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)

Behavioural studies suggested that cerebral angiotensin II (AII) plays an important role in the development of tolerance to electroacupuncture (EA) analgesia. Observations made in this study revealed an increase in AII immunoreactivity (AII-ir) in both CSF and brain as well as an increase in the cerebral content of AI-ir in rats rendered tolerant to EA. The extracts of brain from rats receiving EA for 1h and 3h were subjected to gel filtration and the elution profile was compared with that of normal brain extract. There was a marked right shift of the AII peak from the large molecule precursor to the small molecule AII-ir. The latter peak showed the same retention time in HPLC system as that of AII. The results suggest that the acceleration of the synthesis and release of AII during a long-term EA stimulation might constitute one of the mechanisms for EA tolerance.
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PMID:Accelerated synthesis and release of angiotensin II in the rat brain during electroacupuncture tolerance. 220 46

The effect of spinal anesthesia with barbotage versus without barbotage on the spread of analgesia was investigated. For comparison, hyper- and isobaric bupivacaine 0.5% with adrenaline 1:200,000 was used. MATERIAL AND METHODS. Barbotage was accomplished as follows: after lumbar puncture 0.5 ml CSF was aspirated into the local anesthetic solution, followed by reinjection of 1.0 ml of the solution. This process was repeated six times. Sixty patients who were scheduled for urological or lower limb surgery under spinal anesthesia were selected for this study. Patients were each arbitrarily assigned to one of four groups (isobaric and hyperbaric, without and with barbotage). RESULTS. There was no statistically significant difference in the maximum level of sensory analgesia. The mean maximum level of sensory analgesia reached T9 (group 1), T8 (group 2), T9 (group 3) and T8 (group 4). Time to highest dermatome was significantly shorter with barbotage (groups 1-4: 19.0 min, 13.0 min, 18.7 min, 12.3 min). Times for regression of analgesia to T12 (mean maximum duration) were 142 (+/- 54.9) min, 164 (+/- 29.7) min, 130 (+/- 40.4) min and 144 (+/- 36.2) min (groups 1-4). Motor block grade 3 (Bromage) was achieved in significantly shorter times with barbotage than without. The shortest onset time was recorded with isobaric bupivacaine. The onset time of a complete motor block was 12.5 (+/- 5.5) min in group 1, 6.1 (+/- 2.9) min in group 2, 15.8 (+/- 4.7) min in group 3, and 11.7 (+/- 5.1) min in group 4. CONCLUSIONS. The results showed no significant differences between the maximum segmental sensory levels or duration of anesthesia observed with isobaric and with hyperbaric bupivacaine (with and without barbotage). Sufficient analgesia was obtained with barbotage and without barbotage. Uncontrolled cephalad spread of spinal anesthesia was not observed. Barbotage has the advantage of shortening time for spread to highest dermatome and the time to onset of complete motor block.
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PMID:[The effect of barbotage on the sensory spread in spinal anesthesia using isobaric and hyperbaric 0.5% bupivacaine]. 223 14

This study was performed to determine whether the addition of norepinephrine to local anaesthetics prolongs epidural analgesia in man. In addition, cerebrospinal fluid norepinephrine (NE) concentrations were measured. In the first part of the study, epidural catheters were inserted in 14 patients before herniotomy. Mepivacaine, 1.5 per cent (0.35 ml.kg-1), was administered and norepinephrine (5 micrograms.ml-1) was added in seven patients. The duration of anaesthesia was prolonged from 54 +/- 11 min to 83 +/- 12 min (P less than 0.05) and CSF NE concentrations increased from 68 +/- 12 pg.ml-1 to 336 +/- 85 pg.ml-1 in the NE group (P less than 0.01). In the second part, eight patients with herpetic neuralgia received epidural analgesia at the fourth to eighth thoracic interspace, using bupivacaine 0.25 per cent, with and without NE. The CSF NE concentrations in this group were greater than in the surgical patients before operation and increased from 254 +/- 58 to 406 +/- 58 pg.ml-1 30 min after administration of bupivacaine with NE. The duration of pain relief was prolonged with NE. These results suggest that adding NE to local anaesthetics prolongs epidural analgesia. Moreover, NE concentrations in surgical patients increased to levels similar to those found in patients suffering from herpetic analgesia. This suggests that the increase of CSF NE in chronic pain states has an antinociceptive effect.
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PMID:Cerebrospinal norepinephrine concentrations and the duration of epidural analgesia. 225 89

Headache after unintentional dural puncture with 17- or 18-gauge needles represents a significant source of anesthetic-induced maternal morbidity. We performed this study to determine whether inserting a catheter into the subarachnoid space after dural puncture can significantly alter the incidence of headache. Thirty-five women, requesting labor analgesia, suffered a dural puncture during attempts to identify the epidural space using an 18-gauge Hustead needle (bevel oriented parallel to the longitudinal axis of the back). Subsequently, the anesthesiologist inserted a 20-gauge polyamide catheter into the CSF and provided continuous spinal anesthesia throughout labor and delivery. A second group of 21 women suffered dural puncture with the same epidural technique but without subarachnoid catheter insertion. These women subsequently received lumbar epidural anesthesia. After delivery, we visited all women daily until discharge and questioned them about the presence and severity of headache. Neither the incidence of headache nor the need for therapeutic blood patch differed significantly between the two groups of women. No other anesthetic related complications ensued. Continuous spinal anesthesia after unintentional dural puncture does not decrease the incidence of headache in parturients.
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PMID:Continuous spinal anesthesia after unintentional dural puncture in parturients. 229 83

Epidural narcotics has been shown to produce profound and long-lasting analgesia. It has been suggested that lipid-soluble narcotics such as fentanyl, because of their short transit time in the CSF, are less likely to be associated with delayed respiratory depression and side effects. We tried to combine low concentrations of fentanyl with bupivacaine to minimize side effects and to see if synergistic effect existed. Forty ASA physical status I or II patients who present for cholecystectomy were included in the trial. Before surgery a thoracic epidural catheter was inserted and pain control began when patients became fully awake and complained of pain in the recovery room after surgery. Patients were randomized in a double-blind fashion to one of four groups. Patients in group I were given epidural infusions of fentanyl 0.001%; patients in group 2 received fentanyl 0.001% mixed with bupivacaine 0.1%; patients in group 3 received fentanyl 0.0005%; patients in group 4 received fentanyl 0.0005% mixed with bupivacaine 0.1%. A continuous epidural infusion of these drugs began at a rate of 10 mL/h after a 5-mL bolus of the solution. Pain relief was assessed with visual analogue pain scale. Respiratory rates, vital signs, and mental status were assessed hourly. Except the group 3, the degree of analgesia achieved was similarly satisfactory in all other groups. There was no respiratory depression developed in either group. Motor block was minimal or absent in all groups. The incidence of nausea and pruritus was significant less in group 3 and group 4. In conclusion, the continuous infusion of dilute bupivacaine with fentanyl provides synergistic analgesia with minimal side effects.
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PMID:Comparison of continuous epidural infusion of fentanyl and fentanyl-bupivacaine for post cholecystectomy pain control. 235 68

The analgesic efficacy and CSF pharmacokinetics of intrathecal morphine sulphate and morphine-6-glucuronide (M6G) were compared in a single-blind crossover study. Lumbar intrathecal catheters were sited in three patients with chronic cancer pain, and morphine sulphate 500 micrograms or M6G 500 micrograms given via the catheter on separate days. CSF was sampled for 24 h following drug administration and analysed for morphine and M6G by high pressure liquid chromatography. The mean (SD) requirement for patient controlled analgesia with pethidine was 393.3 (227.4) mg/24 h during the morphine limb of the trial and 226.7 (113.6) mg/24 h during the M6G limb. M6G was not detected in CSF following administration of morphine. Fitting of CSF concentrations to triexponential curves revealed mean (SD) alpha, beta and gamma half-lives of 13.2 (7.4), 54.9 (31.5) and 222.5 (100) min for morphine and 11.2 (2.4), 67.3 (49.9) and 619.3 (629.7) min for M6G.
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PMID:Analgesic efficacy and CSF pharmacokinetics of intrathecal morphine-6-glucuronide: comparison with morphine. 181 36

The effect of two repeated oral doses of 100 mg tofisopam 15 mg midazolam and placebo on the concentrations of monoamine metabolites (MHPG, 5-HIAA, HVA) in lumbar CSF were studied in general surgical patients operated on under spinal analgesia (n = 12 in each group). Midazolam, but not tofisopam, improved the quality of sleep the night before surgery. Both active agents reduced preoperative anxiety of the patients, but tofisopam was without subjective sedative action. In the placebo group, in contrast to the active drug groups, there was a slight positive correlation between the MHPG concentration and degree of anxiety before surgery. The only significant difference in the monoamine metabolites in lumbar CSF was found in the concentrations of HVA between tofisopam and placebo treated patients. The lower HVA concentrations suggest that the curious 3,4-benzodiazepine derivative, tofisopam, modifies central dopaminergic activity.
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PMID:Tofisopam and midazolam: differences in clinical effects and in changes of CSF monoamine metabolites. 241 31

Thirty six comparable patients, ASA 2, without cardiac disease, underwent aortic disobliteration, 19 under epidural 100 micrograms/kg morphine (EM) and 17 under epidural 2 micrograms/kg sufentanil (ES), combined with general anesthesia. To compare the hemodynamics, measurements were taken pre-operatively, after induction of general anesthesia, during aortic dissection, aortic cross-clamping and 3-5 minutes after the first revascularisation. Plasma and CSF drug levels were measured at intervals in 6 patients in the EM end 5 patients in the ES group. Both drugs provided satisfactory analgesia which persisted for 10.4 hours in the EM and 6.3 hours in the ES group. The fall in systemic pressure and left ventricular work in both groups after induction of general anesthesia suggests that EM and ES must be used with caution in patients with hypovolemic or cardiovascular disease. There was a significant difference in SVR between the two groups during the aortic dissection, due to a rise in SBP in the ES group and a tendency for SVR to fall in the EM group. However significant differences in left ventricular work did not occur. Notable was the absence of significant changes in filling pressure, CI and left ventricular function during aortic cross-clamping. After revascularization a significant decrease in systolic blood pressure occurred in association with an increase in heart rate in the EM group. The influence of the plasma and CSF concentrations of morphine and sufentanil on the hemodynamic changes during surgery were evaluated.
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PMID:A study of epidural morphine and sufentanil anesthesia for abdominal aortic surgery. 252 49

This study was undertaken to examine the thermal pain thresholds over a wide area of the lower body surface following the intrathecal administration of capsaicin in rats. Thermal nociceptive thresholds measured under light halothane anesthesia were determined as skin twitch or escape response latencies to the heat stimulation (52.0 degrees C) by a thermal probe. Capsaicin (50 micrograms in 10 microliters) was injected through a chronically implanted catheter whose tip was near the lumbar enlargement of the spinal cord. The hot-plate test (52.0 degrees C) was also performed in all rats tested. Increase in thermal pain thresholds were consistently observed in the low back and abdominal region, while the hind paws did not always respond with prolonged skin twitch or escape latencies. Intensities of thermal analgesia at the sole of hind paws measured by hot-plate test correlated well with those by thermal probe test. In conclusion, intrathecal capsaicin definitely produced thermal analgesia, but its intensity was considerably variable in the hind paws. These results are in keeping with our previous finding that there was much variability in the effect of capsaicin assessed by the hot-plate test, indicating a possibility that capsaicin does not spread uniformly in the CSF because of its water insolubility or difficulty in penetrating to the large nerve roots innervating the hind paws.
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PMID:[Thermal analgesia following intrathecal capsaicin administration in rats--detailed measurements of thermal analgesia over the lower body by a thermal probe]. 258 99

Forty-three ASA physical status I-II adult patients, receiving spinal anesthesia for lower abdominal or lower limb surgery, were allocated randomly to two groups. Group 1 patients (n = 21) were given heavy bupivacaine 12 mg and group 2 patients (n = 22) were given tetracaine 12 mg in 2.5 mL of 10% dextrose. Spinal anesthesia was performed in the lateral decubitus position the at L 3-4 interspace with a 25-G spinal needle. Radial artery blood samples were collected before and after spinal anesthesia fpr pH measurement using a NOVA Biomedical machine; CSF samples were collected before and after injection of local anesthetic, and local anesthetic was also collected at the same time, for pH measurement using a Radio pH meter. The time from injection to maximal cephalad spread of analgesia and level of spinal analgesia were measured by the pin-prick method. The result was regarded as a failure if pain sensation still existed at the level of the operation site after spinal anesthesia. There were 1 failure case in the bupivacaine group and 2 failures in tetracaine group. The pH of CSF and local anesthetic in these failures were compared with those in effective cases, and the results showed that there was no significant relationship between the pH value of CSF and the local anesthetic drug.
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PMID:Effects of pH of cerebrospinal fluid and local anesthetic on the success rate of spinal anesthesia. 263 18


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