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)

Some characteristics of the effects of brief and prolonged stress on tail-flick latency are described. The pharmacological profiles of the latency responses to 30 sec and 30 min footshock are strikingly different. Thus, the increase of tail-flick latency after 30 sec shock is unaffected by naloxone and enhanced by drugs which decrease 5HT or DA-dependent transmission, while the increase after 30 min shock is blocked by naloxone and also by the above drugs. The increased tail-flick latency after 30 sec shock only occurs if tail-flick latency is also determined before shock. This finding, together with the attenuation or enhancement of the post-shock response by drugs that similarly affect conditioned avoidance behavior, suggests that the increased latency after brief shock occurs through a mechanism that is related to passive avoidance learning. Finally, a new approach to the investigation of stress-induced analgesia is described in which neurochemical changes during prolonged immobilization stress are repeatedly monitored using cisternal CSF samples taken in parallel with tail-flick latency measurements.
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PMID:Characteristics of analgesias induced by brief or prolonged stress. 352 90

Both placental and blood-CSF transfer of atropine (0.01 mg/kg intramuscularly) was measured (by RIA) in 11 parturients undergoing Caesarean section under spinal analgesia. In the foeto-placental unit a significant penetration into amniotic fluid was found, whereas in CSF there was a measurable level of the drug (greater than 1.5 ng/ml) in only one mother. Our results show that there is a fundamental difference in the penetrability of tertiary ammonium alkaloids like atropine through these two biological membranes. However, our results concern penetration into human lumbar CSF and do not necessarily reflect potential penetration into the ventricular CSF, choroid plexus or brain ventricular ependyma.
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PMID:Placental and blood-CSF transfer of intramuscularly administered atropine in the same person. 357 43

To determine whether there is a relation between patient age and the effective dose of epidural morphine for relief of incisional pain after abdominal hysterectomy, experience treating 66 patients between the ages of 22 and 84 years was retrospectively examined. Linear regressions were plotted for age vs effective 24-hr morphine dose, age vs pain at rest, and age vs pain during coughing. To evaluate the frequency of side effects, the population was classified into three age groups (less than 40, 40-60, greater than 60 yr) and examined by Fisher's exact test for possible differences. Although there was wide interpatient variability, there was a correlation between patient age and effective 24-hr morphine dose (r = -0.40, P less than 0.01). The relation is described by the following equation: 24-hr morphine dose (mg) = 18-age(0.15). The quality of analgesia did not diminish with the smaller doses administered to the older patients. The frequency of side effects did not differ significantly in the three age groups. These observations may be related to higher CSF morphine concentrations or to a greater analgesic effect from morphine absorbed systemically from the epidural space in older patients.
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PMID:Age predicts effective epidural morphine dose after abdominal hysterectomy. 368 91

Morphine concentrations in plasma in five patients following intrathecal (i.t.) administration and in five other patients following intravenous (i.v.) administration were measured by a specific RIA sensitive to 0.1 ng/ml. Pharmacokinetic analysis showed a similar apparent total body clearance of morphine following both i.t. and i.v. administration, and complete bioavailability of i.t. morphine to the systemic circulation. This indicates that morphine is probably not metabolised in the CNS and that all of an i.t. dose diffuses from CSF to the plasma compartment. However a marked decrease in the i.t. terminal rate constants, involving a flip-flop phenomenon, contributed to the prolonged terminal half-life of i.t. morphine. The slow diffusion of morphine from the i.t. space to the plasma compartment can account for the prolonged analgesia following i.t. administration.
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PMID:Rate-limiting diffusion processes following intrathecal administration of morphine. 375 45

In order to evaluate long-term intrathecal morphine therapy for cancer pain, whatever its location, 121 patients (80% were ambulatory patients) treated between April 1979 and April 1985 at the Cancer Institute of Montpellier (Centre Paul-Lamarque) were assessed. Morphine was stored in a presternal insulin syringe, protected by a sterile and waterproof dressing. A bolus administration of morphine via a subcutaneous lombo-epigastric subarachnoid catheter was scheduled every 12 h. This "closed" device was opened for refilling in an operating room only. The mean follow-up was 68 days (maximum: 13 months). More than 15,000 intrathecal injections were made. The mean daily amount of morphine required was 2.3 mg (extremes: 0.75 and 21 mg). All patients developed tolerance, requiring an adjustment of morphine dosages every 30 to 45 days. With the isobaric morphine solution, good or very good analgesia was achieved in 82% of patients, even in those suffering from thoracic or otolaryngologic pain. Mechanical complications (catheter coming out of the subarachnoid space in 7.67% of cases, leakage of CSF along the catheter in 9.16% of cases) were related to the exteriorization of the proximal catheter tip. With the exception of errors in manipulation, neither infection nor clinical respiratory depression were noticed. Nausea and vomiting were frequent but resolved spontaneously within a few days. Urine retention (33%) occurred mainly in men over 65 years, after pelvic surgery or radiotherapy. Because of the absence of a defined zone of analgesia, the small volumes required and the "ready for use" preparation, intrathecal isobaric morphine therapy will lead to easy self-administration via an implanted pump in the future.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Long-term intrathecal isobaric morphine therapy]. 377 64

The CSF concentrations of mepivacaine in 10 Standardbred horses and of procaine in 10 Holstein cows given the drugs by thoracolumbar subarachnoid injection were determined. Mepivacaine hydrochloride was injected into the horses (502 +/- 60.5 kg) at an average dosage of 30 mg (1.5 ml of 20 mg/ml solution). Analgesia was produced 7.5 +/- 4.3 minutes after injection, extended between spinal cord segments T13 and L3 on both sides of the spinal column, and lasted 47 +/- 18.7 minutes at the T18 dermatome. Procaine hydrochloride was injected into cows (614 +/- 51.5 kg) at a dosage ranging between 75 mg and 100 mg (1.5 ml and 2 ml of 50 mg/ml solution). Analgesia was produced 8.2 +/- 2.0 minutes after injection, extended between spinal cord segments T11 and L4 on both sides of the spinal column, and lasted 47 +/- 17.5 minutes at the T13 dermatome. The critical CSF concentrations of local anesthetics required to eliminate response to pinprick stimulation were 204.4 +/- 90.3 micrograms of mepivacaine/ml in horses and 197.0 +/- 86.1 micrograms of procaine/ml in cows. Average CSF concentrations at 120 minutes after injections were made were 16.8 +/- 15.5 micrograms of mepivacaine/ml and 30.6 +/- 17.1 micrograms of procaine/ml. In in vitro experiments to determine the rates of hydrolysis of mepivacaine and procaine in CSF, significant changes (P greater than 0.05) were not seen in the CSF concentrations of mepivacaine in horses and procaine in cattle after a 120-minute incubation (37 C). The analgesic threshold concentrations of mepivacaine in CSF of horses and procaine in CSF of cows were similar.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Spinal fluid concentrations of mepivacaine in horses and procaine in cows after thoracolumbar subarachnoid analgesia. 383 14

A case of delayed respiratory depression following an intrathecal injection of hyperbaric morphine hydrochloride is reported. This injection was made during a lumbar myelography in a 60 year old patient suffering from metastatic epiduritis unrelieved by oral or parenteral drugs. The differences in densities between the CSF, hyperbaric opiate solution and contrast medium explain the migration of the morphine hydrochloride from the lumbar thecal space to the basal cisternae, giving a fall in the responsiveness to CO2 of the brain stem respiratory centres. Parenteral naloxone did not reverse this ventilatory depression. Only the myosis and the analgesia disappeared. After 16 h of various attempts of reversal by parenteral injections, an intrathecal injection of naloxone was tried. This small dose (0.1 mg), given intrathecally, resulted in a prompt return to normal of respiratory function.
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PMID:[Respiratory depression after intrathecal injection of morphine: value of in situ naloxone]. 384 Sep 64

The existence of opiate receptors in the spinal cord led the authors to seek a clinical application. 1 - A peroperative injection of morphine was administered in 170 cases: 0.005 mg/kg of fentanyl in 105 cases and 0.05 mg/kg of morphine in 65 cases. In addition to usual surveillance (blood pressure, heart rate and central venous pressure), more extensive haemodynamic investigations were undertaken in 20 patients using a Swan-Ganz catheter. Blood concentrations (11 cases) and CSF concentrations (2 cases for each time of measurement) were determined in the case of fentanyl. In 20 patients (10 of whom had received fentanyl and 10 morphine) there was sophisticated cardio-respiratory surveillance postoperatively. 2 - 0.05 mg/kg or morphine (404 cases), 50 mg of pethidine (10 cases) and 0.1 mg of fentanyl (10 cases) were injected postoperatively. A comparison was made of the analgesia obtained. After three types of anaesthesia: epidural with bupivacaine with intubation (10 cases), halothane with intubation (10 cases) and neuroleptanaesthesia (10 cases), an injection was given of 0.05 mg/kg of morphine, with cardiorespiratory surveillance. Results were as follows: 1 - There were no significant variations in haemodynamic parameters peroperatively, indicative of adequate analgesia. Blood concentrations of fentanyl were as follows: 3.2 +/- 2.1 ng/ml after 10 minutes, 2 +/- 1.7 ng/ml after one hour, 1.4 +/- 1 ng/ml after two hours and 0.4 +/- 0.3 ng/ml after four hours. CSF concentrations were much higher; 34 ng/ml after one hour, 30 ng/ml after two and three hours and 25 ng/ml after four hours. No cardio-respiratory depression was seen after the peroperative injection of morphine. 2- The duration of analgesia following a postoperative injection of a morphine derivative was as follows: morphine 17.3 +/- 3.9 hours, pethidine 3.5 +/- 0.5 hours, and fentanyl 5.1 +/- 0.7 hours. The epidural injection of morphine after neuroleptoanaesthesia caused respiratory depression in two of the 10 cases, with a rise in pCO2 of 0.45 and 0.52 KPa. The results are discussed and compared with those of other authors. In conclusion, the authors emphasize the advantages of this method which makes it possible to obtain with smaller doses analgesia of longer duration than following a systemic injection of morphine, whilst at the same time decreasing the side effects.
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PMID:[Value of morphine derivatives administered by the peridural route per- and postoperatively]. 611 39

Narcotics have been shown to act selectively upon nociceptive synaptic junctions in laminae 1 and 2 of the dorsal horn of the spinal cord. Subarachnoid or epidural injection of narcotics can produce selective segmental analgesia of great intensity and prolonged duration that is free of motor or sympathetic blockade. However, poorly lipid-soluble drugs, such as morphine, that tend to linger in the water phase of the CSF may spread rostrally to involve opiate receptors in brain stem nuclei. Delayed respiratory depression and lifethreatening apnoea is therefore the greatest danger. Other undesirable side effects include itching, nausea and vomiting and urinary retention. All side-effects are antagonized by naloxone. Intraspinal narcotic analgesia has many useful applications for the relief of acute or chronic pain. Obstetrical pain is less amenable to this approach. Effective and safe management of acute pain requires that the patients be under adequate surveillance to avoid the danger of insidious respiratory depression. Chronic malignant pain is well controlled by relatively small doses of narcotic, and these patients can be managed at home on a long-term basis.
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PMID:Spinal opiate analgesia: its present role and future in pain relief. 614 23

A 16-year-old boy had congenital absence of pain sensitivity and no impairment of other sensory modalities. Routine electrophysiologic investigation showed no abnormalities. The threshold and latency of electrically elicited corneal reflex and cortical potentials evoked by tooth pulp stimulation were normal, but suprathreshold electric stimulation of corneal mucosa and dental pulp, as well as electric stimulation of dorsal roots, did not elicit pain. The total CSF opioid activity was raised. However, naloxone hydrochloride administration failed to reverse the analgesia. The axon reflex to intradermal injection of histamine dihydrochloride was absent. Cutaneous nerve branches showed unspecific changes affecting part of unmyelinated axons. most of the unmyelinated as well as the myelinated axons were normal. We consider the case an example of congenital indifference to pain.
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PMID:Congenital absence of pain. 616 87


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