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)

Changes of FHR long term variability (LTV) were studied in four groups of patients under different types of analgesia. The LTV was evaluated according to our visual criteria in each episode of more than one minute of duration on baseline fetal heart rate level between contractions. In the balanced anesthesia group incidence of the episodes with LTV decreased significantly after the administration of Diazepam and Methoxyflurane (64%-30%), further decreasing after the injection of Pethilorfan, but it increased to some degree within 20 min. before delivery. In the epidural group the change of LTV was mild, but the LTV decreased after each administration of 0.25% Bupivacaine (58%-44%-36%). It is also showed mild increase within 20 min. before delivery. Loss of variability was persistently noted until the end of labor from 20-40 min. after the administration of Diazepam and Pentazocine in the modified NLA group. The change in paracervical block group was quite different from the other groups. The incidence of episodes with LTV was increased after the injection of 1% Lidocaine Hydrochloride (35%-41%). There was no significant different of blood gas and acid-base balance among four types of analgesia.
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PMID:[FHR long term variability under various obstetrics analgesia (author's transl)]. 722 58

The present study aimed at appreciating the variations of femoral blood flow caused by epidural analgesia in women during delivery. In all cases the women lay supine, the cutaneous analgesia was below T 9. Bupivacaine at the average dose of 25 mg was used. Three preparations (bupivacaine 0.25 p. cent, bupivacaine 0.25 p. cent + adrenaline 1/200,000) were used. No significant variation in femoral blood flow was observed whether the solution injected contained adrenaline or not.
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PMID:[Variations of blood flow during epidural analgesia measured by a non-invasive method, i.e. transcutaneous pulsed ultrasonic Doppler velocimetry (author's transl)]. 730 37

The spread of lumbar epidural analgesia was studied in 48 old urological patients (56-81 years). Bupivacaine 0.5% 20 ml was injected at either 1 ml/s with a Tuohy needle with the bevel directed cephalad (Group I) or caudad (II) and at 0.22 ml/s directed cephalad (III) or caudad (IV). Immediately after injection, the patients moved from a sitting to a horizontal position and analgesia was tested every 2 min by skin pin-prick. At 10 min, there were differences in the mean caudad spread; the greatest spread in Group II was 4.5 segments and the smallest in Group III 2.4 segments, not significant (n.s.). The differences became smaller with time and the maximal spread after 30 min was similar in all groups. In six patients, who all belonged to either Group I or Group III (bevel cephalad), skin analgesia did not reach the S 5 segment. One of the Group I patients developed a transient motor paralysis of the lower extremities immediately upon injection. All patients recovered completely from the block and no toxic reactions were observed. The duration of the block and the accompanying fall of blood pressure were similar in the different groups. The mean venous blood levels of bupivacaine were highest in Group III and lowest in Group I (n.s.). The highest individual bupivacaine blood level was 1.25 micrograms/ml 30 min after injection, while generally the highest concentrations appeared at 20 min after injection. The study indicated a lack of significant difference on varying the speed of injection or turning the Tuohy needle, but it has to be emphasized that this may apply only to bupivacaine, which has distinct physicochemical properties, and also to old patients with an age-dependently modified epidural space.
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PMID:Lumbar epidural anaesthesia with bupivacaine in old patients: effect of speed and direction of injection. 732 44

We report on the analgesic efficacy of intrathecal infusions of opioids alone or in combination with bupivacaine in 16 nonmalignant pain patients with implanted pumps. Three patients had nociceptive pain, five had neuropathic pain, and 8 had mixed pain syndromes. Infusional therapy was delivered over a combined monthly total of 445 mo of therapy (mean, 27.8 mo). Dose requirements appeared to be stable with a mean dose increase of 0.26 mg/mo. Bupivacaine was added to the opioid to enhance pain control in 13 patients who received combination therapy for an average of 11.7 mo/patient. Thirteen patients (81%) reported good to excellent results with opioid alone or opioid combined with bupivacaine. The addition of bupivacaine improved analgesia in two of three patients with nociceptive pain (66.7%), compared to eight of ten patients with a pure or mixed neuropathic component to their pain (80%). We conclude that intrathecal opioids alone or in combination with bupivacaine are efficacious for the treatment of nonmalignant pain states and are relatively free of significant side effects or tolerance.
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PMID:Intrathecal infusional analgesia for nonmalignant pain: analgesic efficacy of intrathecal opioid with or without bupivacaine. 752 83

A randomized double-blind study was undertaken using 0.5 per cent bupivacaine ilioinguinal field block and oral papaveretum-aspirin tablets to assess pain relief after hernia surgery. A consecutive series of 200 men undergoing repair of a unilateral inguinal hernia underwent random allocation into one of the four groups to receive: bupivacaine and papaveretum-aspirin (group 1), bupivacaine and oral placebo (group 2), saline and papaveretum-aspirin (group 3), or saline and oral placebo (group 4). Patients were prescribed postoperative opiates to be given on demand. Pain levels and mobility were assessed at 6 and 24 h after operation. Patients in group 1 reported significantly less pain, required less additional opiates and had better mobility than those in group 4 (pain score P < 0.001 at 6 h and P = 0.002 at 24 h) and group 3 (P = 0.002 for pain and mobility scores at 6 h). Bupivacaine alone provided good immediate postoperative pain relief (P = 0.002 group 2 versus group 4 at 6 h). The combination of bupivacaine and papaveretum-aspirin provided the best results and is suitable for day-case postoperative analgesia.
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PMID:Pain relief after inguinal hernia repair: a randomized double-blind study. 866 24

We have investigated in 10 patients the effect of extradural anaesthesia on temporal summation by comparing pain thresholds to single and repeated (five impulses at 2 Hz) electrical stimuli and compared these tests with pinprick and cold stimulation. Bupivacaine 0.5% (20 ml) was injected at L2-3. After extradural anaesthesia the threshold to repeated stimuli was significantly lower than the threshold to single stimuli (P = 0.0007). Nine patients lost cold sensation and 10 patients pinprick sensation. Pain to single electrical stimulation disappeared in six patients and pain to repeated electrical stimulation in one. Pain may be evoked by temporal summation of repeated electrical stimuli even when pinprick sensation, cold sensation and pain to single electrical stimuli are inhibited. Thus temporal summation should be taken into consideration when extradural analgesia is assessed.
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PMID:Temporal summation during extradural anaesthesia. 757 94

The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1-2 patients undergoing elective laparoscopic cholecystectomy. The patients were randomly selected (20 patients in each group) to receive in double-blind fashion 100 mo of either plain 0.15% bupivacaine (150 mg.100 ml-1) or the same solution with adrenaline (1.5 micrograms ml-1), or the same volume of saline into the right subdiaphragmatic space at the end of surgery. The patients were kept in the Trendelenburg's position for 20 min after the instillation. Venous blood samples for the determination of bupivacaine plasma concentrations were drawn up to 180 min. Plasma bupivacaine concentrations peaked at 30 min (highest individual value 2.6 micrograms ml-1) after instillation. Bupivacaine concentrations were significantly lower in the bupivacaine-adrenaline group. During the follow-up no difference between the groups occurred as to the time to first demand of analgesia, severity of postoperative pain, amount of consumed analgesics during 7 days, and length of hospitalization. In all groups, 30-45% of the patients complained of right shoulder pain. After the first 24 hours, pain at rest and during moving was reported as mild and was managed with oral ketoprofen. It is concluded that postsurgical intraperitoneal instillation of 150 mg bupivacaine in 100 ml of saline had no effect on pain after laparoscopic cholecystectomy.
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PMID:Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. 779 86

Bupivacaine, being a racemic local anesthetic, exists as an equal mixture of its component enantiomers R(+)- and S(-)-bupivacaine, which behave pharmacokinetically as independent drugs after injection into the body. Intercostal neural blockade using bupivacaine was performed for postoperative analgesia in 12 patients after orthotopic liver transplantation. Arterial blood, sampled serially, was assayed by enantioselective high-performance liquid chromatography for R(+)- and S(-)-bupivacaine. The average of the simultaneous R(+):S(-) ratios of blood bupivacaine concentrations in the 12 patients was 0.74 (SD 0.11); however, the use of a population mean value or a mean value for any patient denies the time-dependence of this entity. The blood enantiomer concentration difference was reflected in the maximum measured concentrations which, after the first dose, were, respectively, 0.38 (SD 0.19) and 0.52 (SD 0.28) mg.L-1.100 mg-1 RS-bupivacaine administered (P = 0.0003). The difference in blood concentrations between the enantiomers, reflected by the R(+):S(-) ratio being less than unity, could be explained by a greater mean total body clearance and a larger apparent volume distribution of R(+)-bupivacaine. Elimination of both enantiomers was prolonged in these patients after liver transplantation compared to data from the literature, but there was no tendency for either enantiomer to accumulate selectively, even upon repeated dosing. We conclude that this demonstration of differences in pharmacokinetics (and, in laboratory studies, also in pharmacodynamics) between the bupivacaine enantiomers points to the need for future studies to recognize the enantiomeric duality of this local anesthetic.
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PMID:Bupivacaine enantiomer pharmacokinetics after intercostal neural blockade in liver transplantation patients. 781 21

Traditional methods of managing acute pain have expanded to include PCA and epidural analgesia. The lumbar plexus block can be added to these methods. It is useful for patients undergoing some knee surgeries, both preoperatively and postoperatively. The lumbar plexus innervates both motor and sensory components of much of the anterior and medial aspects of the lower extremities. Used alone or in conjunction with NSAIDs or narcotics, lumbar plexus block avoids the lethargy and altered mental status often associated with effective doses of narcotics. Bupivacaine (Marcaine) is often the anesthetic of choice. This article describes the effective block area, catheter placement, medication administration, and specific nursing care considerations. Evaluation for medication side effects and potential toxicity are included. Potential for future use is explored.
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PMID:Lumbar plexus block for the management of acute pain. 793 35

The objective of this study was to assess the effectiveness of a previously described technique of regional analgesia (continuous infusion of local anesthetic through a catheter placed at the time of amputation within the exposed sciatic or posterior tibial nerve) on relieving the postoperative pain in a heterogeneous group of patients who underwent lower extremity amputations. A second objective was to determine the effect of such treatment on the incidence and characteristics of phantom limb pain 6 months or more after surgery in the same patients. The study design was retrospective, unblinded, controlled (postoperative pain), and unblinded questionnaire and interview (phantom pain) were utilized. Subjects were inpatients at Harborview Medical Center, University of Washington, Seattle, WA. Nineteen bupivacaine-treated and 40 nonbupivacaine-treated patients who underwent lower extremity amputation subsequent to trauma, infection, long-standing injury (poor or no function), congenital deformity, or burns were evaluated in the postoperative pain management assessment. Nine treated and 12 untreated patients were interviewed in the phantom pain assessment. Bupivacaine 0.5% 2-6 ml/h was infused through a polyamide 20-gauge catheter inserted into the sciatic or posterior tibial nerve sheath under direct vision at the time of surgery. All patients, treated and control, received opioid analgesics systemically during the 72-hour period of study. The postoperative opioid analgesic requirement of treated patients was compared with that of control patients who received opioid analgesics alone. A questionnaire was administered to assess presence, severity, and character of phantom pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Continuous regional analgesia by intraneural block: effect on postoperative opioid requirements and phantom limb pain following amputation. 796 76


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