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)

Effects of epidural anesthesia induced with bupivacaine alone (group C), bupivacaine and fentanyl (group E), or bupivacaine and intravenous fentanyl (group I) on the onset and spread of cold sensory block, the onset of analgesia and the degree of motor block were compared. Seventy-five patients undergoing lower limb or abdominal surgery were allocated to three groups of 25; patients of group C received 15 ml of 0.5% bupivacaine and 2 ml of 0.9% saline epidurally, patients of group E received 15 ml of 0.5% bupivacaine and 2 ml of fentanyl epidurally, and patients of group I received 2 ml of fentanyl intravenously and 15 ml of 0.5% bupivacaine and 2ml of 0.9% saline epidurally. The onset time of cold sensory block at T11 was significantly shorter in groups E (6.8 +/- 1.9 (SD) min) and I (7.3 +/- 1.7 min) than in group C (9.3 +/- 1.9 min). The onset time of analgesia was also significantly shorter in groups E and I than in group C. The segmental spread of cold sensory block at 20 min after initial injection was significantly larger in groups E and I than in group C. There was no significant difference in motor block at 20 min among the three groups. Respiratory depression appeared more frequently in group I than in groups C and E. These results suggest that epidural administration of fentanyl offers a clinical advantage over intravenous administration for analgesia during epidural block.
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PMID:[Comparison of epidural versus intravenous administration of fentanyl during epidural block]. 909 8

Thirty subjects undergoing posterolateral thoracotomy were allocated randomly to receive one of two analgesic regimens: group Pre received i.v. morphine, i.m. diclofenac and intercostal nerve blocks from T2 to T11, 20 min before operation and placebo injections after operation. Group Post received placebo injections before operation, and i.v. morphine, i.m. diclofenac and intercostal nerve blocks from T2 to T11 at the end of surgery, before discontinuation of anaesthesia. Visual analogue pain scores, extent and duration of intercostal nerve block, analgesic consumption and complications were assessed during the postoperative period by a single blinded observer. Subjects were followed-up for a minimum of 12 months to determine the incidence of post-thoracotomy pain syndrome. During the first 48 h after operation there were lower pain scores in group Pre when taking a vital capacity breath but there were no significant differences between the groups in any other measure. The effects of pre-emptive analgesia given before surgery appeared to be relatively modest in terms of analgesia, analgesic consumption and long-term outcome and were of limited clinical significance.
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PMID:Pre-emptive effect of multimodal analgesia in thoracic surgery. 960 75

Prolonged nerve conduction blockade has been proposed to result from the summed effects of charged and neutral local anaesthetics. Thirty-seven patients were randomly allocated to receive intravenous patient-controlled analgesia alone or combined with intercostal blockade (T7-T11) with a mixture of 0.45% bupivacaine and 0.6% phenol for post-cholecystectomy analgesia. Adequacy of pain relief was measured by patient scores on a 10-cm visual analogue scale and by dose-demand ratio, amounts of loading dose and total consumption of morphine and also the duration of patient-controlled analgesia in each group. No differences were found between groups in post-operative scores, dose-demand ratios and loading doses of morphine. However, in the combined treatment group, a significantly lower total consumption of morphine (P < 0.05), associated with a shorter duration of patient-controlled analgesia (P < 0.02) and a decreased mean number of unsuccessful demands (P < 0.001) were recorded. Intercostal blockade with bupivacaine-phenol supplements intravenous patient-controlled analgesia for post-cholecystectomy pain relief.
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PMID:Intercostal nerve blockade with a mixture of bupivacaine and phenol enhance the efficacy of intravenous patient-controlled analgesia in the control of post-cholecystectomy pain. 978 66

We have compared intrathecal bupivacaine 1.25 mg and fentanyl 25 micrograms (group A) with bupivacaine 2.5 mg and fentanyl 25 micrograms (group B), for combined spinal-epidural analgesia in 49 labouring parturients in a prospective, randomized, double-blind study. Onset and quality of analgesia were similar in both groups, with median visual analogue scale pain scores of 0 achieved in 5-10 min. Median duration of analgesia was longer in group B (median 120 (range 90-120) min) compared with group A (75 (75-105) min) (P = 0.013). Median upper sensory level was higher in group B compared with group A at 15 min (T6-7 vs T11, P = 0.003) and at 30 min (T6 vs T11-12; P = 0.001). Motor block was greater in group B: seven patients had a modified Bromage score > or = 1 compared with none in group A at 15 min (P = 0.017). Group B also had a greater decrease in arterial pressure. Patient-midwife satisfaction scores and other side effects were similar. We conclude that intrathecal bupivacaine 1.25 mg with fentanyl 25 micrograms provided analgesia of similar onset and quality compared with bupivacaine 2.5 mg and fentanyl 25 micrograms. Although the duration of analgesia was shorter, the incidences of motor block and hypotension were less with the smaller dose.
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PMID:Combined spinal-epidural analgesia in labour: comparison of two doses of intrathecal bupivacaine with fentanyl. 1070 Jul 84

Several methods are available to measure splanchnic blood flow and gut ischaemia. Tonometry is most practical for peri-operative use. Epidural blockade from T5 to T11 causes mesenteric arteriovenous vasodilation and may increase splanchnic blood flow. This study assesses the ability of tonometry to measure differential effects of opiate and epidural analgesia on splanchnic blood flow. Forty patients for elective colorectal surgery were randomly allocated to receive epidural infusion or intravenous morphine. Gastric mucosal PCO2, pHi, standard pHi, PCO2 gap and pH gap were measured after induction and on termination of surgery. These parameters were within normal limits at the end in most cases and there was no significant difference between the groups. The complication rate was similar in both groups and was not correlated with low pHi, but was correlated with blood loss. We were unable to demonstrate a difference in splanchnic perfusion, as assessed by gastric tonometry, between the two groups.
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PMID:A comparison of opiate- and epidural-induced alterations in splanchnic blood flow using intra-operative gastric tonometry. 1112 54

Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower thoracic spine and retraction of the left lower lobe of the lung. Despite initially planning opioid-based postoperative analgesia, a joint anaesthetic and surgical decision was made to use epidural analgesia in an attempt to avoid potential postoperative respiratory complications. Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167% with diamorphine 0.1 mg ml(-1) provided excellent analgesia. The technique was associated with no postoperative complications.
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PMID:Epidural analgesia after spinal surgery via intervertebral foramen. 1561 2

To determine the efficacy and safety of subarachnoid butorphanol combined with lidocaine, six calves were studied. Each calf underwent two treatments, at least one week apart, via subarachnoid injection: (1) butorphanol (0.03 mg/kg) plus 2% lidocaine (4 mg/kg) and (2) 2% lidocaine (4 mg/kg) alone. Subarachnoid injections were performed at the lumbosacral space. Analgesia, motor block, sedation, heart rate, arterial blood pressure, respiratory rate, arterial oxygen saturation as measured by pulse oximetry, and rectal temperature were compared before and after subarachnoid administration of drugs. Subarachnoid administration of the butorphanol-lidocaine combination induced bilateral prolonged analgesia extending from the coccygeal to the T11-T13 dermatomes in the calves, with minimal sedation and severe ataxia. Cardiovascular effects were significant in both treatments: heart rate was increased, and there was a minimal decrease in arterial pressure. It was concluded that adding a small dose of butorphanol to subarachnoid lidocaine in calves is effective and safe.
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PMID:Subarachnoid butorphanol augments lidocaine sensory anaesthesia in calves. 1663 89

Kidney transplantation related femoral neuropathy can mimic epidural catheter related radiculopathy in clinical presentation. Anesthesiologists should keep this possibility in mind when performing epidural anesthesia or analgesia for kidney transplantation. We present a 52-year-old male who after undergoing cadaveric kidney transplantation under general anesthesia in combination with epidural analgesia made possible by catheterization via T11-12 interspace for reinforcement of anesthesia and for postoperative patient-controlled epidural analgesia (PCEA) sustained sensory disturbance and muscle weakness of the lower limbs. These symptoms did not improve after discontinuation of the PCEA. Epidural hematoma with secondary radiculopathy was contemplated initially. Serial examinations including thoracic-lumbar CT scan, abdominal sonography, electromyogram and nerve conduction study were thus performed. The final diagnosis turned out to be surgical procedure related femoral neuropathy. We believe this is the first instance ever reported about the dilemma in making a predicative diagnosis from two conditions near akin in kidney transplantation. Accurate diagnosis made through serial image and electrophysiologic studies are essential to appropriate management.
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PMID:Epidural analgesia masked the diagnosis of femoral neuropathy following renal transplantation. 1703 7

The segmental nerves T6-T11 pass through and innervate the rectus abdominis muscle and overlying skin. The arcuate lines compartmentalize the rectus, but they are deficient posteriorly and hence a catheter tunnelled into the posterior sheath can be used to achieve an effective continuous analgesic block. Volume is important to fill the compartment. It is a simple surgical procedure that has several advantages and appears a viable alternative to epidural analgesia.
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PMID:Rectus sheath catheters for continuous analgesia after upper abdominal surgery. 1859 29

Major abdominal surgery, and also radical cystectomy, is followed by a delayed return of bowel function attributable to postoperative ileus (POI), which, in addition, stands out as one of the most frequent complications that causes increased length of stay (LOS). Some variability exists in the definition of POI since time to return of peristalsis and time to first passage of flatus, which are commonly referred to as indicators of bowel activity, have their own weaknesses, observer dependent and time dependent, among other variables. A number of causes have been recognized to induce or maintain the condition of ileus. Some among them are part of the perioperative period. The practices of mechanical bowel preparation (MBP) and of fasting before surgery have been challenged and can be safely abandoned. The perception of pain is an acknowledged promoter of POI; therefore, providing complete pain control constitutes the rationale in favor of administering anesthesia and analgesia combined, both in the form of concurrent general and epidural anesthesia (i.e., at the thoracic level, T9, T11), and represents the mainstay of intraoperative measures. Hypovolemia is also associated with an increased risk of POI. The use of nasogastric tubing (NGT) has been associated with increased pulmonary complications; moreover, bowel resection can be performed safely without postoperative NGT. Early postoperative provision of artificial nutrients has shown beneficial effects, both in the form of total parenteral and enteral nutrition (PEN, EN). We devised a perioperative care regimen, adopting a multimodality approach aimed at minimizing the effects of the above listed factors to ascertain if they could contribute to preventing or reducing POI and the complications associated with radical cystectomy and intestinal urinary diversion. In addition, we investigated the impact of early artificial nutrition, combining PEN and EN via a jejunal nutrition cannula. Time to return of bowel movements, time to reinstitution of a regular diet, presence and duration of POI, and incidence and nature of complications constituted the study end points. Of 143 consecutive patients, 107 who underwent radical cystectomy with intestinal urinary reconstruction were able to be evaluated for results and complications. The male to female ratio was 86:21, the mean age was 74 years, and more than two-third belonged to the American Society of Anesthesiologists categories II and III. Pathologic stages of disease were bladder confined in 48 patients, locally advanced in 33, and extravesical in 26. Urinary diversion with intestine consisted in the configuration of heterotopic reservoirs in 39 patients, orthotopic substitution in 38, and uretero-ileo-cutaneostomy in 30. Bowel movements returned after a median time of 2 days (range, 1-6), and the median time to reinstitution of a regular diet was 4 days (range, 3-9). POI beyond postoperative day 4 was observed in 17.7% of the patients. Overall, a total of 28 patients (26.1%) experienced complications, specifically, medical complications in 19 patients and surgical complications leading to relaparotomy in 11. The mortality rate was 3.7%. No effects were observed on postoperative protein depletion, despite the provision of early artificial nutrition. Our results suggest that a short median time of return of both peristalsis and flatus, and to regular diet resumption with a low incidence of POI, can be obtained in the majority of patients with a perioperative regimen aimed at reducing the effect of some of the causes associated with induction or maintenance of POI. Further studies of multimodality perioperative care plans, similar to that used in the present study, are required.
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PMID:Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. 1796 14


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