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

Three studies that describe antipyretic bioassay are detailed. Reference Standard Endotoxin (RSE) was used to induce fever in healthy male volunteers under randomized, single-dose, double-blind, parallel, and standard drug-control conditions. Thirty minutes before administering RSE, the subjects were medicated with test drug, and oral temperatures were recorded every 15 minutes for 6 to 8 hours. Two NSAIDs and a centrally acting analgesic were evaluated. Both doses of a propionic derivative, three high doses of tebufelone (a new NSAID), as well as the high dose of flupirtine effectively obtunded the fever response to RSE. Adverse reactions consisting of flu-like symptoms such as myalgia, headache, and chills were also significantly reduced with the standard as well as test drugs. The authors conclude that the RSE model is a quick, safe, and reliable method to evaluate antipyresis and to predict other pharmacologic effects of these types of drugs, such as analgesia.
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PMID:A new clinical bioassay for antipyresis. 188 Feb 32

At first sight it seems impossible to put into practice the 1992 resolution of the German Federal Council recommending increased frequency of hospital based operative care for ambulatory patients and the duty to do so under full financial coverage. A detailed analysis of the current situation suggests that this may be possible even today--with some reservations regarding the infrastructure of the hospitals. Selection and preparation of the patient is a process in which the anaesthesiologist must play an important role. Delegation of this duty to the surgeon or the general practitioner is not permitted. The anaesthesiologist must have sufficient time, prior to the procedure, to meet the patient; meeting the patient for the first time a few minutes before induction of anaesthesia is unacceptable. Even if one concedes freedom of methods, one drug and one procedure should be avoided while caring for surgical ambulatory patients: this drug is succinylcholine, because of life-threatening hyperkaliaemia in children with occult myopathy and severe and frequent myalgia especially in ambulatory patients. The procedure not suitable in ambulatory patients is subarachnoidal analgesia--due to an unacceptably high percentage of headaches in young ambulatory patients. The postoperative care and observation must be delegated to especially qualified persons only--and these persons should not be distracted by duties outside the recovery area. The anaesthetist must--in addition--be available at all times without delay. Pain, nausea and emesis molest the ambulatory patient during the postoperative course to a particular extent. The anaesthesiologist must take care of these complaints--even if the patient is discharged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesia for surgery in ambulatory patients: organizational aspects of the hospital physician]. 777 59

We have studied the effectiveness and sequelae of low-dose suxamethonium in 60 day-case oral surgery patients requiring nasal intubation. Anaesthesia was induced with propofol and alfentanil; 60 patients were allocated randomly to three groups of 20 patients and received no suxamethonium, suxamethonium 0.25 mg kg-1 or 0.5 mg kg-1. All patients received i.v. fentanyl and diclofenac 100 mg rectally for analgesia. Good intubating conditions were produced in all 20 patients receiving suxamethonium 0.25 mg kg-1, in 19 patients receiving suxamethonium 0.5 mg kg-1 and in 11 patients not receiving a neuromuscular blocker. The incidence of postoperative myalgia after suxamethonium 0.25 mg kg-1 (20%) did not differ significantly from the incidence after propofol and alfentanil alone (28%).
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PMID:Effectiveness and sequelae of very low-dose suxamethonium for nasal intubation. 788 Jul 2

A prospective randomized study was undertaken on elderly patients undergoing intraocular, predominantly cataract, surgery to compare the intraoperative, recovery and postoperative features associated with general anaesthesia employing either the spontaneous (SV) or controlled ventilation (IPPV) techniques of respiration using isoflurane, nitrous oxide and a constant FiO2 of 0.33. SV patients received isoflurane 0.97% (mean). IPPV patients were intubated with atracurium alone, and received isoflurane 0.60% (mean). Heart rates were lower intraoperatively with IPPV, and blood pressures were lower with SV. Intraocular pressure measurement identified three subgroups of patients within each respiratory group: a large subgroup (70% of SV, 64% of IPPV patients) with a high-normal initial mean intraocular pressure which fell intraoperatively; a small subgroup (25% of SV, 24% of IPPV patients) with a low normal initial mean intraocular pressure which rose intraoperatively; and a small subgroup (5% of SV and 11% of IPPV patients) in whom the intraocular pressure remained unchanged. A satisfactory operative field was reported by surgeons in 87% of SV and in 86% of IPPV patients. SV patients had a lower mean end-operative SaO2 than IPPV patients (SV 95.0%; IPPV 96.7%), and were extubated sooner at the end of anaesthesia. In the recovery ward the times to awakening, vomiting incidences, analgesic usages and recovery times were similar, and patients were similarly restful. Postoperatively, the incidences of vomiting, headache, fever, sore throat and myalgia were similar, but SV patients required more analgesia for headache. We conclude that both technique properly performed are similarly satisfactory for cataract surgery in elderly patients.
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PMID:Clinical comparison of spontaneous respiration versus controlled ventilation general anaesthesia using isoflurane for intraocular surgery: intraoperative, recovery and postoperative effects. 789 72

We have investigated the possibility of using the pre-operative measurement of cholinesterase activity to predict the postoperative development of myalgia following the administration of suxamethonium. Seventy-seven patients presenting for elective extraction of wisdom teeth were entered in the study. All patients received a standard anaesthetic regimen, including suxamethonium to facilitate tracheal intubation, and standardised postoperative analgesia. Myalgia was assessed postoperatively and no correlation between muscle pains and cholinesterase activity was found.
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PMID:Suxamethonium-induced muscle pains are not related to cholinesterase activity. 828 36

We have studied, in 150 patients undergoing elective oral surgery, the effectiveness and sequelae of pretreatment with rocuronium for reducing myalgia after suxamethonium. Patients were allocated randomly to one of three groups: anaesthesia was induced with propofol and fentanyl, and group V received vecuronium 1 mg, group R rocuronium 6 mg and group P placebo pretreatment. Suxamethonium 1.5 mg kg-1 was given 60 s after the pretreatment agent. All patients received ketorolac 10 mg i.v. and morphine 10 mg i.m. for analgesia. The incidence of postoperative myalgia on day 1 after rocuronium (20%) was significantly less than after vecuronium (42%) (P < 0.05) or placebo (70%) (P < 0.01). By day 4 the incidence of myalgia was 28.6% in the rocuronium group, 46.3% in the vecuronium group and 95% in the placebo group. Intubating conditions were not affected adversely by any pretreatment regimen.
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PMID:Rocuronium pretreatment reduces suxamethonium-induced myalgia: comparison with vecuronium. 865 25

The ability of muscle pain to generate somatosensory sensibility changes is controversial. Thus, in the present study, tonic infusion of hypertonic saline (5%, 7.1 ml administered over 15 min) into the tibialis anterior (TA) muscle was used as an experimental model to induce local and referred pain. The sensibility to high-intensity pressure stimuli applied to the local pain area, referred pain area and an arm was assessed in 14 healthy volunteers. Infusion of isotonic (0.9%) saline into the other leg served as control. The subject continuously scored the pain intensity on an electronic visual analogue scale (VAS). Pressure pain threshold (PPT) was determined on the TA muscle (2 cm and 10 cm from the infusion site), at the frontal aspect of the ankle (area of referred pain) and on the arm. To minimise the skin component of the PPT, the skin covering the assessment sites was anaesthetised with an anaesthetic creme. The PPTs were obtained before and after cutaneous analgesia, 1 min and 10 min after infusion start and 10 min after the pain had disappeared. Infusion of hypertonic saline caused significantly (P<0. 05) higher VAS scores than infusion of isotonic saline. A significant (P<0.04) increase of the PPT (i.e., decreased sensibility) was found at the ankle and on the arm during muscle pain compared to the control condition. No significant differences in PPTs on the TA muscle were found during saline-induced muscle pain compared to the infusion of isotonic saline. The decrease in deep sensibility at the heterotopic sites (referred pain area and arm), but not at homotopic sites (TA muscle), probably reflected the phenomenon of diffuse noxious inhibitory control (DNIC). The inhibitory mechanism during muscle pain was shown to be effective for the deep tissue sensibility in healthy subjects. Thus, a pathologically disturbed inhibitory mechanism may result in widespread deep hyperalgesia in muscle pain patients.
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PMID:Experimentally induced muscle pain induces hypoalgesia in heterotopic deep tissues, but not in homotopic deep tissues. 951 13

Suxamethonium in the doses of 1.0, 0.5 and 0.25 mg/kg was compared with mivacurium 0.15 mg/kg in 80 patients requiring nasotracheal intubation for maxillofacial surgery in a double-blind randomized controlled trial. Anaesthesia was induced with thiopentone 5 mg/kg and alfentanil 15 micrograms/kg. Patients were randomly allocated to one of the four relaxant groups. Anaesthesia was maintained with enflurane in 70% nitrous oxide and 30% oxygen and analgesia provided with intravenous pethidine 0.5 to 1.5 mg/kg and rectal indomethacin 100mg. All patients given mivacurium or suxamethonium 1 mg/kg had acceptable intubating conditions. Significantly fewer patients given suxamethonium 0.5 mg or 0.25 mg/kg had acceptable intubating conditions (90% and 70% respectively) (P = 0.003). Poor intubating conditions requiring additional relaxation were seen in two patients given suxamethonium 0.25 mg/kg and two given 0.5 mg/kg, while no patients given suxamethonium 1.0 mg/kg or mivacurium 0.15 mg/kg required additional relaxation (P = 0.004). Only four patients had postoperative myalgia, all of whom were given suxamethonium 0.5 mg/kg or more but no significant difference between groups could be demonstrated.
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PMID:Mivacurium compared with three different doses of suxamethonium for nasotracheal intubation. 980 7

Topical analgesics are widely marketed for treatment of muscle and joint pain. We have recently developed a model of muscle pain and have used this model to evaluate the efficacy of commercially available topical and peroral ketoprofen in order to evaluate the time- and dose-dependence of analgesia. In the present study, we examined the dose- (0, 50, and 100 mg) and time-dependence (hourly to 8 h) of commercially available peroral and topical ketoprofen. In order to achieve infusion times of 8 h (and thus study the time course of analgesic action), we adapted the model of low pH-induced muscle pain in humans to these requirements by applying the infusions continuously for 10 min every hour for 8 h. We found that the 10 min infusion produced reliable and consistent pain levels that were reproducible over the 8 h of the study. The study was performed double-blind, randomized, and with a 1-week interval between each of five different sessions (cross-over). Altogether six volunteers underwent intramuscular infusions of isotonic phosphate-buffered saline solution of pH 5.2; during each 8 h session the infusion was switched on eight times with a duration of 10 min at 50 min intervals (there was no infusion during the 50 min interval). The intramuscular infusion of low pH phosphate buffer induced a localized dull-aching or stinging muscle pain sensation; the flow rate of the pH infusion was individually adjusted to induce pain of a magnitude of 20% on a visual analogue scale (ranging from "no pain" (0%) to "unbearable pain" (100%)). Twenty minutes after starting the infusion the volunteers received a capsule with either a placebo or 50 or 100 mg ketoprofen perorally and, in addition, either placebo gel or 50 or 100 mg of a 2.5% commercial ketoprofen gel was applied topically to the skin. One of the sessions included a placebo gel and an oral placebo. The intensity of the recurrent pain stimulus was significantly reduced by 59% following administration of 100 mg peroral ketoprofen within the first 3 h (P<0.03, Wilcoxon test); this analgesia lasted up to the sixth hour of the experimental protocol. Oral ketoprofen (50 mg) was less effective and reduced the pain intensity by 45% (P<0.05) from only the second to the third hour. In contrast, pain reduction after topical ketoprofen application was not of the same magnitude but appeared to be faster to develop (with a maximum effect within 1 h) on average. The maximum pain suppression with 100 mg topical 2.5% ketoprofen gel was by 51% (significant with P<0.03), while 50 mg topical ketoprofen produced a non-significant reduction of 29%. The apparent analgesia was rapid to develop but transient and pain ratings increased back to baseline values within 3 h for the 100 mg dose and within 2 h for the 50 mg dose. This data suggests that topical application of commercial gel-based systems does not provide long-lasting analgesia in the muscle when compared to perorally-dosed ketoprofen. In addition, the data show that even doses of 100 mg peroral ketoprofen do not provide complete relief of muscle pain.
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PMID:Analgesic profile of peroral and topical ketoprofen upon low pH-induced muscle pain. 1140 35

Considerable progress has been made in understanding and treating pain associated with pediatric AIDS. The World Health Organization (WHO) estimates that 1000 new pediatric HIV infections occur daily, with 67% in Africa and 30% in South and Southeast Asia. Perinatally infected children show two types of progression, a precocious form that is usually fatal by the 4th year and a less rapidly progressing form in which survival exceeds 80% at age 7. Neurologic effects are frequently apparent by 3-6 months in the severe form. The pain may result specifically from the HIV infection and its complications, from intercurrent or opportunistic infections, or from examinations and treatment. The emotional pain suffered by pediatric HIV patients is often very great. Seropositive children are more subject to bacterial infections than seropositive adults, and their infections are more recurrent, prolonged, and painful than those in immunocompetent children. Infants with HIV encephalopathy may suffer painful sensations from mild stimuli and extreme irritability and spasticity. Abdominal HIV pain often results from multifactorial etiologies, and the usual therapies may be of little efficacy. Children with full-blown AIDS may complain of joint or muscle pain or headaches that are of unexplained etiology. Indications for painful diagnostic procedures should be carefully considered before the child is subjected to them, and protocols for analgesia should be developed. Pain medications may be selected according to the WHO classification, in accordance with the intensity of the pain. Antidepressants and anticonvulsants may be used for neuropathic pain, and painful spasticity may be reduced with myorelaxants. Children are often responsive to behavioral methods such as relaxation, hypnosis, or distraction.
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PMID:[Pain from AIDS (child)]. 1234 7


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