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)

It is widely accepted that the nociceptive state and opiate-induced nociception are regulated at least in part by calcium ions. Animal experiments suggest that systemically or intracerebroventricularly applied calcium antagonizes analgesic effects, whereas calcium chelating agents or calcium channel blockers enhance them. Recently, von Bormann et al. [3] reported a fentanyl-saving effect in cardiovascular patients who had received an intraoperative infusion of nimodipine; this finding was discussed as a possible synergistic analgesic interaction. Since doubts remained as to whether this interpretation was justified, the present study aimed to verify, in awake postoperative patients, whether nimodipine increased the analgesic efficacy of fentanyl. Forty ASA I-II patients (mean age 43-44 years) undergoing elective hysterectomy under standardized balanced anesthesia were investigated. In the recovery room, they were allowed to self-administer fentanyl by means of the On-Demand Analgesia Computer (ODAC). Demand dose was 34.5 micrograms, infusion rate 4 micrograms/h, lockout time 1 min, hourly maximum dose 250 micrograms. The patients were randomly and double-blindly assigned to have an additional infusion of either placebo (P) or nimodipine (N: 15 micrograms/kg/h during the first 2 h, 30 micrograms/kg/h from the 3rd to the 12th h). Fentanyl consumption, pain scores (actual and retrospective), blood pressure, heart rate, respiratory rate, and side-effects were monitored. The mean duration of patient-controlled analgesia was 16 (P) to 19 (N) h, during which time 0.64 +/- 0.46 (N) to 0.79 +/- 0.43 (P) micrograms fentanyl/kg/h was demanded. Pain relief was very satisfactory in 92.5% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The clinical significance of drug interactions between opiates and calcium antagonists. A randomized double-blind study using fentanyl and nimodipine within the framework of postoperative intravenous on-demand analgesia]. 256 86

Morphinic drugs added to epidural local anesthetic during labour enhance analgesia and obstetrical conditions. Fentanyl, 1 microgram/kg-1, is safe for the newborn. Alfentanil is of faster and shorter duration and its pharmacokinetics suggests less accumulation than fentanyl. The aim of this study is to compare Alfentanil versus Fentanyl when added to an epidural continuous bupivacaine 0.125% infusion. Two groups of parturients are constituted: group A 10 micrograms/kg alfentanil, group F 1 microgram/kg fentanyl. Pain is assessed with a 0 to 10 points scale. There are no differences between the two groups for age, weight, parity, term, initial cervical dilatation and new born weight. Analgesia begins quickly in the two groups, and is more pronounced in the group A (than in the group F (p less than 0.005). Analgesia is maintained for the whole dilatation course. Pain scores increase during expulsion but are significantly lower than the initial scores. No difference is noted as regards analgesia supplementation. Obstetrical data: labour duration, oxytocin dosage, expulsion strength, instrumental extraction rate and uterin evacuation are similar in the 2 groups. No cesarean section is observed. Neonatal status, established according to Apgar scores and then Amiel Tison neurological scales (0 to 30) respectively at 30 to 120 minutes are in the same favorable ranges: Apgar score is in all cases more than 9. The neurological score is 24 (group A) and 22.9 (group F) at 30 minutes and increases significantly at 120 minutes in the 2 groups (27 in the two groups).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Addition of a morphinomimetic to the continuous perfusion of 0.125% bupivacaine for peridural obstetrical anesthesia. A comparative study of fentanyl and alfentanyl]. 256 2

Many drugs potentiate the action of non depolarizing relaxants. These interactions are of clinical importance if such drugs are administered during the perioperative period. H2 Antagonists are increasingly often used for premedication. Cimetidine inhibits the elimination of a number of drugs used in the perioperative period. We therefore investigated whether H2 antagonists enhanced neuromuscular blockade by vecuronium, a medium short acting non depolarizing muscle relaxant. METHODS. The study was carried out in 24 female patients (ASA class I or II) scheduled for microsurgical procedures. Neuromuscular transmission was recorded electromyographically using four stimulations every 20 s to the ulnar nerve. After induction with thiopentone, anesthesia was maintained with fixed concentrations of volatile anesthetics. Fentanyl was administered for additional analgesia. Vecuronium was used as the sole muscle relaxant. Fixed repetitive doses of vecuronium (0.8-1.2 mg) were injected whenever the T1 returned to 25%. This time interval was defined as the T1-25 period. The study proper started when the T1-25 period had stabilized. After two control periods, six patients in each group received either 200 or 400 mg cimetidine or 100 mg ranitidine. The fourth group was the control group. The T1-25 periods and the maximal EMG depression were recorded automatically for at least two further periods. The first measured period was recorded as 100% and the length of each other periods was calculated as a percentage of the control period. This method enables an intraindividual comparison of the length of the T1-25 period and the maximal EMG depression before and after administration of the H2 antagonists. A two-tailed Student's t-test was used to test statistical significance, P less than 0.05 being accepted as significant. RESULTS. In the control group and in the group with 200 mg cimetidine or 100 mg ranitidine no statistical significant prolongation of the T1-25 period or of the maximal EMG depression could be observed, while after 400 mg cimetidine there was significant prolongation (mean 161 +/- 14.8%) of the T1-25 period and significantly greater EMG depression compared with the pre-cimetidine values. In the groups with 200 mg cimetidine or 100 mg ranitidine few patients showed prolongation of the T1-25 period up to 130%. DISCUSSION. Our results confirm experimental studies that have shown cimetidine to enhance aminoglycoside--relaxant interactions. Because we found an immediate response to the administration of the H2 antagonists, the interaction cannot be on the elimination side; it must be at the neuromuscular junction. Experimental investigation has shown that calcium reverses the cimetidine effects. It is therefore probable that the cimetidine--relaxant interaction occurs at the presynaptic level. Careful observation seems to be necessary if H2 antagonists, especially cimetidine, are administered intraoperatively at the same time as drugs that also enhance
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PMID:[Interactions of H2 antagonists and non-depolarizing muscle relaxants]. 256 80

Using a model of local myocardial ischaemia in the dog, the authors studied the electrostabilizing effect of a combination of the benzodiazepine midazolam (Dormicum Hoffman--La Roche) and the strong narcotic analgesic drug Fentanyl (Richter). The electrostabilizing effect was assessed using the method of ventricular fibrillation threshold (VFT) measurement. The same increase in the fibrillation threshold as that induced by the administration of midazolam or fentanyl alone was achieved by a combination of both drugs given, however, in reduced doses. The electrostabilizing effect of benzodiazepines and potent analgesics is enhanced by their simultaneous administration. At the same time, the adverse side effects observed on the administration of fentanyl alone (bradycardias, hypotension, cardiac blockade) due to the prevalence of parasympathetic drive, are reduced. Simultaneous administration of a benzodiazepine and an analgesic has become a modern technique, in anaesthesiology, so-called analgosedation. Experiments have shown the technique, in addition to the generally recognized analgesia, sedation and anxiolysis, exerts electrostabilizing effects on the myocardium damaged by ischaemia. The authors therefore recommend analgosedation in the drug treatment of acute myocardial infarction.
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PMID:The electrostabilizing effect of a combination of midazolam and fentanyl: an experimental study in the dog. 261 72

60 patients (ASA class I-II) undergoing knee arthrotomy received in a double blind fashion, a transdermal drug delivery system, containing either fentanyl (delivery rate of 75 micrograms/hour)--Fentanyl TTS--or placebo. The system remained in place for 24 hours. Even when piritramid was added as escape analgesia, all respiratory and hemodynamic parameters, as well as blood gas analysis showed no statistical significant difference between both groups (fentanyl or placebo). One patient had evidence of a beginning respiratory depression, but no specific therapy was needed. No significant side effects were seen. Concerning escape medication, a highly statistically significant difference in favour of Fentanyl TTS was found (p less than 0.001).
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PMID:Transdermal fentanyl against postoperative pain. 267 77

The reversal of the neuroleptanalgesic combination of fentanyl/fluanisone using mixed agonist/antagonist opioids has been investigated in the rabbit. All of the compounds studied (naloxone, nalbuphine, meptazinol, butorphanol, buprenorphine, pentazocine, doxapram) reversed the respiratory depression and sedation produced by fentanyl/fluanisone. Fentanyl/fluanisone produced profound analgesia for 180 min, which was rapidly and completely antagonized by naloxone. The mixed agonist/antagonist opioids produced a reduction in the degree of analgesia but, in contrast to naloxone, analgesic activity persisted from 120 min (meptazinol) to 420 min (buprenorphine). Administration of buprenorphine to rabbits anaesthetized with fentanyl/fluanisone and midazolam confirmed that the reversal of respiratory depression was accompanied by the return of arterial pH, PCO2 and PCO2 to preanaesthetic values. The use of neuroleptanalgesic anaesthetic regimens, which have been shown to provide effective surgical anaesthesia, combined with reversal using a mixed agonist/antagonist opioid to provide postoperative analgesia, appears to be a valuable refinement of current laboratory animal anaesthetic practice.
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PMID:Reversal of fentanyl/fluanisone neuroleptanalgesia in the rabbit using mixed agonist/antagonist opioids. 270 94

The effects of intrathecal midazolam and fentanyl on electrical current threshold for pain were measured using stimulating electrodes in the neck and tail of rats with chronically implanted lumbar subarachnoid catheters. This involved the measurement of the minimum current (50 Hz 2 ms pulses 0-5 mA), which made the rat squeak when applied alternately to electrodes at each skin site. The responses measured in milliamperes were expressed as a number of times control readings. Equieffective doses of both midazolam and fentanyl produced a significant increase in electrical threshold for pain in the tail (mean +/- SEM 3.14 +/- 0.51 and 2.89 +/- 0.35: P less than 0.05; Wilcoxon sum rank test) in the absence of any change in the neck (mean +/- SEM 1.28 +/- 0.13 and 0.96 +/- 0.12, NS), thus demonstrating a spinal effect. Fentanyl caused a significant simultaneous increase in tail flick latency (mean +/- SEM 67.8 +/- 20.1%, P less than 0.05), but midazolam did not (mean +/- SEM 4.22 +/- 2.76%, NS). Intraperitoneal injections of naloxone (0.25 mg/kg) blocked the response to fentanyl in both tests and did not affect the response to midazolam. Intraperitoneal flumazenil (5 mg/kg) blocked the midazolam antinociceptive effect but did not affect the response to fentanyl in either test. Tail withdrawal in response to non-noxious stimulation was preserved in all animals with spinal analgesia, indicating that myelinated afferent and efferent pathways were still functioning. Righting reflex, coordination, motor power, and alertness were also preserved in the presence of both drugs. Both drugs caused spinally mediated antinociceptive effects that were qualitatively different.
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PMID:Intrathecal midazolam and fentanyl in the rat: evidence for different spinal antinociceptive effects. 271 11

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 micrograms/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.
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PMID:Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system. 272 46

Fentanyl citrate is a synthetic narcotic 1,000 times as potent as meperidine. It produces minimal hemodynamic effects and is characterized by a rapid onset of sedation and analgesia, a relatively short duration of action (approximately 30 to 40 minutes), and rapid reversal with opiate antagonists. These properties make fentanyl an ideal drug for emergency department use. The safety of fentanyl use in an adult ED population has not previously been studied. We retrospectively reviewed the charts of 841 patients who received fentanyl at the University of Cincinnati Center for Emergency Care between January 1985 and June 1988. The study population included 497 (59%) men and 344 (41%) women, with an average age of 33 years. The average dose of fentanyl was 180 micrograms (range, 25 to 1,400 micrograms). Six patients (1%) experienced mild side effects including nausea (one), emesis (two), urticaria (one), and pruritus (two). Nine patients (1%) developed more serious complications including six cases (0.7%) of respiratory depression and three cases (0.4%) of hypotension. Two of 183 patients (1%) who received midazolam and two of nine patients (22%) who received haloperidol developed respiratory depression. Four of the six patients with respiratory depression and two of the three patients with hypotension were intoxicated. All of the complications were transient, and none resulted in hospitalization. We conclude that fentanyl is a safe drug for use in the ED. To maximize safety, we recommend careful dosing and titration, close patient monitoring, and the availability of naloxone hydrochloride and resuscitation equipment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The safety of fentanyl use in the emergency department. 238 73

Fentanyl citrate is a potent short-acting narcotic reported to cause less nausea and sedation than morphine or meperidine hydrochloride. The purpose of this prospective investigation was to determine whether a safe but adequate intrapartum dosing schedule is possible. A total of 137 women with uncomplicated term pregnancies were offered a standard intravenous dose (50 mcg or 100 mcg hourly as needed) of fentanyl citrate during active labor. Temporary analgesia and mild sedation were apparent in each case. The cumulative dose varied in accordance with maternal needs (mean, 140 +/- 42 micrograms; range, 50 mcg to 600 micrograms). Apart from a brief decrease in fetal heart rate variability that lasted 30 minutes, no worrisome pattern was apparent from exposure to fentanyl citrate. Pediatric examinations were performed without knowledge of analgesic therapy on infants exposed to fentanyl citrate and those not exposed to analgesics. No differences were found in frequencies of newborn depressed respirations, low Apgar scores, or neurologic and adaptive capabilities at two hours and 24 hours postnatally. With the use of the described dosing schedule, fentanyl citrate was helpful during labor and did not cause immediate or prolonged hazards to the mother and unborn infant.
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PMID:Fentanyl citrate analgesia during labor. 275 Aug 5


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