to ropivacaine.
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PMID:Ropivacane 0.1 % with or without fentanyl for epidural postoperative analgesia: a randomized, double-blind comparison. 1460 21

We report a case of a 75-yr-old female patient in whom motor deficits and paresthesias occurred after lumbar epidural analgesia. These symptoms were eventually found to be due to a tethered cord syndrome. An epidural catheter was inserted for analgesia after colon surgery. The postoperative course was characterized by fluctuating sensory and motor symptoms. A magnetic resonance imaging scan showed an intraspinal mass, which was removed by laminectomy. The presented complication is of major interest because the intraspinal tumor, which must have been present for years, became acutely symptomatic. Tethered cord syndrome is caused by a limited longitudinal mobility of the cord. It is often seen as a part of spinal closure defects and is also associated with intrathecal tumors. Typically, adult patients complain of weak legs, paresthesias of the legs, and urinary incontinence. However, our patient had denied any muscular or neurological problems or urinary incontinence during the preoperative interview. Postoperative electromyogram and electroneurography ascertained chronic neurogenic lesions of multiple lumbar and sacral nerve roots. Three months after the operation, the patient was able to walk 100 m with a crutch.
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PMID:Muscle weakness and paresthesia associated with epidural analgesia in a patient with an intrathecal neurofibrolipoma as part of a tethered cord syndrome. 1528 40

We noted in our practice of obstetric anesthesia at a large teaching hospital that the epidural catheter failure rate was higher than previously reported. We undertook this study to determine the incidence of epidural catheter failure in parturients and to determine the primary causes of failure. After institutional approval, we evaluated the charts of parturients who received epidural analgesia for labor or anesthesia for cesarean section for 6 randomly selected months spanning one year. We examined 4240 anesthesia records for patient-related data, operator-related data (years of training) and technical information. The participants were unaware there was a study in progress, and data were collected in a systematic fashion so as to minimize data collection related biases. Chi2, Mantel-Haenszel chi2, analysis of variance and univariate logistic regression were used to analyze data. P<0.05 was considered statistically significant. Overall epidural catheter failure rate was 13.1% with a dural puncture rate of 1.03%. The major causes of catheter failure were no analgesia and unilateral block. The experience of the anesthesiologist, the mode of delivery, patient age, patient weight, type of epidural catheter, occurrence of paresthesia and the use of CSE were all associated with significantly different epidural catheter replacement rates. Despite the initially high failure rate, the overall patient satisfaction rate was greater than 98%.
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PMID:Incidence of epidural catheter replacement in parturients: a retrospective chart review. 1532 Nov 32

Needle size and shape may influence the incidence of paresthesias, post-dural puncture headache and other complications during combined spinal-epidural (CSE) procedures. We have noted a relatively high incidence of transient paresthesias during placement of the spinal needle during CSE for labor analgesia. The purpose of this study was to compare the occurrence of paresthesia and post-dural puncture headache in parturients who received CSE analgesia with either a 25-gauge or 27-gauge Whitacre needle. In a prospective observational study, data were gathered from 478 consecutive women receiving labor analgesia. Incidence, duration, and character of any paresthesias upon spinal needle placement and the incidence and treatment of headache were recorded. The incidence of paresthesia with the two needles was similar (16% with 25-gauge vs 15.4% with 27 gauge) but the incidence of post-dural puncture headache was higher with the 25-gauge needle (4% vs 0.7% with 27 gauge, P < 0.05). Our data suggest that with Whitacre needles, 27-gauge might be preferable to 25-gauge needles to reduce the rate of post-dural puncture headache in parturients but that they do not alter the incidence of transient paresthesias.
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PMID:Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor. 1532 5


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