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

A solution of 0.75% bupivacaine (Marcaine) in 8.25% dextrose was compared with a similar solution of tetracaine (Pontocaine), the drug most used for spinal anesthesia in the USA. The study employed a randomized double-blind method and a standardized technique for spinal anesthesia in 435 patients. For perineal and lower extremity surgery, 7.5 mg of the local anesthetic was injected, and for intra-abdominal gynecologic surgery, 12 mg was administered. With the 7.5-mg dose, in only one of 121 patients was anesthesia unsatisfactory when bupivacaine was used; anesthesia was unsatisfactory in 19 of 114 patients when tetracaine was used. With the 12-mg dose, 12 patients given bupivacaine and 14 given tetracaine had unsatisfactory analgesia. With both doses, the motor blockade lasted significantly longer with tetracaine. Epinephrine added to the local anesthetic solution significantly increased the duration of action of both drugs. It also prolonged the duration of postoperative analgesia of tetracaine significantly more than the duration of bupivacaine. Bupivacaine 0.75% in 8.25% dextrose is a safe, reliable local anesthetic solution for spinal anesthesia.
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PMID:Spinal anesthesia: bupivacaine compared with tetracaine. 719 47

The influence of the addition of epinephrine to epidural morphine on postoperative analgesia were investigated in 60 ASA physical status I or II patients aged average 45 yr. The treatments were given following lower extremity operation under epidural anesthesia with 2% Xylocaine solution in 20 mL. The subjects were randomly divided into 2 groups. Group A (n = 30) received 2 mg epidural morphine in 10 mL normal saline without epinephrine. Group B (n = 30) received 2 mg epidural morphine in 10 mL normal saline with epinephrine 0.1 mg (1:100,000, 10 micrograms/mL). Patients were assessed for quality and duration of postoperative analgesia, as well as the incidence and severity of side effects after epidural morphine administration. The addition of epinephrine to epidural morphine had significantly increased the quality and duration of analgesia. The side effects of pruritus, nausea, vomiting, and urinary retention were more intense after epinephrine-morphine administration. However, respiratory depression was not observed in both groups.
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PMID:Influence of epinephrine as an adjuvant to epidural morphine for postoperative analgesia. 830 50

56 males and 14 females undergoing various lower abdominal and lower limb surgery were given Spinal Anaesthesia using 2% Plain Xylocaine. The different volumes used were 3.0ml, 3.5ml and 4.0ml. The levels of analgesia achieved were adequate for the surgery. There was no significant difference between the 3 volumes in the mean levels of analgesia obtained and the mean duration of sensory and motor blockade. This study has confirmed the usefulness of 2% Plain Xylocaine in Spinal Anaesthesia.
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PMID:2% plain xylocaine for subarachnoid or spinal anaesthesia. 851 81

Two forms of 0.5% bupivacaine hydrochloride, Anecaine (Pliva) (n = 15) and Marcaine (Astra) (n = 15) were used for epidural anesthesia. The clinical picture of conduction block induced by the two local anesthetics varied. It manifested by a shorter latent period of analgesia development at the level of catheter and the drug infusion (LII) and relatively delayed development of analgesia in peripheral zones for Anecaine in comparison with marcaine. The authors conclude that solutions of local anesthetics containing the same active agent in the same concentrations under different commercial names manufactured by different companies may be characterized by different clinical picture of conduction blockade.
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PMID:[A clinical trial of the use of 2 forms of bupivacaine hydrochloride (Anecaine and Marcaine) for epidural anesthesia]. 1056 Jan 58

Since the introduction of cocaine local analgesia in 1886, and the subsequent development of procaine (1904) and other closely related ester-type compounds, dentistry has prided itself on being as close to 'painless' as possible. In the late 1940s the newest group of the local anesthetic compounds, the amides, was introduced. The initial amide local analgesic, lignocaine (Xylocaine), revolutionised pain control in dentistry worldwide. In succeeding years other amide-type local anesthetics, mepivacaine, prilocaine, bupivacaine and etidocaine, were introduced. They gave the dental practitioner a local anesthetic armamentarium which provided pulpal analgesia for periods of from 20 minutes (mepivacaine) to as long as three hours (bupivacaine and etidocaine with adrenaline). In addition these popular drugs proved to be more rapid-acting than the older ester-type drug and, at least from the perspective of allergenicity, more safe. In 1976, in Germany, the newest amide local analgesic, carticaine HCl was introduced into dentistry. Articaine (the generic name was changed) possesses properties similar to lignocaine but has additional properties which made the drug quite attractive to the general dental practitioner. In 1986 articaine was introduced in North America (Canada) where it has become the most used local anesthetic, supplanting lignocaine. Articaine has been approved for use in the United Kingdom. In this introductory discussion we review the development of articaine and discuss its place in the dental local analgesic armamentarium.
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PMID:[New anesthetics]. 1103 79

Pain is the most undesirable and threatening experience for surgical patients. This study aims to determine the efficacy of pre-incisional analgesic bupivacaine infiltration (preemptive analgesia) on postoperative pain relief after appendectomy. A prospective randomized double-blinded study was conducted on 123 patients aged 13-45 years with a preoperative and-postoperative diagnosis of acute appendicitis admitted to Siriraj Hospital, Bangkok, from January to May 2002. They were randomly set into two groups: the control (61 patients) and the preemptive (62 patients). In the preemptive group, bupivacaine (Marcaine) was infiltrated into the skin and subcutaneous tissue along the proposed wound line before gridiron incision, and also into the muscle layer after incision. The control group received no injection. Routine appendectomy was done. Pain score was assessed by the patients in the first 48 hr while they were lying supine and as they moved to a sitting position at 24 and 48 hr after operation. Morphine injection was given on patients' request with pain score = 5 every 4 hr in the first 48 hr or until analgesic paracetamol could be taken orally. The pain score during the first 6, 12, 24, and 48 hr, including the score while sitting up, were all significantly lower ( p < 0.001) in the preemptive group. So were the total number of morphine injections and the amount of morphine used postoperatively. The pain reduction could be due to interruption of inflammatory or pain mediator cascades that normally occur during an operation. This study showed that pre-incisional bupivacaine infiltration is an effective and simple method of reducing postoperative pain for patients undergoing appendectomy.
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PMID:Efficacy of pre-incisional bupivacaine infiltration on postoperative pain relief after appendectomy: prospective double-blind randomized trial. 1595 51

The infusion pain pump has been a valuable addition to postoperative pain management in plastic and reconstructive surgery. Concerns have been raised regarding the potential ischemic or infectious complications of placing a catheter beneath the operative site for infusion of local anesthesia (+/- epinephrine). The purpose of this review is to document our experience with this form of postoperative pain control in plastic surgical procedures. Thirty-six consecutive transverse rectus abdominis muscle (TRAM) flap breast reconstruction patients were reviewed and included in the series (16 left, 10 right, and 10 bilateral). The average age was 52 years, and 4 patients had a simultaneous symmetry procedure. The cohort was divided into those with a postoperative pain pump versus those without a pain pump. Data points queried included type, route, and amount of narcotic administered per day in the postoperative period, as well as complications. All patients received patient-controlled analgesia (PCA) (morphine, n = 34; meperidine (Demerol, Sanofi-Synthelabo), n = 1; hydromorphone hydrochloride (Dilaudid, Abbott Pharmaceutical) n = 1). The pain pump was used in 16 patients (bupivacaine (Marcaine, AstraZeneca, n = 16). It was typically infused starting postoperatively at a rate of 4 mL/d and discontinued on postoperative day 2. Supplemental intravenous narcotics were required in 12% (n = 2/16) of patients with a pain pump versus 35% (n = 7/20) in those patients without a pain pump. There were no significant differences in the average number of days the PCA was used (1.8 days with a pain pump versus 2.2 without), and patients with the pain pump started postoperative medications slightly earlier (1.8 versus 2.0 days). PCA requirements were significantly lower in those patients with the pain pump. The average days to discharge for patients with a pain pump were 3.4 compared with 4.7 days in those patients without the pain pump. There were no differences in donor-site or breast complications. The postoperative pain pump has been useful in reducing the intravenous narcotic requirements and length of stay in patients following TRAM flap breast reconstruction. There were no flap, donor-site, or implant complications related to the presence of the catheter. Cost-effectiveness and patient satisfaction data would be interesting.
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PMID:Use of the infusion pain pump following transverse rectus abdominis muscle flap breast reconstruction. 1583 7

Background. We investigated the efficacy of intra - articular bupivacaine with morphine administration after knee joint arthroscopy.<br /> Material and methods. The present study compared intra- arthicular bupivacaine with intra-arthricular morphine for postoperative analgesia in 56 patients (21 women, 35 men) (age 20-70, mean 39.8) undergoing knee joint arthroscopy.<br /> Intraoperatively, the patients received anaesthesia spinaly (0.5 % Marcaine spinal ASTRA) and immediately following surgery received 10 ml intra-arthricular injection consisting either of 0.5 % bupivacaine (group I), 5 mg morphine + 0.9 % saline (group II).Postoperative analgesia was supporeted by intravenous doses of proefferalgan.<br /> In all patients the visual analogue pain score (VAS), PaO2, systolic blood preassure (SABP), diastolic blood preassure (DABP), heart rate (HR), respiratory rate (f), supplemented analgesia and possible side effects were monitored postoperatively.<br /> Results. Intra-arthricular administration of each solution was well toleratede and non side effects were noted.<br /> There was non significant difference among the two groups in monitored parameters. The mean time of postoperative analgesia was 185,7 +/- 25.3 min for bupivacaine group and 390.3 +/- 35,4 min for morphine group.<br /> Total amount proefferalgan supplamentation was the highest in group I.<br /> Conclusions. Postoperative intra- arthricular injections of bupivacaine and morphine for patients undergoing knee joint arthroscopy can provide a safe and effective analgesia and therefore shound be recommended and widely implamented into the clinical use as a standard procedure.
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PMID:Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy. 1803 69

Breast reconstruction with submuscular tissue implants is associated with substantial postoperative pain. High pain scores despite large doses of opioids were described in earlier studies, which indicated that opioids alone or together with paracetamol are insufficient. In the present placebo-controlled study we aimed to evaluate the analgesic efficacy of local anaesthesia as a supplement. Forty-three women who had previously been operated on for breast cancer and were listed for unilateral secondary breast reconstruction were assigned at random to one of two groups. The patients received 2.5 mg/ml levobupivacaine (Chirocaine) 15 ml or placebo in a double-blind manner through an indwelling catheter in the operation site every three hours for 45 hours. All patients were given oral paracetamol 1 g x 4 orally and morphine intravenously as patient-controlled analgesia. A visual analogue scale (VAS) was used to assess the intensity of the postoperative pain. Amount of morphine used was recorded. The women in the levobupivacaine group (n=21) reported significantly less pain at rest during the first 15 hours postoperatively (p<0.05). During mobilisation the intensity of pain was lower for the first six hours (p=0.01) and for the interval 18-24 hours (p=0.045) in the same group. Total mean (SD) consumption of opioids in the levobupivacaine and placebo groups was 24.6 mg (22.88) and 33.8 mg (30.82), respectively (p=0.28). After reconstruction, levobupivacaine injected locally every third hour as a supplement to paracetamol orally and morphine given by PCA resulted in improved pain relief at rest and during mobilisation. Morphine consumption was reduced, but this was not significant (p=0.28).
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PMID:Placebo-controlled trial of local anaesthesia for treatment of pain after breast reconstruction. 1999 49

Levobupivacaine (Chirocaine) is a long-acting amide local anaesthetic that is effective when administered as an epidural, spinal, peripheral nerve or ocular block, or by topical application or local infiltration. In comparative trials, its clinical effects were not generally significantly different from those of bupivacaine or ropivacaine, although there was some variability in efficacy findings in different clinical populations. Levobupivacaine was generally well tolerated. Levobupivacaine provides effective anaesthesia and analgesia for a wide range of clinical populations and is a useful alternative to bupivacaine.
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PMID:Levobupivacaine: a review of its use in regional anaesthesia and pain management. 2039 58


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