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)

The clinical effects of spinally (subarachnoid) administered, preservative-free fentanyl were assessed in 120 healthy women who underwent cesarean section with spinal anesthesia using 0.5% hyperbaric bupivacaine. Subjects were divided at random into four groups (n = 30) the first of which received 2 mL of saline containing no fentanyl (group 0); the second, 0.25 micrograms/kg (group 25); the third, 0.5 micrograms/kg (group 50); and the fourth, 0.75 micrograms/kg (group 75) of fentanyl in a blinded manner. Surgical anesthesia was excellent in 100% of treated patients and in 87% of group 0. Respiratory rate decreased significantly in groups 50 and 75 and was recorded as early as 4 min after the administration of the drug. Nevertheless, respiratory depression did not develop in any patient, and 40 min later all groups had a similar respiratory rate. Regression of anesthesia to the T-12 dermatome took a longer time as the dose of fentanyl increased, but all patients had recovered by 240 min after the injection. Effective postoperative analgesia lasted longer and significantly increased with the dose of fentanyl administered: group 0, 197 +/- 77 min; group 25, 305 +/- 89 min; group 50, 640 +/- 142 min; and group 75, 787 +/- 161 min (data expressed as mean +/- SD; P less than 0.001 between groups). Neonatal status was the same in all groups. Sedation and pruritus were the main side effects. The combination of bupivacaine and a low dose of fentanyl (0.25 micrograms/kg) provides excellent surgical anesthesia with short-lasting postoperative analgesia and very few negative side effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. 156 31

Spinal techniques (epidural and subarachnoid injection) are taught in veterinary curricula, but because they are less convenient they are not used widely in practice. Many animals undergoing routine (below the umbilicus level) surgical procedures can be anesthetized with mild sedation and caudal epidural analgesia. Ninety minutes of analgesia is provided by the shorter-acting agents, whereas bupivacaine provides 4 to 6 hours. Twelve percent of our attempts failed to produce analgesia. Sedation, surgeon acceptance, and patient temperament contributed to an additional few failures. High-risk cases are better handled on oxygen.
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PMID:Lumbosacral epidural management. 158 90

Sedative-analgesic treatment of patients on long-term artificial ventilation aims at protection from stress related to their disease or therapy. By stabilising both the patient's vital functions and psychological state this treatment may contribute to therapeutic success. The choice of drugs depends primarily on the nature and course of the underlying disease. Midazolam and propofol are available as hypnotics for short-term sedation during the post-operative period. The purpose of this study was to evaluate the effects of both agents on cardiovascular function, cortisol production, lipometabolism, and the recovery period following 24-h sedation. METHODS. Twenty female patients (mean body weight: 72 kg, mean age: 60 years) were randomly assigned to receive either midazolam or propofol over 24 h following major abdominal surgery. Balanced anaesthesia (halothane/O2/N2O/fentanyl) was administered for the surgical procedure. Assisted ventilation was used in all patients during the post-operative sedation period. Sedation depth was maintained at III-IV on the Ramsey scale. On arrival in the intensive care unit (ICU), an initial i.v. bolus of midazolam 0.1 mg/kg or propofol 1 mg/kg was followed by a continuous infusion (midazolam: 0.1 mg/kg.h; propofol: 2 mg/kg.h). Supplementary boluses of one-half the initial dose were given if required. Post-operative analgesia was achieved with 3 mg intravenous piritramide at 2-h intervals. A 7F Swan-Ganz catheter was inserted in the pulmonary artery and haemodynamic and biochemical parameters were monitored at 4-h intervals over 24 h starting 2 h after arrival in the ICU. Catecholamines were measured by high-pressure lipid chromatography (HPLC), cortisol by radioimmunoassay, midazolam by HPLC and ultraviolet detection, and propofol by HPLC and fluorescence detection. Data were calculated as means. The statistical analysis was performed according to the Mann-Whitney test, and significance was accepted for P less than 0.05. RESULTS. On administration of the propofol bolus at the onset of sedation, a decrease in blood pressure was particularly observed in patients with masked hypovolaemia, however, this decrease was easily controlled by volume administration. Independent of the type of sedation, the haemodynamic parameters remained unchanged throughout the observation period. At all times of measurement the mean heart rate was lower in the propofol group (90/min) when compared with the midazolam group (100/min), however, this difference did not reach significance. There were also no significant differences in cardiac index at all times of measurement, although it increased in both groups within the first 12 h by 0.6 l/min.min2. In both groups this increase was associated with a reduction in peripheral resistance and an increase in rectal temperature. To achieve the desired sedation depth, midazolam was administered at a mean dosage of 0.11 mg/kg.h and propofol at 1.9 mg/kg.h. Catecholamine levels decreased in both groups within the first 8 h: after 8 h of sedation the plasma levels of noradrenaline and adrenaline were 525 and 65 pg/ml, respectively, in the midazolam group and 327 and 51 pg/ml in the propofol group. (ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Propofol versus midazolam. Long-term sedation in the intensive care unit]. 163 17

Conscious sedation is commonly utilized in pediatric dentistry. Although opioid analgesics are often employed, patient safety would be enhanced if nonopioid drugs were used. The purpose of this study was to determine if rectal ketamine could produce plasma concentrations that would achieve both conscious sedation and analgesia to gingival needle puncture. Five 2-year-old male Macaca fuscata monkeys were given rectal ketamine at a dosage of 60 mg/kg and 90 mg/kg one week apart. Blood was drawn at selected times after administration, and vital signs, level of sedation, and consciousness were assessed. Plasma ketamine concentrations ranged from 240 to 820 ng/mL and from 390 to 3120 ng/mL after rectal administration at doses of 60 mg/kg and 90 mg/kg, respectively. Two monkeys after the high dose showed analgesia to a gingival needle puncture at plasma ketamine concentrations that ranged from 1390 to 3120 ng/mL. A good level of sedation was consistently observed in four monkeys (80%) following rectal ketamine at a dosage of 90 mg/kg, whereas one monkey showed a consistently good level at a dosage of 60 mg/kg. Sedation and dose were significantly (P less than 0.001) associated with plasma ketamine concentrations; physiologic parameters were not (P greater than 0.05). The results of this study suggest that rectal ketamine can produce plasma concentrations of the drug sufficient to achieve sedation in the monkey. The attainment of concomitant analgesia to a gingival needle puncture was not as predictable.
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PMID:Conscious sedation and analgesia with rectal ketamine in the Macaca fuscata monkey. 181 29

We sought to compare epidural lidocaine to several short-acting epidural narcotics for their efficacy in controlling pain during extracorporeal shock wave lithotripsy (ESWL), hemodynamic changes, side effects and patient acceptance. To determine what contribution, if any, the local anesthetic test dose makes to the above factors, we also compared epidural sufentanil with and without a preceding test dose of local anesthetic with epinephrine. One hundred ASA I-III patients scheduled for elective ESWL were divided equally into five groups to receive one of the following epidural drugs through an epidural catheter: 2% lidocaine with 1:200,000 epinephrine (Group L), 1000 micrograms alfentanil (Group A), 200 micrograms fentanyl (Group F) or 60 micrograms sufentanil (Groups S and S-). Group S- differed from all other groups in omission of the test dose and direct injection of the opioid through the epidural needle. Significant hypotension occurred in 20% of patients in Group L compared to 0% in the narcotic groups (p less than 0.01). Clinically significant respiratory depression was not observed in any group. Mild pruritus was observed in up to 60% of patients in the narcotic groups (p less than 0.01). Sedation was observed in all of the narcotic groups, particularly in Group S-, in which more than half of patients were drowsy (p less than 0.05). Requirements for adjuvant analgesics during ESWL were highest in Group A. Patient acceptance was high throughout the study. We conclude that epidural alfentanil, fentanyl and sufentanil are as effective as epidural lidocaine plus epinephrine in providing analgesia during ESWL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of epidural narcotics, with and without a test dose, to epidural lidocaine for extracorporeal shock wave lithotripsy. 214 29

The authors conducted a randomized double-blind controlled study comparing groups of patients receiving iv or epidural fentanyl infusions to determine whether, at comparable levels of analgesia, 1) the severity of side effects was different; and 2) plasma fentanyl concentrations differed between the two groups. Twenty-eight ASA physical status 2 women scheduled to undergo elective cesarean section were randomized into two groups to either receive fentanyl intravenously and saline epidurally or fentanyl epidurally and saline intravenously. After delivery of the infants under epidural anesthesia, each patient received a bolus of fentanyl 1.5 microgram/kg either intravenously or epidurally, and a fentanyl infusion was begun via the same route. Concurrently, a saline bolus and infusion were given via the alternate route. The rates of the fentanyl and saline infusions were adjusted until each patient was comfortable. Patients rated their pain, nausea, and pruritus on visual analogue scales. Sedation was evaluated by an observer. Respiratory depression was evaluated by end-tidal PCO2. Data were analyzed by unpaired two-tail t tests. Plasma fentanyl concentrations were measured at 12 and 24 h. Three patients in the iv group were dropped from the study because of inadequate pain relief. For the remaining 25 patients, similar infusion rates of fentanyl were required to produce similar levels of analgesia at 12 and 24 h. The severity of nausea, pruritus and sedation, and end-tidal PCO2 were similar for both groups. The plasma concentrations of fentanyl were significantly greater in those who received iv fentanyl at 12 h but not at 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section. 200 64

Thirty patients undergoing abdominal surgery were randomly assigned postoperatively into two groups for a double-blind evaluation of the analgesic potency and cardiorespiratory effects of either 50 micrograms sufentanil or 5 mg morphine injected epidurally. After sufentanil injection, good postoperative analgesia was obtained, with a linear analog score (LAS) of less than 5 starting 5 min after injection and lasting for more than 6 hr. Linear analog scores obtained during coughing (LASC) and during movement (LASM) were less than 5 after 10 min and lasted for more than 4 hr. Respiratory rate decreased significantly for 2 hr after sufentanil injection. After morphine, pain relief started after 20 min and lasted for more than 12 hr. Respiratory rate decreased after 30 min. Sedation was greater after sufentanil than after morphine. PaCO2, which increased significantly 1 hr after sufentanil, did not change after morphine. Peak expiratory flow significantly improved for 2 hr after both sufentanil and morphine, whereas forced vital capacity improved for 4 hr after sufentanil and 8 hr after morphine administration. Forced expiratory volume did not change with either drug. It is concluded that 5 mg morphine injected epidurally provides longer lasting analgesia than does 50 micrograms sufentanil, but that in the first hours analgesia is better after sufentanil. Injection of either drug was accompanied by remarkable cardiovascular stability.
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PMID:Analgesic and cardiorespiratory effects of epidural sufentanil and morphine in humans. 288 21

In postoperative patients using patient-controlled analgesia (PCA) to administer i.v. doses of morphine sulfate, respiratory rates and subjective rankings of pain, sedation, and liking for the drug were correlated with plasma morphine concentrations. In 12 patients selected before surgery, the initial morphine sulfate dose of 0.6 mg/sq m was increased or decreased as needed. Every two hours, cumulative morphine sulfate dose, respiratory rate, and sedation were recorded by the nurse, along with the patient's evaluation of pain and liking for the drug. Plasma was collected in the morning and evening during PCA therapy for morphine analysis. Data were analyzed by analysis of covariance. Dosing rates and rankings of pain, sedation, and liking decreased as a function of time postoperatively, but respiratory rates did not. Sedation and respiratory rates were independent of morphine concentration. Liking of the drug increased directly with plasma morphine concentration but decreased with time. A high level of pain was directly related to morphine use. For all significant relationships, there was high interpatient variability, with the exception of changes in pain rankings induced by morphine. Patients defined a minimum effective plasma morphine concentration of 20-40 ng/mL. The maximum plasma morphine concentration achieved by self-administration was 82 ng/mL. These postoperative patients used patient-controlled analgesia to deliver morphine sulfate i.v. for pain relief, not for euphoria, and did not exhibit sedation or respiratory depression. Morphine was consistently effective at plasma concentrations of 40 ng/mL or greater.
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PMID:Relationship between plasma morphine concentrations and pharmacologic effects in postoperative patients using patient-controlled analgesia. 315 20

An open pilot study was undertaken to evaluate the analgesic properties of epidurally administered sufentanil in the early postoperative period. After orthopaedic surgery of the lower extremity, four different groups of five adult patients each received either 15 micrograms (group 1), 30 micrograms (group 2), 50 micrograms (group 3) or 75 micrograms (group 4) sufentanil via an epidural catheter previously used for the surgical procedure. Results were satisfactory in groups 3 and 4 with very good relief of pain and a mean duration of action of 372 and 307 minutes respectively. Dosage above 50 micrograms did not seem to improve the quality or duration of pain relief, although the onset of action was faster with 75 micrograms. Sedation was always present in patients with effective analgesia. In the present study respiratory depression was not evident, but three patients complained of itching and two of urinary retention.
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PMID:Epidural sufentanil for postoperative pain relief. 316 8

Detomidine was administered twice to six foals (14 to 94 days old) using three different doses (10, 20 and 40 micrograms/kg bodyweight intravenously) in a double blind trial. Sedation, analgesia, heart rate and clinically observed side-effects were recorded. Detomidine showed strong sedative effects at all doses tested. Sedation deepened very little by increasing the dose from 10 to 40 micrograms/kg bodyweight, but the duration of the effect was longer. Analgesia was considered good with the largest dose (40 micrograms/kg), and moderate or non-existent with the lower doses. Detomidine caused a decrease in heart rate at all doses and other observed side-effects included ataxia, heavy breathing, arrhythmia, sweating and frequent urination. No adverse effects were observed.
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PMID:Detomidine (Domosedan) in foals: sedative and analgesic effects. 318 Nov 16


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