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

A descriptive analysis of the progression of epidural block with repeated doses of 0.25% bupivacaine was performed, assessing pain relief (visual analog scoring), dermatomal spread of sensory and motor block, and the associated management and outcome of labor. The influence of epinephrine 1:200,000 on these observations was also assessed by the random assignment of study patients into two groups, one receiving 10 ml of 0.25% bupivacaine plain (n = 28) and another group receiving 10 ml of 0.25% bupivacaine with commercially added epinephrine 1:200,000 (n = 27). Only primigravid patients were studied. Data comparisons were considered significant at p less than 0.05. With repeated doses of 0.25% bupivacaine, administered within fixed dosing intervals of 60-90 minutes, there was an increasing spread of sensory block toward sacral dermatomes while the upper level of sensory block did not change. Sacral sensory analgesia was present in only 3.5% of patients after the first dose of bupivacaine but was evident in 63.2% of patients following the fourth epidural injection. A similar increase in the number of patients with significant motor weakness was also seen as the number of top-up doses increased. A comparison of patients receiving plain solutions and epinephrine containing bupivacaine showed similar demographic profiles between the groups. Both groups received a similar dose of bupivacaine and experienced comparable management and outcome of labor. Epinephrine in a 1:200,000 concentration did not influence the changing characteristics of the epidural block over time. The duration of labor was not significantly different between groups (10.3 +/- 5.2 hours for the plain group and 11.0 +/- 4.7 hours for the epinephrine group).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sacralization of epidural block with repeated doses of 0.25% bupivacaine during labor. 229 81

The benefits of caudal analgesia are well recognized in the prevention of postoperative pain following pediatric surgery. The possibility of motor weakness may deter anesthetists from using this technique. This study investigates motor function prior to discharge in boys who, as day case patients, received caudal analgesia for pain relief following circumcision. Motor function was assessed using a simple and clinically relevant scale. Three different dosage regimens of bupivacaine were compared. No important motor weakness was demonstrated, and there was no difference with respect to motor block in the three groups. Caudal analgesia may be recommended as a suitable technique for day case patients.
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PMID:Caudal analgesia for pediatric day case surgery: assessment of motor function prior to discharge. 231 May 77

A lack of uniform methodology used in the assessment of different injection speeds in spinal anesthesia by different authors formed the basis of the current study, which compared under randomized conditions the effects of various injection speeds during intrathecal administration of 4 ml 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine. MATERIALS AND METHODS. Eighty male ASA Physical Status II and III patients scheduled for transurethral resection of the prostate under spinal anesthesia were selected. They were randomly divided into four groups of 20 each. Patients were given 4 ml of either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine according to the following scheme: I: 4 ml tetracaine/0.25 ml.s-1; II: 4 ml tetracaine/0.5 ml.s-1: III: 4 ml bupivacaine/0.25 ml.s-1; IV: 4 ml bupivacaine/0.5 ml.s-1. The study was carried out in a double-blind fashion and puncture was performed at the L3-4 interspace using a 25-gauge needle with the patient in the sitting position. Following injection of the anesthetic solution (0.25 ml.s-1 or 0.5 ml.s-1 without barbotage), the patient was immediately placed in the lithotomy position with the table remaining horizontal. The level of anesthesia using pin prick and the degree of motor blockade, using a 0 to 3+ scale where 0 represented no motor weakness and 3+ complete motor block, were assessed at specific intervals. Statistical analysis was performed using the Mann-Whitney rank sum test: P value of less than 0.05 was considered statistically significant. RESULTS. Bupivacaine injected at 0.25 ml.s-1 was associated with a higher dermatome level than at 0.5 ml.s-1 (P less than 0.05). Time to highest dermatome, however, was shorter with bupivacaine 0.5 ml.s-1 compared to 0.25 ml.s-1 (P less than 0.05) (Table 3, Fig. 1). Time to highest level of analgesia was shorter with tetracaine 0.25 ml.s-1 compared to 0.5 ml.s-1 (P less than 0.05) (Fig. 2). At 0.25 ml.s-1, tetracaine achieved the highest dermatome faster than bupivacaine (P less than 0.05). Tetracaine injected at 0.5 ml.s-1, however, was associated with a higher segmental level than bupivacaine (P less than 0.05). At 0.25 ml.s-1 bupivacaine and tetracaine achieved a 3+ motor block faster than at 0.5 ml.s-1 (P less than 0.05). Complete motor blockade, however, was significantly longer with tetracaine at both injection speeds (0.25 and 0.5 ml.s-1) compared to bupivacaine (P less than 0.05). CONCLUSIONS. The results suggest that 4 ml 0.5% hyperbaric bupivacaine or tetracaine injected at 0.25 or 0.5 ml.s-1 provides a rapid and reproducible spread of analgesia for transurethral surgery. However, our findings suggest that speed of injection is of little i
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PMID:[The effect of the injection speed on the blockade characteristics of hyperbaric bupivacaine and tetracaine in spinal anesthesia]. 267 28

A comparative trial between three different dosage regimens of bupivacaine administered by the caudal route, used for the prevention of postoperative pain in children undergoing elective inguinal herniotomy or ligation of patient processus vaginalis was undertaken. The regimens compared were bupivacaine 0.25% (1 ml/kg), bupivacaine 0.25% or 0.5%: (Age (years +2)/10 ml per dermatome to be blocked. This being calculated for inguinal surgery to be Age (years) + 2 ml. A linear analogue pain scale was used to evaluate pain, all three regimens being found to produce excellent analgesia, there being no significant difference between the pain scores of the three groups. Time to onset of analgesia, as indicated by changes in intraoperative heart rate in response to surgical stimulation were also similar in all groups. No evidence of postoperative motor weakness or disturbance of bladder function was found and there were no symptoms or signs attributable to local anaesthetic toxicity.
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PMID:Caudal anaesthesia for postoperative pain relief in children: a comparative trial of different regimens using plain bupivacaine. 267 89

From the data in the literature it can be seen that 40% of the surgical population has insufficient postoperative analgesia. Many reasons have been given for this: pain control delegated to the doctor on duty and/or the nursing staff; administration of drugs 'on demand', if the patient asks for them, or the nurses feel it to be necessary; fear of causing side effects such as respiratory insufficiency; or provoking addiction by giving narcotics. The aim of this paper is to evaluate the intensity of pain, the side effects, the degree of activity, anxiety, feeling of weakness and the mood of patients surgically treated for oncological diseases of the thorax and upper abdomen, comparing two different antalgic approaches. Thirty-five patients were studied. Pain was treated on demand with a narcotic, or an anti-inflammatory drug, or not treated at all; 20 patients were treated with analgesics given at predetermined hours, following the regime: methadone 10 mg intramuscularly (i.m.) every 12 h from the first to the third day following surgery and sodium diclofenac 75 mg (i.m.) every 12 h from the fourth to the seventh day. Results showed that patients treated with analgesics given intramuscularly at fixed hours have a significantly better pain control during the whole week of treatment (P less than 0.001), on average sleep more (P less than 0.001), spend more time standing or sitting and fewer hours lying down (P less than 0.001), have a higher performance status and feel less weak (P less than 0.05) than the group of patients treated with drugs 'on demand', or not treated at all.
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PMID:Treatment of postoperative pain: comparison between administration at fixed hours and 'on demand' with intramuscular analgesics. 273 11

The purpose of this study was to determine if the addition of sufentanil would improve the quality of analgesia obtained with 0.125% epidural bupivacaine infusions given to women in active labor. Forty healthy laboring women were randomly assigned to two equal groups. Group 1 had epidural analgesia instituted with the bolus injection of 10-15 ml 0.125% bupivacaine containing sufentanil 2 micrograms/ml, followed 30 minutes later by initiation of an epidural infusion of 0.125% bupivacaine containing sufentanil 1 microgram/ml at a rate of 10 ml/hr. Group 2 had epidural analgesia instituted with 10 or 15 ml of 0.25% bupivacaine with an epidural infusion of 0.125% bupivacaine begun 30 minutes later at a rate of 10 ml/hr. Infusion rates were altered as required to maintain an analgesic level to the tenth thoracic dermatome. Analgesia assessed by visual analog pain scores was significantly better in group 1. Significantly fewer epidural injections were required in group 1, and less motor weakness occurred in these patients. The addition of sufentanil to epidural bupivacaine infusions given in labor improves analgesia and reduces "top-up" requirements.
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PMID:Continuous infusion epidural analgesia in labor: the effect of adding sufentanil to 0.125% bupivacaine. 296

The anaesthetic management of two patients with severe muscle weakness--one suffering from acute dermatomyositis, the other from acute polymyositis--is described. Both patients presented for surgery for malignancy. Anaesthesia was induced with etomidate in one, thiopentone in the other. Alfentanil was used for analgesia and atracurium for muscle paralysis in both. Neuromuscular blockade was monitored using a peripheral nerve stimulator and no problems were experienced. Recovery of neuromuscular transmission and ventilatory function after operation were normal.
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PMID:Anaesthesia and acute dermatomyositis/polymyositis. 313 34

Local anesthetics given in the epidural space of a horse may cause hind limb weakness in addition to analgesia. Because alpha 2 agonists given by epidural injection cause sensory blockade without motor effects in human beings and other species, their use in veterinary anesthesia is appealing. This study was designed to examine the effectiveness of xylazine HCl, an alpha 2 agonist commonly used in horses. Xylazine, 0.9% NaCl, and lidocaine were given by epidural injection to horses subjected to perineal electrical stimulation. Administration of xylazine (0.17 mg/kg of body weight, diluted to a 10-ml volume, using 0.9% NaCl) induced approximately 2.5 hours of local analgesia without apparent side effects. Higher doses of xylazine caused mild hind limb ataxia. Administration of lidocaine induced a similar duration of analgesia, with severe hind limb ataxia (100% incidence). We concluded that xylazine given by epidural injection results in safe, effective perineal analgesia in horses.
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PMID:Epidural injection of xylazine for perineal analgesia in horses. 320 51

Lumbar epidural analgesia was performed in a 28 year old primigravida through a L2-L3 catheter. The first dose induced satisfactory analgesia for 1 h. After the second dose of 8 ml of 0.25 bupivacaine, the patient's systolic blood pressure fell from 110 to 80 mmHg. As vena caval compression can contribute to hypotension, the patient was immediately placed in the left lateral position and oxygen was administered through a mask. Rapid infusion of 250 ml of modified gelatin resulted in a prompt and lasting restoration of blood pressure to its initial level. The third dose of 8 ml of 0.25% bupivacaine produced satisfactory analgesia without any adverse effect. The last dose (4 ml of 0.50% bupivacaine administered with the patient in half sitting) gave a left-sided Horner's syndrome and weakness in the left arm. An epidurogram, performed through the catheter 2 h after delivery, with the patient lying supine, showed unilateral left spread ascending to upper thoracic levels with delayed spread toward the right lumbar epidural space. The troubles persisted 6 h after the final bupivacaine dose, then resolving completely.
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PMID:[Claude Bernard-Horner syndrome and lumbar epidural analgesia]. 370 48

Saddle blockade with pethidine hydrochloride was performed in 111 patients undergoing short surgical operations on the perineum. A dose of 5% pethidine 0.5 mg kg-1 was injected to the subarachnoid space at L4-5 or L5-S1 with the patient in the sitting position. Sensory blockade was achieved in 5.28 +/- 1.43 min. This extended to the sacrococcygeal area, perineum, buttocks and posterior surface of thighs, and was followed 1-2 min later by motor blockade. During the operation the patients were stable haemodynamically and no respiratory depression was recorded. Sensory blockade lasted for 141 +/- 26.06 min and was followed by postoperative analgesia, the mean duration of which was 301 +/- 98.38 min. Postoperative neurological complications were recorded in three patients (2.7%): headache alone in one, headache associated with backache in one, and leg weakness, backache, nuchal rigidity and photophobia in another. Seven patients (6.3%) complained of itching, five patients (4.5%) of nausea and vomiting and two (1.8%) developed urinary retention.
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PMID:Saddle block with pethidine for perineal operations. 375 47


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