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)

Three groups of 15 patients each were randomly assigned to receive a retrobulbar anesthetic block with 0.5% bupivacaine, 0.5% bupivacaine/2% lidocaine or 0.5% bupivacaine/2% lidocaine/1:100 000 epinephrine for unilateral cataract surgery. Hyaluronidase was added to each of the preparations, which were used in double-blind fashion. Lid and globe akinesia and corneal anesthesia were graded after 4 minutes of ocular massage and 36 minutes later (at the end of the procedure) to assess the rapidity of onset and the duration of action of the anesthetics. Overall, bupivacaine/lidocaine/epinephrine was the most effective in producing akinesia of the lids and globe. Bupivacaine alone was more effective than bupivacaine/lidocaine without epinephrine in producing akinesia, although it was slower in producing anesthesia. There was no difference between the groups in the frequency of pain or of the need for analgesia 6 hours postoperatively.
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PMID:Retrobulbar anesthesia for cataract surgery: comparison of bupivacaine and bupivacaine/lidocaine combinations. 405 61

Two methods of periocular anaesthesia (PI and PII) were compared with the traditional retrobulbar block in a prospective study of 450 patients undergoing elective cataract extraction and intraocular lens implantation. A solution of local anaesthetic containing equal amounts of 2% lignocaine and 0.5% bupivacaine was used in all the groups. Hyaluronidase (75 IU/10 ml of local anaesthetic solution) was added. Three groups of patients were studied, with 150 patients in each group. The retrobulbar injection (group R) was performed with 4 ml of the anaesthetic solution through the lower eyelid inferotemporally and a further 6 ml was injected for seventh cranial nerve block. In the first periocular technique (group PI) the local anaesthetic was injected inferotemporally (5 ml) through the lower lid and superonasally (5 ml) through the upper lid. In the second periocular technique (PII) the injections were performed inferotemporally (5 ml) and into the medial compartment (2 ml) of the orbit at the medial canthus. Satisfactory anaesthesia could be achieved with all of these methods. Additional block because of insufficient akinesia of the muscles was required in 12% (18/150) in group R, in 19% (28/150) in group PI, and in 11% (16/150) in PII. The medial compartment technique (PII) was associated with the highest percentage of total akinesia of the muscles and lowest reblock rate. All three methods produced sufficient analgesia during surgery and there were no differences in the requirements for additional analgesic drugs during surgery. It is concluded that the medial compartment technique represents a good alternative to retrobulbar block.
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PMID:Regional anaesthesia for cataract surgery: comparison of three techniques. 811 Jun 68

We studied the effect of the addition of hyaluronidase to a mixture of lignocaine 2% and bupivacaine 0.75% for peribulbar anaesthesia in 60 patients presenting for elective intra-ocular surgery. Using a randomised, double-blind design, patients were allocated to one of three groups: no hyaluronidase (group A) (n = 20); hyaluronidase 50 iu.ml-1 (group B) (n = 20); hyaluronidase 150 iu.ml-1 (group C) (n = 20). The speed of onset of the block, the presence of akinesia, analgesia and the need for supplementary injections were assessed. The addition of 150 iu.ml-1 of hyaluronidase resulted in a mean (SEM) time to akinesia of 9.2 (0.9) min compared to 10.9 (0.9) min in the control group and 10.7 (1.1) min in those receiving the lower dose. Fewer patients in group C required a further injection (20%) than those in groups A (40%) or B (45%). None of the findings were statistically significant. Hyaluronidase was not associated with any complications.
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PMID:An evaluation of two concentrations of hyaluronidase for supplementation of peribulbar anaesthesia. 869 95

Morphine is often administered by the subcutaneous (SC) route when venous access is difficult to achieve. Hyaluronidase temporarily increases the permeability of SC connective tissues by degrading hyaluronan and has been shown to increase the dispersion and absorption of coadministered molecules. Therefore, hyaluronidase could enhance the pharmacokinetics of subcutaneous morphine. This Phase IIIB, double-blind, randomized, placebo-controlled crossover study compared the pharmacokinetics, safety, and tolerability of morphine administered SC with and without 150U of recombinant human hyaluronidase (rHuPH20) with those of intravenous (IV) morphine administration in 13 patients in a hospice or palliative care setting. Each patient received morphine 5mg parenterally daily for three days by a different method each day: IV, SC plus rHuPH20, and SC plus placebo (normal saline). The primary endpoint was the time to maximum plasma concentration (T(max)) for morphine. Concomitant SC administration of rHuPH20 enhanced the absorption rate of morphine compared with SC morphine with placebo, significantly reducing the mean T(max) from 13.8 to 9.2 minutes, a 33% decrease (P=0.026). The respective values for geometric mean maximum plasma concentration were 94.9 and 107.5nmol/L, a 13% increase (P=0.024), and the area under the plasma concentration vs. time curve values were 7.7 and 7.2micromol x min/L (P=0.23). Morphine plus rHuPH20 appeared to be safe and well tolerated. In patients requiring opioid analgesia, SC morphine plus rHuPH20 provides pharmacokinetic characteristics that are superior to those of SC morphine alone. These positive results warrant further studies on analgesic efficacy of morphine delivered with rHuPH20.
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PMID:The INFUSE-Morphine study: use of recombinant human hyaluronidase (rHuPH20) to enhance the absorption of subcutaneously administered morphine in patients with advanced illness. 1981 65

This article reviews the use of adjuvants to local anaesthesia for ophthalmic regional anaesthesia. Hyaluronidase, bicarbonate, epinephrine, muscle relaxants, opiates and clonidine have all been described singly and in combination for use as an adjuvant to ophthalmic regional anaesthesia. The article focuses on the efficacy of the adjuvants with regard to improving akinesia, analgesia, speed of onset and reducing block failure. A description of the pharmacological action of each adjuvant is given followed by a review of randomised control trials, dosage and notable papers on the subject. There is no effective consensus between anaesthetists or surgeons on the use of adjuvants to local anaesthesia and it so is the purpose of this review to draw attention to the wealth of current data and allow an informed decision on the choices available.
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PMID:Adjuvants to local anaesthesia in ophthalmic surgery. 2144 Dec 37