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)

A double blind controlled prospective trial investigated the analgesic effect of topical Bupivacaine in 15 adult patients undergoing bilateral tonsillectomy. Each patient had one tonsillar fossa exposed to Bupivacaine 0.5 per cent solution and the other to normal saline. When visited four to six hours post-operatively, 12 out of 15 patients (80 per cent) stated that the Bupivacaine exposed side to be more uncomfortable than the saline exposed side. On the first post-operative morning 9 out of 15 patients (60 per cent) confirmed the same. The remaining patients were unable to detect a significant difference and no patient found the Bupivacaine side to be more comfortable. These results suggest that topical Bupivacaine 0.5 per cent solution has no place in providing post-operative analgesia in adult tonsillectomy.
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PMID:Can post-tonsillectomy pain be reduced by topical bupivacaine? Double blind controlled trial. 267 Dec 18

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

Morphine and bupivacaine have been administered caudal via to 28 children between 2 and 12 years old for the postoperative pain treatment. All of them were submitted to general anesthesia and randomly divided into 3 groups depending on the drug administered caudal via. a) Morphine group (n = 10): morphine chlorhydrate 50 micrograms/kg (0.5 ml/kg of morphine solution 100 micrograms/ml). b) Bupivacaine group (n = 10): bupivacaine 0.5%, 2.5 mg/kg. c) Control group (n = 8): no drug administered. Pain evaluation was made on the basis of physiological and clinical data. In the morphine group, the postoperative time until analgesia was required 20 +/- 5 hours and analgesia has been significantly better (p less than 0.001) than bupivacaine and control group. The number of analgesic drug needed during the postoperative 24 first hours was also less in morphine group. No differences on postoperative complications were seen among the 3 groups and no case of respiratory depression was observed. It is concluded that epiduro-caudal morphine provides effective and prolonged analgesia and can be safely used for postoperative pain treatment in pediatric urologic surgery. However, we believe, that larger series of patients will provide better information of its efficacy and other side effects.
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PMID:[Postoperative analgesia using caudal morphine in pediatric surgery: randomized double-blind study compared with bupivacaine]. 267 19

An epidural type catheter was placed in the pleural space under direct vision before the closure of the chest in 24 patients who underwent thoracotomy for various types of lung or aortic surgery. All patients received intrapleural injections of 20 ml of 0.5 per cent bupivacaine with or without epinephrine as initial pain therapy. Patients also received subsequent doses of a similar volume of 0.375 per cent bupivacaine with epinephrine 1:200,000 up to four times a day for a maximum duration of seven days. Good pain relief was achieved in patients who underwent lateral and posterior thoracotomies. No pain relief was achieved in patients who underwent anterior thoracotomy or in patients in whom there was excessive bleeding in the pleural space. Bupivacaine blood concentrations were measured in 11 patients following the initial dose of 20 ml of 0.5 per cent bupivacaine (with epinephrine 1:200,000 in five of the 11 patients). The mean peak plasma concentration of bupivacaine when used with epinephrine was 0.32 +/- 0.02 microgram.ml-1. The mean peak plasma concentrations of bupivacaine when used without epinephrine was 1.28 +/- 0.48 microgram.ml-1. Our present data show that intrapleural analgesia is useful in the management of postoperative pain in patients who undergo thoracotomy. Our data also show that there is a significant decrease in peak plasma concentrations of bupivacaine when epinephrine is added to the solution (P less than 0.05).
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PMID:Intrapleural analgesia for post-thoracotomy pain and blood levels of bupivacaine following intrapleural injection. 270 7

Following lumbar extradural analgesia with 0.5% bupivacaine, the placental transfer of bupivacaine was examined in 40 women undergoing elective and 40 women undergoing emergency Caesarean section. Within each group, the patients received randomly either plain bupivacaine or bupivacaine with adrenaline 1 in 200,000. Plasma bupivacaine concentrations were measured in blood samples taken simultaneously at delivery from the umbilical vein (UV), umbilical artery (UA) and maternal vein (MV). Bupivacaine concentrations in MV, UV and UA were not significantly affected by the presence of adrenaline, but were positively correlated with first dose to delivery interval (FDD) while MV and UV were inversely correlated with last dose to delivery interval (LDD). Mean ratio of UV:MV concentrations of bupivacaine was 0.346 and for UA:MV it was 0.305. There was no significant correlation between any fetal:maternal ratio and FDD or LDD. UA:UV ratio appeared to increase towards unity 30-40 min after the last dose. The presence of adrenaline was associated with an increase in UA:UV in the elective group (P less than 0.01). In eight patients who received adrenaline there was reverse placental transfer (UA:UV greater than 1). There was no evidence of progressive fetal accumulation of bupivacaine beyond 30-40 min.
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PMID:Effect of time and adrenaline on the feto-maternal distribution of bupivacaine. 273 Aug 22

The investigation was carried out in 80 patients scheduled for transurethral resection of prostate (TUR-P). All patients were ASA I or II, and received no premedication. Before anesthesia, elastic bandages were applied to both lower extremities and 6 mL/kg of G/S (5% Glucose in 0.9% saline solution) was administered by intravenous infusion. The patient was placed in the lateral position and dural puncture was performed at the L3-4 interspace using a standard midline approach with a 23 gauge spinal needle. The patients were allocated randomly to four groups, each group consisting of 20 patients. Three mL of 0.5% Bupivacaine was administered in group A; 3 mL of 0.5% Bupivacaine with 1 mL 10% G/W (Glucose water) in group B; 2 mL of 0.5% Bupivacaine with 1 mL 10% G/W in group C and 3 mL of 0.5% Bupivacaine in 8% glucose in group D. Assessment of the sensory and motor blockade and measurement of arterial pressure and heart rate were performed after injection. All data were analyzed by ANOVA. A p value of less than 0.05 was considered statistically significant. The results showed that the duration of analgesia with plain Bupivacaine was shorter than with hyperbaric Bupivacaine (2.59 +/- 0.81 h vs 3.12 +/- 0.72 h, P less than 0.05). The maximum cephalad spread of analgesia was lower with plain Bupivacaine (T 9 +/- 2 vs T 7 +/- 2, P less than 0.05). Patients receiving either 3 mL or 4 mL of hyperbaric bupivacaine were similar in regard to duration and maximum cephalad spread of analgesia, but the effect on the cardiovascular system was more severe in the group receiving 4 mL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spinal anesthesia with bupivacaine for transurethral resection of prostate: effects of specific gravity, volume and dose]. 279 18

Bupivacaine wound infiltration together with efficient esophagogastric decompression and immediate elemental feeding in 43 consecutive, well-instructed patients who had undergone cholecystectomy reduced their postoperative analgesia requirements to an average of 17 (+/- 46, SD) mg of meperidine during the initial 24 hours. No analgesics were requested by 35/43 patients (81%) and 40/43 were discharged within 24 hours of surgery. All 86 conventionally treated control patients required narcotics, averaging 4.4 (+/- 0.3, SD) doses and amounting to 290 (+/- 25, SD) mg of meperidine or its equivalent during their first postoperative day and were discharged in 6.5 (+/- 0.7, SD) days. None were discharged in less than 3 days. Home interview by a visiting nurse was carried out for a block of 19 treated patients and their families. Six patients were interviewed prospectively within 33 to 64 hours of surgery, with a repeat visit 1 to 2 months later. Retrospectively studied patients were only seen 1 to 4 months after surgery. These interviews confirmed the patients' and their families' satisfaction with their bodily functions, their limited discomfort, and their independence from the hospital. Wound infiltration with a long-acting local anesthetic, efficient removal of swallowed air, and immediate, full enteral nutrition contribute to reduced postoperative pain and narcotic use in well-instructed patients, thus leading to safe and satisfactory early discharge.
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PMID:Reducing postoperative pain, narcotics, and length of hospitalization. 286 30

Bupivacaine was utilized for postoperative analgesia in patients undergoing orchiopexy and hernia repair. In a study of 75 pediatric patients, ranging in ages from twelve months to twelve years, who had undergone orchiopexy and hernia repair during a three-year period, 42 received bupivacaine hydrochloride as a local infiltration block anesthesia to relieve postoperative pain; 33 patients did not receive bupivacaine. Patients receiving bupivacaine had less postoperative pain and were more comfortable when leaving the hospital within a few hours after surgery.
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PMID:Use of bupivacaine as block to relieve postoperative pain in pediatric orchiopexy and hernia repair. 287 45

Bupivacaine and chloroprocaine have proven to be valuable local anesthetics for a variety of surgical and obstetrical situations. Bupivacaine is particularly useful as a long acting agent which provides excellent sensory analgesia particularly during labor with minimal blockade of motor fibers. The 0.75% solution is useful for epidural surgical anesthesia since it does result in a decrease in onset time and a more marked motor blockade. In recent years, this agent has been reported to cause rapid cardiovascular collapse in some patients. Cardiotoxicity associated with bupivacaine is related not to the concentration employed but to the total dosage administered as a rapid intravenous injection. The careful administration of this agents to avoid an accidental intravenous injection should not preclude the use of 0.75% bupivacaine for epidural anesthesia in surgical patients. This concentration is not recommended in obstetrical cases. Chloroprocaine is valuable as a rapid onset, short duration local anesthetic with a low potential for systemic toxicity. The 3% solution is particularly useful for providing a rapid onset of action. In recent years, localized neural irritation has occurred in some patients in whom large amounts of this agent were administered epidurally or intrathecally. The local neural toxicity of chloroprocaine solutions is referably to the low pH and the inclusion of sodium bisulfite in these particular solutions. The toxicity of chloroprocaine solutions is related to total dosage rather than the concentration of solution employed. Careful administration of chloroprocaine epidurally in order to avoid accidental subarachnoid injection should preclude the possibility of local neural toxicity.
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PMID:Is there a need for chloroprocaine 3% and bupivacaine 0.75%? 305 87

We describe a method, which is both specific and rapid, for the measurement of bupivacaine concentrations in plasma using high-performance liquid chromatography. Bupivacaine plasma concentrations, pharmacokinetics and protein binding in the postoperative period were investigated in seven patients (58-77 years old) following hip surgery. Postoperative analgesia was achieved by epidural bolus injections of 25 mg bupivacaine 0.25% every 6 h. Sufficient pain relief without side-effects was obtained. Total (maximum 1.13 micrograms/ml) as well as free (maximum 0.1 microgram/ml) bupivacaine plasma concentrations remained below toxic threshold levels and no cumulation occurred. Increased protein binding in the postoperative period is reported, emphasizing the importance of measuring the free fraction in addition to the total plasma concentration. The free fraction decreased from 5.4% preoperatively to 2.7% in the postoperative period (P less than 0.05). Changes in plasma protein binding of bupivacaine and changes in plasma levels of the acute phase reactant alpha-1-acid glycoprotein were correlated (r = 0.8, P less than 0.05). Difficulties in interpreting the elimination parameters following epidural administration are discussed, leading to the conclusion that the derivation of dosage regimens from kinetic parameters following epidural administration is not warranted.
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PMID:Pharmacokinetics and protein binding of bupivacaine in postoperative epidural analgesia. 318 23


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