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

Postoperative pain is an important factor in the management of children undergoing thoracotomy. Intercostal nerve block has been used in adult patients, but its applicability in the pediatric age group has not been previously evaluated. Eighty-nine children (85 girls and 31 boys) aged 6 months to 16 years (mean age 4.7 years) underwent ligation of a patent ductus arteriosus (PDA) through a left thoracotomy. Twenty-nine children received intercostal blocks with bupivacaine from the level of the second to sixth thoracic vertebrae. Sixty cases constituted the control group. The patients with intercostal block had fewer doses of pain medication postoperatively, 2.7 mean (0 to 9), than did the control patients, 3.9 mean (0 to 21). The mean hospital stay was shortened in the patients with nerve block, 5.1 days versus 7.3 days for the control group. No ill effects of bupivacaine were noted. We conclude that intercostal nerve block is a valuable procedure reducing the need for postoperative analgesia and shortening hospital stay.
J Thorac Cardiovasc Surg 1977 Aug
PMID:Kindness pays dividends: the medical benefits of intercostal nerve block following thoracotomy. 88 80

Epidural analgesia for control of postoperative thoracotomy pain in patients with carcinoma of the lung and chronic obstructive airway disease is described. The rationale and procedure for its use are presented. Epidural analgesia used in 8 patients requiring pulmonary resection who had chronic obstructive airway disease resulted in an improved postoperative course and avoided use of narcotics or a respirator in 7 of the 8 patients.
J Thorac Cardiovasc Surg 1976 Jan
PMID:Epidural anesthesia following thoracotomy in patients with chronic obstructive airway disease. 124 61

To evaluate the effects of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary complications, a randomized, double-blind, placebo-controlled study was conducted on 80 patients undergoing elective thoracotomy for pulmonary (n = 47) or oesophageal (n = 33) procedures. In patients who received continuous bupivacaine infusion, the requirement for intramuscular opiate and rectal diclofenac was less, the score on a visual linear analogue pain scale lower and recovery of pulmonary function more rapid than in saline-infused controls. Postoperative pulmonary complications occurred in 35% of the saline group, but only 10% of the patients with bupivacaine infusion (p < 0.01). In patients with chronic obstructive airways disease (COAD), the incidence of postoperative pulmonary complications was 54.5% in the saline group and only 4.5% in the bupivacaine group (p < 0.01). Among the patients without COAD there was no significant intergroup difference in such complications. We conclude that continuous extrapleural intercostal nerve block is effective for post-thoracotomy analgesia and reduces pulmonary complications of thoracotomy in patients with COAD.
Scand J Thorac Cardiovasc Surg 1992
PMID:Continuous extrapleural intercostal nerve block and post-thoracotomy pulmonary complications. 128 37

Continuous intrapleural bupivacaine administration was assessed in a randomized double-blind manner with respect to its analgesic effect and its impact on breathing after thoracotomy. The pleural cavity was infused continuously for 48 hours in 24 patients following thoracotomy for pulmonary resection. 12 patients received 10 ml/h of bupivacaine hydrochloride 0.5% solution, and 12 patients 10 ml/h NaCl 0.9% solution. There were no differences in the patients' characteristics, extent of surgery, mode and duration of general anaesthesia. There were no complications related either to the catheter or to bupivacaine. The amount of postoperative opioid, given on request, was used to assess the effect of bupivacaine administration on pain relief. Post-thoracotomy breathing was assessed by measuring the forced vital capacity (VC) prior to and after physiotherapy. The VC values measured 24 h, 36 h and 48 h after the operation were similar in both groups of patients with or without bupivacaine administration (p greater than 0.05). Patients given bupivacaine required significantly less opioid analgesia than those who received NaCl 0.9% at 24 h (p less than 0.001), 36 h (p less than 0.001) and 48 h (p less than 0.01) after the operation. Continuous intrapleural bupivacaine analgesia through a paravertebral catheter positioned in the paravertebral groove is safe and provides efficient pain relief after thoracotomy.
Thorac Cardiovasc Surg 1992 Apr
PMID:Pain relief and respiratory mechanics during continuous intrapleural bupivacaine administration after thoracotomy. 163 78

Opioid agonists and antagonists have both been reported to augment myocardial contractile force in vitro. We reported that the strong opioid agonists morphine and levorphanol, the weak agonist dextrorphan (an optical isomer of levorphanol), and the opioid antagonist naloxone all potentiate the stimulatory effects of the beta-adrenergic agonist isoproterenol on isometric tension generated by isolated rabbit right ventricular myocardium. The EC50 of isoproterenol was found to be shifted leftward 2.7-, 5.4-, 5.3-, and 3.4-fold respectively (p less than 0.05 when compared with controls), when the opioids were added at a final concentration of 1 x 10(5) M. Lower concentrations of opioid or antagonist did not potentiate the effects of isoproterenol. The rank order potency for potentiation thus differs markedly from that of opioid analgesia. The observed potentiation is therefore not agonist specific and not stereospecific. Furthermore, the drugs alone at a range of concentration from 10(-8) to 10(-5) M had no effect on isometric tension generated. We conclude that opioid agonists and antagonists potentiate the response of ventricular myocardium to the effects of beta-adrenergic stimulation by a novel mechanism unrelated to the binding of these drugs to opioid receptors. The paradoxical augmentation of myocardial contractility by either class of agent under a variety of clinical and experimental conditions is thus explained by these findings. Either agent may interact with myocardial tissue to cause increased sensitivity to stimulation by circulating catecholamines.
J Cardiovasc Pharmacol 1991 Jan
PMID:Opioids potentiate contractile response of rabbit myocardium to the beta adrenergic agonist isoproterenol. 170 57

The complex and sometimes severe metabolic, haemodynamic or blood modifications induced by cardio-pulmonary bypass (CPB), can result in alteration of cerebral electrogenesis and even in epileptic paroxyms. Nineteen epileptics (EP) and 41 risk patients (PR), 31 with a family history of epilepsy (FHE) and 10 prone to epilepsy (PPE) were operated upon under CPB; 6 of the EP and 2 of the PPE had abnormal but no paroxymal EEG features during operation. None of the other EP or PR showed any epileptic abnormalities. It seems that normothermia, light haemodilution and elimination of neuroleptic drugs for analgesia prevent per and post-operative epileptic paroxysms.
J Cardiovasc Surg (Torino)
PMID:Epilepsy and cardiac surgery. 175 5

The results of heart-lung transplantation are improving with increasing experience in postoperative management, but obliterative bronchiolitis may still develop late postoperatively. We have performed 19 heart-lung transplants, with 1-month, 1-year, and 2-year actuarial survival rates of 95% +/- 5%, 84% +/- 8%, and 69% +/- 16%, respectively. Three early recipients died of bronchiolitis, and four patients who were operated on more than 2 years ago are currently being followed up with bronchiolitis. Since August 1988, 13 surviving recipients have undergone serial postoperative bronchoscopies and transbronchial biopsies with topical analgesia. Diffuse bronchomalacia, involving the main bronchi down to the fifth-order bronchi bilaterally, has developed in four patients with bronchiolitis 9 +/- 2 months after the diagnosis of bronchiolitis was confirmed. Pulmonary function tests have revealed a lower ratio of forced expiratory volume in 1 second to forced vital capacity, lower specific airway conductance, and higher airway resistance in heart-lung recipients with bronchomalacia than in patients with bronchiolitis alone. We conclude that diffuse bronchomalacia occurs frequently in heart-lung transplant recipients who have obliterative bronchiolitis. Bronchomalacia worsens the functional airflow obstruction caused by bronchiolitis and may play an important role clinically in the declining respiratory status of heart-lung transplant recipients.
J Thorac Cardiovasc Surg 1991 Apr
PMID:The importance of acquired diffuse bronchomalacia in heart-lung transplant recipients with obliterative bronchiolitis. 145 43

The possible involvement of endogenous opioid peptides in the cardiovascular responses observed following central alpha-adrenoceptor stimulation with clonidine, alpha-methyldopa (alpha-MD), and 6-hydroxydopamine (6-OHDA) was examined in conscious normotensive Wistar and spontaneously hypertensive (SHR) rats. Clonidine [2.5 micrograms intracisternally (i.c.)] produced rapid hypotension (-36 +/- 2 mm Hg) and bradycardia (-53 +/- 5 beats/min) in SHR that were similar to observations in animals given either naloxone (50 micrograms i.c. or 10 mg/kg i.p.) or appropriate saline control injections. Peripheral doses of naloxone (1-2 mg/kg) or saline did not further change arterial pressure or heart rate in either Wistar rats or SHR given alpha-MD (1.0 mg i.c.) 3 h earlier. In addition, central doses of naloxone (3 X 50 micrograms i.c.) given at hourly intervals did not affect the responses to alpha-MD. Central administration of 6-OHDA acutely releases noradrenaline which produces an initial fall in arterial blood pressure and heart rate. Intracisternal 6-OHDA (400 micrograms) produced similar time course and maximum circulatory effects in rats given naloxone (50 micrograms i.c. before and at each subsequent hour) as in saline-treated animals. Naloxone (1 mg/kg s.c.) significantly attenuated morphine-induced analgesia. These findings do not support a critical role of endogenous opioids in mediating the acute antihypertensive actions of clonidine and alpha-MD or in the cardiovascular responses produced by noradrenaline release following central 6-OHDA.
J Cardiovasc Pharmacol
PMID:Cardiovascular responses to central clonidine, alpha-methyldopa, and 6-hydroxydopamine in conscious normotensive and spontaneously hypertensive rats following naloxone. 258 Oct 87

After anterolateral thoracotomy, before incision closure, indwelling plastic catheters were inserted percutaneously under digital and/or visual control into the intercostal space of access and the two neighbouring ones. Initially, we injected 25 mg of bupivacaine through each catheter (to a total of 75 mg), and subsequently - on the patients demand - another 15 to 25 mg per catheter. To date, 25 patients received repetitive intercostal nerve blocks by this method (ICB-group). We compared their personal and perioperative data with those of another 30 patients, receiving opiates systemically after major thoracic surgery (SA-group). Multiple blood samples from the ICB-group were analyzed by gaschromatography for bupivacaine concentration-time-profiles. In 19 of 25 patients (76%) the bupivacaine-injections provided sufficient analgesia, 6 patients required additional analgesics. The duration of general anaesthesia (ICB: 174 min vs. SA: 136 min) and the operation time (ICB: 103 min vs. SA: 94 min) were not statistically different in both groups. The periods of intensive care therapy (ICB: 0.7 d vs. SA: 1.2 d), artificial respiration (ICB: 11.2 h vs. SA: 21.6 h) and hospital stay (ICB: 12.1 d vs. SA: 14.2 d) were shorter for the ICB-group. Atelectasis (ICB: 20% vs. SA: 37%) and pneumonia (ICB: 0 vs. SA: 13%) were observed less frequently than in the control group, whereas tachyarrhythmia occurred in 6 of 25 ICB-patients compared to 4 of 30 SA-patients. Nevertheless, none of these parameters reached statistical significance (p less than 0.05). Maximum bupivacaine levels of 0.65 +/- 0.21 micrograms/ml were found after 29 +/- 12 min of intercostal application.(ABSTRACT TRUNCATED AT 250 WORDS)
Thorac Cardiovasc Surg 1989 Oct
PMID:Repetitive intercostal nerve block via catheter for postoperative pain relief after thoracotomy. 258 43

Postoperative pain relief and stress hormones were examined during the use of continuous epidural infusion of morphine at a rate of 0.1 mg/hr in 30 patients (Group B) after coronary artery bypass grafting. This was compared to our routine method of postoperative analgesia of intravenous morphine 2 mg/2 hr and as needed in another 30 patients (Group A). Continuous epidural morphine infusion required occasional supplementation with intravenous morphine and achieved effective analgesia in 80% of the patients. Pain relief was adequate in 50% of the patients in Group A. The mean dose of morphine used in Group B during the first 3 postoperative days was 5 mg per patient per day and was significantly lower than that used in Group A (mean 18 mg per patient per day). Serum morphine was undetectable (below 2.5 ng/ml) in Group B and was significantly lower than that in Group A (17 ng/ml). Epidural analgesia was associated with adequate postoperative pulmonary and cardiovascular functions; nausea and vomiting occurred in two patients. Levels of postoperative stress, serum cortisol, and beta-endorphin were significantly lower in Group B than in Group A. This study shows that continuous epidural infusion of morphine at a rate of 0.1 mg/hr provides selective and effective pain relief and reduces postoperative stress after cardiac operations. This method of analgesia was also associated with minimal side effects and provides an alternate approach for treatment of pain after cardiac operations.
J Thorac Cardiovasc Surg 1987 Jun
PMID:Continuous epidural infusion of morphine for pain relief after cardiac operations. 295 42


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