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)

Bupivacaine (Marcaine) is being used increasingly in obstetrics for epidural analgesia, by virtue of the good sensory block obtained and the minimum of side-effects on the mother and newborn infant. At a concentration of less than 0.5 p. 100, analgesia is excellent with a minimal effect on motor fibres. Side-effects and toxicity are limited by the use of fractionated doses from the beginning of labour or of a single dose during or at the end of labour calculated in relation to the effect sought. Any action on the newborn infant would appear to be exceptional, if dose recommendations are respected, the high percentage of Marcaine bound to proteins limiting its transplacental passage.
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PMID:[The use of Marcaine in obstetrical analgesia]. 2 48

Continuous lumbar epidural anesthesia was instituted in 49 healthy parturients who were randomly assigned to three treatment groups: 14 patients received chloroprocaine, 3 per cent; 19 received bupivacaine, 0.5 per cent, and 16 received a mixture containing chloroprocaine, 1.5 per cent, and bupivacaine, 0.375 per cent. Observations relating to the characteristics of the anesthetic block and to maternal and fetal well-being were made by a trained nurse observer. Times to onset of analgesia, times to maximum block, and adequacies of analgesia were similar in all groups. Bupivacaine lasted significantly longer than chloroprocaine or the mixture (68 versus 50 and 52 min, respectively, for the first injection), and caused the least motor block. No clinical superiority could be demonstrate for the mixture as compared with bupivacaine or chloroprocaine used individually. There was no sign of material or fetal toxicity with any of the three treatment regimens.
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PMID:Comparison of a chloroprocaine--bupivacaine mixture with chloroprocaine and bupivacaine used individually for obstetric epidural analgesia. 48 90

The following report of our experience using isobaric Bupivacaine 0.5% in 6,228 operations (intrathecal technique) will consider the intra operative period. In 55.8% of cases the lower extremities were operated upon and in 44.2% the lower abdomen. In 1,487 cases (23.9%) side effects/complications were evident and a classification of such is as follows: anaesthetic technique 5.29%, cardiorespiratory 15.69%, operator/operative technique 6.13%. The percentage remained relatively constant irrespective of age but a higher pre op risk classification (A.S.A. System) resulted in a marked increase in the above figures. The principal side effects encountered were as follows: Bradycardia 7.5%, hypotonia 6.3%, insufficient analgesia 3.9%, extrasystoles 2.9%. Grave complications occured in 0.15% and within this group 4 patients died intraoperatively; a relationship with the mode of anaesthesia has not been proven.
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PMID:[Spinal anaesthesia using bupivacain--clinical experience of more than 6000 cases (author's transl)]. 49 24

Bupivacaine, 0.125 per cent, with epinephrine, 1:800,000, was administered to 3,000 women in labor. Administration was in the lumbar epidural space for the purpose of achieving satisfactory analgesia with minimal or no motor paralysis. The usual initial dose of 12.5 mg (mean 13 +/- 2 SD) resulted in good sensory analgesia in 83 per cent of the patients and lasted for about and hour (mean 58 +/- 16 min). The mean total dose used for labor and delivery was 55 +/- 20 mg and the mean dose per hour 23 +/- 13 mg. Satisfactory analgesia for labor and delivery was obtained in 92 per cent of the patients, and in 66 per cent there was no discernible motor blockade. In the 3,000 patients, there was no adverse reaction to bupivacaine or epinephrine. No patient had a total spinal block or neurologic sequelae, and no neonatal depression could be attributed to the anesthetic.
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PMID:Bupivacaine, 0.125 per cent, in obstetric epidural analgesia: experience in three thousand cases. 49 59

A study to evaluate segmental epidural analgesia in labor is described. Bupivacaine (0.25 per cent) was used during the first stage of labor and for the second stage, either 3 per cent - Chloroprocaine delivered through the catheter (Group I) or 1 per cent Lidocaine as a perineal infiltrate (Group II) was used. There were 124 full term patients of whom, 36 were nulliparous and 88 were multiparous. The effects of segmental epidural analgesia on maternal blood pressure, pain relief, preservation of lower limb motor power, duration and progress of labor, and fetal outcome were evaluated. Pain relief during the first stage of labor was satisfactory in 114 (92 per cent) of the patients. There were no significant changes in maternal blood pressure, motor power in lower limbs, efficiency of uterine contractions and internal rotation of the presenting part when analgesia was effective. The use of 2-Chloroprocaine for second stage pain relief required low forceps delivery in 84 (91 per cent) patients, as compared to 14 (44 per cent) patients that had 1 per cent Lidocaine local infiltration. Fetal outcome, was excellent in all cases in that the one minute Apgar score was never lower than 7.
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PMID:Segmental epidural analgesia for labor and delivery. 53 63

Isobaric bupivacaine 0.5% with adrenaline 1:200,000 was used for spinal anaesthesia. The influence of dose (mg) and volume (ml) on segmental spread and duration of spinal block was investigated. Bupivacaine 10 or 15 mg was injected in 2 or 3 ml of solution. The segmental spread and duration of analgesic block was tested at certain time intervals. The results showed that: 1. an increase in dose is not followed by a larger segmental spread or longer duration of analgesic block, 2. the increase of the volume injected is followed by an increase in segmental spread of analgesic block. This is independent of the concentration of the local anaesthetic, 3. the segmental regression of analgesic block starts in the cephalad segments. Therefore, higher spread of analgesic block provides prolonged analgesia in the lower segments. The results of this investigation are controversal in relation to the reports in the literature of the last two decades. The increase in dosage of the local anaesthetic did not increase the segmental spread and duration of analgesia. Only the volume injected is responsible for an increase in segmental spread of analgesia. Of course the concentration of the local anaesthetic injected has to be at least the minimal concentration necessary to result in a sensory nerve block.
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PMID:[The dose-effect-ratio of isobaric bupivacaine in spinal analgesia (author's transl)]. 76 May 84

Pethidine or an epidural injection of bupivacaine are common forms of obstetric analgesia in Britain. Bupivacaine has been thought to have little effect on the fetus, but neurobehavioural studies have cast doubt on this. We therefore investigated the elimination of these drugs by babies in similar population groups. Bupivacaine was largely eliminated in just over one day, while pethidine required between 2 and 6 days. This could account for the persisting depression in babies whose mothers had received pethidine.
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PMID:Elimination of pethidine and bupivacaine in the newborn. 92 10

The incidence of contamination of catheters and syringes used during epidural analgesia for parturients and the effectiveness of bacterial filters were investigated. The effect of bupivacaine on bacterial viability and growth was also studied. Syringes in 5/101 cases were contaminated, while catheter tips located in the epidural space were sterile. Organisms isolated were skin commensals and probably originated on the hands of anesthetic personnel. Bupivacaine (0.25%) was bacteriocidal to S epidermidis and Corynebacterium spp at 37C but not at room temperature. These findings illustrate the efficacy of using bacterial filters during continuous epidural analgesia. New syringes should be used for each epidural injection as insurance against seeding of bacteria in the presence of a defective filter.
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PMID:Bacteriologic aspects of epidural analgesia. 94 77

The influence of epidural block with bupivacaine (Marcaine-adrenalin) on fetal heart rate, uterine activity, and the frequency and intensity of contractions was studied in twenty-five nulliparae at term. Uterine activity was found to decrease during the first 30 minutes following epidural block. In the time interval 30 to 40 minutes after epidural block uterine activity increased again and attained the same level as during the last 10 minutes before analgesia. The frequency of uterine contractions did not decrease after the block. The lower levels of uterine contractility were due only to a lower amplitude of the contractions. The regularizing effect of epidural analgesia on incoordinate uterine action was noted. The recording of fetal heart rate in the time interval studied revealed no pathological findings. Mode of delivery, mean labour duration and Apgar scores after epidural block were comparable with earlier studies of a larger patient population. This study suggest that epidural analgesia does not induce any important changes in fetal heart rate but temporarily decreases uterine activity.
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PMID:Epidural analgesia in labour. IV. Influence on uterine activity and fetal heart rate. 97 61

Bupivacaine and etidocaine were compared in 0.375% and 0.5% solutions (without adrenaline) in a double-blind study in thoracic epidural analgesia following upper abdominal surgery. Special regard was taken to duration and adequacy of analgesia and changes in motor function. Duration of analgesia was roughly comparable for all four solutions. Bupivacaine 0.375% and etidocaine 0.5% seemed to be appropriate concentrations for adequate pain relief. Motor function, as assessed by changes in FVC, FEV1 and PEFR was not influenced to any greater extent. A progressive fall in FVC with successive injections, indicating increasing motor weakness, did not occur.
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PMID:Relief of pain following upper abdominal operations by thoracic epidural block with etidocaine. 110 16


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