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)

The critical care patient population has much to gain from properly administered neural blockade. Effective analgesia alone may make the difference between a patient who is able to compensate for their acute insult and one who cannot. A good example is the patient with multiple fractured ribs, who, after intercostal nerve blocks, no longer requires intubation and mechanical ventilation. The authors believe that effective analgesia is just the beginning of the beneficial effects of neural blockade, because blockade of the afferent limb of sympathetic and sensory nerves may circumvent the neuroendocrine response to acute injury. There is evidence that the stress response is not beneficial in the hospital setting and in fact may be detrimental. Some of the effects include elevated plasma catecholamines, ADH, cortisol, and blood glucose, which contribute to tachycardia, hypertension, increased myocardial work and oxygen consumption, salt and water retention, and a catabolic state with negative nitrogen balance. Whether these changes result in reduced morbidity and mortality has been the subject of several studies, but more studies are needed. It would seem that critically ill patients with little physiologic reserve might be the best population to study because even a small improvement may improve survival. A small beneficial effect in healthy postoperative patients may not be clinically apparent. Most would agree that neural blockade used intraoperatively results in reduced blood loss and a lower incidence of postoperative thromboembolism. The continuation of these techniques into the postoperative period may reduce morbidity and mortality in high-risk patients. A word of caution is in order. The indiscriminate application of the techniques described in this article to critically ill patients would not be in the patients' best interest. Nerve blocks are only safe in the hands of those physicians specifically trained to perform them. In addition, local anesthetics have a low therapeutic ratio, and their administration requires continual observation. The use of epidural or intrathecal opioids alone or in combination with other agents also has potentially serious side effects, and requires continual patient monitoring. The proper performance and maintenance of these techniques requires a large commitment of time, manpower, equipment, and a multidisciplinary approach to include physicians, nursing, and support staff. Nerve blocks and other sophisticated techniques started in the operating room or critical care unit should not necessarily be discontinued when the patient is transferred to a ward bed because the full benefit of this therapy may not have been fully realized.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Nerve blocks in the critical care environment. 218 9

The purpose of the present study was to assess the repercussion of morphine injected in the intrathecal space on postoperative neuroendocrine response and the correlation with pain relief in the postop period. We studied 50 healthy patients (ASA I-II) submitted to orthopaedic surgery under general anaesthesia (N = 25) or spinal anaesthesia (N = 25). In the group under general anaesthesia we observed a hypersecretion of ADH, ACTH, cortisol and aldosterone during and after surgery. In the group un spinal anaesthesia, it was evident, on the contrary, a blockade of the neuroendocrine response during surgery, as well as an attenuation during postoperative period. Intraoperative and postoperative bleeding with spinal anaesthesia was significantly lower (p less than 0.01; p less than 0.05 respectively) than with general anaesthesia. Postoperative analgesia was excellent in group with spinal anaesthesia; the average duration of analgesia was 16.3 hours. We conclude that small intrathecal doses of morphine have beneficial effects and may be used usefulness in orthopaedic surgery.
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PMID:[A bupivacaine-morphine combination by intrathecal route: correlation between pain relief and postoperative neuroendocrine response]. 285 85

In a randomized study, 20 patients received temazepam 20 mg orally the night before and 20 mg in the morning of an operation performed under spinal analgesia (Group I); 20 patients received flunitrazepam I mg similarly (Group 2). Different aspects of the premedication were evaluated verbally, with the aid of a visual analogue scale, Maddox wing apparatus, the critical flicker fusion threshold test, blood pressure and heart rate measurements, serum and CSF cortisol and plasma ADH measurements, as well as CSF drug level determinations. Clinically, temazepam 20 mg proved to be comparable with flunitrazepam I mg, although the latter more effectively prevented cardiovascular changes and pre-operative hormonal stress reaction. No correlation was found between the CSF drug level (bioassayed by radioreceptor assay) and the clinical response of the two benzodiazepines, nor was there any correlation between the cortisol or ADH levels versus the CSF drug levels. On the whole, flunitrazepam proved to be marginally better than temazepam as an oral premedicant.
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PMID:Temazepam versus flunitrazepam as an oral premedication in adult surgical patients. 289 5

In order to demonstrate pharmacokinetic and pharmacodynamic interactions between fentanyl and buprenorphine, 3 groups of patients (n = 30) were compared, receiving either fentanyl (0.005 mg/kg b.w.) or buprenorphine (0.01 mg/kg b.w.) or both opioids as analgesic during surgery for disc protrusion. For a period of 4 h haemodynamic parameters were monitored and blood samples were taken for determination of the following concentrations: ADH, ACTH, cortisol, glucose, unbound glycerol, fentanyl and buprenorphine. Blood gas analyses were performed up to 2 h postoperatively. Although in all groups haemodynamic parameters were constant, there was an increase in factors related to operative stress (cortisol, glucose, unbound glycerol, postoperative acidosis) after the combination of both opioids, while postoperative ventilatory parameters in this group were not improved by the partial agonist buprenorphine. Plasma levels were not affected by combined application, except for a slight elevation of buprenorphine concentrations during additional use of fentanyl. Buprenorphine, at least in higher dosages, seems to antagonize analgesia induced by fentanyl, although respiratory depression is even more pronounced. It may be assumed, that with partial agonists the relation of agonistic and antagonistic activity may be different, depending on the dosage used and on the respective pharmacologic effect observed during investigation.
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PMID:[Intra- and postoperative interactions between the 2 opioids fentanyl and buprenorphine]. 301 44

Plasma-levels of antidiuretic hormone were measured in patients undergoing major abdominal surgery pre-, intra- and postoperatively. All patients (n=20) received neuroleptanalgesia as anaesthetic procedure; 10 of them received etomidate additionally. Initial value of vasopressin as well as values after induction of anaesthesia stayed within normal range in all patients. The operation period was accompanied by elevated ADH-levels with a maximum of 500% above initial values. 5 patients having been antagonized postoperatively with naloxone 0.005 mg/kgbw showed marked increase in ADH-level. In comparison to former investigations we conclude that NLA can not block stress-induced rise in vasopressin-concentration effectively as seen under the combination of NLA plus epidural analgesia.
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PMID:[Effect of neuroleptanalgesia on operation-induced rise in the antidiuretic hormone]. 686 65

44 patients undergoing major abdominal and thoracic surgery received different anaesthetic treatment and different pain therapy during the postoperative period (4 groups). Analysis of plasma vasopressin was performed in all patients pre-, intra- and five days postoperatively. In two groups of patients under neuroleptanalgesia (group A and B) ADH-levels increased markedly during the operation procedure, whereas those of patients under NLA plus epidural analgesia with bupivacaine 0.5% (group C and D) showed only a slight increase intraoperatively. During the postoperative period pain relief was provided by giving fentanyl epidurally (group B and D) or with systemic administration of piritramide (group A and C). During the investigation period vasopressin secretion in patients under epidural opiate therapy was significantly less pronounced as in patients under systemic opiate therapy.
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PMID:[Anesthesia procedure and postoperative ADH secretion]. 688 20

Anesthesia for major general surgery should involve the use of anesthetic techniques that might reduce the risk of intraoperative and postoperative complications. The combination of intraoperative epidural anesthesia with local anesthetics (EPA) and the use of epidural opiates for postoperative pain relief shows advantages over the application of pure general anesthesia and over postoperative systemic analgesia. Epidural opiates lead to better quality analgesia with a quicker onset and longer duration than systemical analgesics. The spirographic parameters of ventilatory function PF, FVC, FEV [1], paO2, and paCO2 decreased significantly (p less than 0.05) compared with preoperative values when systemic analgesia was performed. After epidural opiates no significant decrease could be seen. Intraoperative use of EPA has the advantages of better hemodynamic conditions and a blockade of the endocrine-metabolic response to surgery. Postoperative peridural opiates block the endocrine response as well: the serum levels of ADH and cortisol are lower than under systemic analgesia.
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PMID:[Peridural anesthesia and analgesia results in general surgery]. 706 41

In the psychic stress, ADH releases at the same time with CRF which intensifies the effects of it. Endogenous opioids cause above all the analgesia and paradoxical euphoria of stress. Psychic stress needs through the risk of heart frequency a higher capacity and it aggravates the valvular insufficiency and the valvular stenosis. The patient with rheumatic mitral stenosis could have a genetic psychic location predisposed to a higher vulnerability for psychic stress.
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PMID:[A clinico-etiopathogenic update on mental stress as a cardiovascular risk factor]. 945 94

Hyponatremia can be a complication of opioid therapy, which has been postulated to occur secondary to inappropriate antidiuretic hormone secretion (syndrome of inappropriate antidiuretic hormone secretion [SIADH]). We report severe hyponatremia following wisdom teeth extraction with opioid analgesia in a 19-year-old female with diabetes insipidus (DI) and acquired panhypopituitarism that challenges this theory. As this patient has DI, we believe opioid treatment caused severe hyponatremia by the following mechanisms: (1) Opioids have a direct antidiuretic effect independent of changes in ADH, as demonstrated in Brattleboro rats with central DI. (2) Hydrocodone may have stimulated this patient's thirst center contributing to hyponatremia, as demonstrated in animal studies. Opioid use can cause hyponatremia in patients independent of ADH. It is important for clinicians to be aware of this so that patients can be appropriately counseled.
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PMID:Opioid-induced hyponatremia in a patient with central diabetes insipidus: independence from ADH. 2859 7