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 administration of narcotic analgesics to postoperative patients was examined with 180 uncomplicated adult appendectomy patients. Narcotic analgesic doses were transcribed from the hospital records of these patients for the entire postoperative period. Equianalgesic doses were calculated so that all medications were comparable with meperidine. Eighty-three percent (n = 150) of the patients received meperidine. Patients who received meperidine were given significantly more narcotic analgesics than those who received morphine sulfate. The amount of narcotic analgesics received by patients was significantly related to their length of hospital stay. Meperidine and Tylenol #3 (acetaminophen with codeine phosphate; McNeil Pharmaceutical, Spring House, PA) comprised the significantly associated analgesics. These findings suggest a need to reexamine the current use of meperidine in postoperative analgesia.
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PMID:Postoperative narcotic analgesic administration. 823 38

Topically applied acetylsalicylic acid (ASA), salicylic acid (SA) and indomethacin were tested in an experimental pain model that provides direct nociceptor excitation through cutaneous tissue acidosis. In 30 volunteers, sustained burning pain was produced in the palmar forearm through a continuous intradermal pressure infusion of a phosphate-buffered isotonic solution (pH 5.2). In 5 different, double-blind, randomized cross-over studies with 6 volunteers each, the flow rate of the syringe pump was individually adjusted to result in constant pain ratings of around 20% (50% in study 4) on a visual analog scale (VAS). The painful skin area was then covered with either placebo or the drugs which had been dissolved in diethylether. In the first study on 6 volunteers, ASA (60 mg/ml) or lactose (placebo) in diethylether (10 ml) was applied, using both arms at 3-day intervals. Both treatments resulted in sudden and profound pain relief due to the cooling effect of the evaporating ether. With lactose, however, the mean pain rating was restored close to the baseline within 6-8 min while, with ASA, it remained significantly depressed for the rest of the observation period (another 20 min). This deep analgesia was not accompanied by a loss of tactile sensation. The further studies served to show that indomethacin (4.5 mg/ml) and SA (60 mg/ml) were equally effective as ASA (each 92-96% pain reduction) and that the antinociceptive effects were due to local but not systemic actions, since ASA and SA dis not reach measurable plasma levels up to 3 h after topical applications. With a higher flow rate of acid buffer producing more intense pain (VAS 50%). ASA and SA were still able to significantly reduce the ratings by 90% or 84%, respectively. On the other hand, by increasing the flow rate by a factor of 2 on average, during the period of fully developed drug effect it was possible to overcome the pain suppression, which suggests a competitive mechanism of (acetyl-) salicylic antinociception.
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PMID:Topical acetylsalicylic, salicylic acid and indomethacin suppress pain from experimental tissue acidosis in human skin. 865 34

As part of an evaluation of post-operative analgesia for craniotomy patients, a postal questionnaire was sent to 183 consultant members of the Neuroanaesthesia Society of Great Britain and Ireland, inquiring about their current practices for post-operative neurosurgical analgesia. Replies were received from 110 neuroanaesthetists in 37 different neurosurgical centres. Intramuscular codeine phosphate or dihydrocodeine was the mainstay of post-operative analgesia for 97% of neuroanaesthetists despite the fact that over half of them thought that analgesia was inadequate. Only four neuroanaesthetists would ever consider using opioids post-operatively because of fears about respiratory depression and sedation, yet all except one used opioids per-operatively. Post-operative analgesia for craniotomy patients is perceived as inadequate by most neuroanaesthetists, yet traditional prejudice against opioid use prevents this being remedied. We suggest that patient-controlled analgesia with morphine could be a safe alternative to codeine phosphate.
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PMID:Post-operative analgesia for craniotomy patients: current attitudes among neuroanaesthetists. 866 79

Unrelieved cancer pain remains a significant problem worldwide. Patients receive inadequate analgesia for a variety of complex and multifactorial reasons. Limited availability of opioids secondary to concerns about potential diversion of these medications for illicit use and poor compliance with oral regimens are significant factors in many countries. This study was designed to develop and test an implantable opioid delivery device capable of releasing a potent opioid subcutaneously at a continuous rate for 4 weeks. A low temperature solvent casting technique was used to formulate ethylene vinyl acetate (EVA) copolymer disks containing 50% hydromorphone by weight. The release characteristics of disks of different height and diameter, coated and uncoated, and with and without a central uncoated channel were studied. The effect of temperature and pH were also evaluated. In vitro assessments were conducted in phosphate buffer using UV spectrophotometry. In vivo studies employed New Zealand White Rabbits and a radioimmunoassay. Plasma levels following hydromorphone delivery by polymer, osmotic pump, and intravenous administration were compared. In vitro, uncoated EVA polymer disks measuring 1.05 cm in diameter and 0.27 cm in height released an initial large burst of hydromorphone. Coating the disks with 100-200 microM of poly(methyl-methacrylate) prevented drug egress from the polymer. A central uncoated channel measuring 1.25 mm in diameter in an otherwise coated polymer virtually eliminated the initial burst of drug release and provided near zero-order hydromorphone release at an average rate of 164 micrograms per hour for 4 weeks. Doubling the height of the polymer approximately doubled the release rate while doubling the diameter of the polymer extended the duration of drug release to over 8 weeks. In rabbits, stable plasma hydromorphone concentrations (23-37 ng/ml) were sustained for 4 weeks following implantation of 2 polymers with an uncoated central channel. No initial burst of hydromorphone release was noted. Increasing the number of polymers produced sustained and predictable increases in plasma hydromorphone concentrations. Plasma levels were similar with subcutaneous hydromorphone delivered by polymer and osmotic pump and much less variable than with intravenous bolus hydromorphone. A uniquely configured implantable drug delivery device has been developed using materials which are approved for human use. It safely and reproducibly releases hydromorphone for weeks in vitro and in vivo without an initial burst of drug release. Varying the thickness, diameter, and number of implants provides flexibility in the release rate and duration of release. This implantable opioid delivery device could provide a sustained subcutaneous infusion of hydromorphone to patient with cancer pain in developed and developing nations without pumps, catheters, or extensive outpatient support services. In addition, it should improve compliance and reduce concern regarding illicit diversion of opioids.
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PMID:In vitro and in vivo studies of subcutaneous hydromorphone implants designed for the treatment of cancer pain. 882 16

In a human acid pain model, which uses continuous intradermal pressure infusion of a phosphate-buffered solution (pH 5.2) to induce localized non-adapting pain, the flow was adjusted to result in constant pain ratings of about 20% or 50% on a visual analog scale (VAS). Six volunteers in each group participated in 4 different placebo-controlled double-blind cross-over studies to measure rapidly evolving cutaneous analgesia from topically applied new ointment formulations of acetylsalicylic acid (ASA) and salicylic acid (SA) as well as of commercial ibuprofen and benzocain creams. Similar, log-linear dose-response curves were found for both ASA and SA, significant in effect at 3 g/kg and higher drug contents and reaching saturation level at 15 or 30 g/kg, respectively, which, 20 min after application, caused a mean pain suppression of 95% using ASA and 80% using SA. Half-maximal effects were achieved using 3 g/kg ASA or 15 g/kg SA. The SA action was also clearly slower to develop. With an increased flow of the acidic buffer, producing lower effective tissue pH and more intense pain, the effect of ASA and SA decreased to 73% pain suppression. A competitive mechanism of both drug effects was suggested by the fact that, with 15 g/kg ASA and SA, pain reduction could be reversed by increasing the buffer flow by a factor of 1.75, on average. Commercial ibuprofen (50 g/kg) and benzocain creams (100 g/kg) were comparably as effective as ASA and SA, but the local anesthetic caused a loss of all cutaneous sensations while the touch threshold (von Frey) under the specific analgesics was the same as under the placebo ointment. Thus, topical applications of non-steroidal anti-inflammatory drugs (NSAIDS) dissolved in different ointment formulations have proven dose-dependently effective and specific in suppressing experimental acidotic pain by a local and competitive mechanism.
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PMID:Dose-dependent competitive block by topical acetylsalicylic and salicylic acid of low pH-induced cutaneous pain. 886 48

Codeine and morphine were compared in a double-blind study of postoperative analgesia in 40 patients after intracranial neurosurgery. Eighteen patients received codeine phosphate 60 mg and 18 morphine sulphate 10 mg, both by intramuscular injection; 4 patients (10%) required no analgesia. Both drugs provided analgesia within 20 min of injection but morphine was more effective than codeine beyond 60 min (p = 0.01). Fewer doses of morphine than codeine were required (p = 0.003). Nine patients requested one dose of morphine and 9 two doses. Seven patients required three doses of codeine and 1 patient required four doses. Neither drug caused respiratory depression, sedation, pupillary constriction or unwanted cardiovascular effects. We conclude that, in the doses used, morphine is a safe alternative to codeine for analgesia after neurosurgery and has a more persistent action.
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PMID:A double-blind comparison of codeine and morphine for postoperative analgesia following intracranial surgery. 894 93

We have performed a prospective randomised trial of 30 patients undergoing craniotomy to compare intramuscular codeine phosphate with patient-controlled analgesia using morphine 1 mg bolus with a 10-min lockout and no background infusion. For 24 h postoperatively, pain, nausea, Glasgow coma score, respiratory rate and sedation score were assessed. There was a wide variation in the amounts of morphine requested by the patients in the patient-controlled analgesia group in the first 24 h postoperatively (range 2-79 mg, median 17 mg). There was a small, but non-significant, reduction in pain scores in the patient-controlled analgesia group. There were no significant differences between the two groups in respect of nausea and vomiting, sedation score or respiratory rate. No major adverse effects were noted in either group. Patient-controlled analgesia with morphine is an alternative to intramuscular codeine phosphate in neurosurgical patients which merits further investigation.
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PMID:Pain following craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate. 920 94

A retrospective analysis of the first 50 cases of neonatal cleft lip repair performed at the Hospital for Sick Children is presented. The patient population included 11 expremature infants of less than 45 weeks postconceptual age. There was no mortality at the time of follow-up. There was one case of peroperative hypoxaemia. There was one case of postoperative laryngospasm requiring reintubation. Postoperatively there were four cases of mild hypoxaemia and one patient with transient apnoea. No patients required blood transfusion. Seventy-six percent of patients did not require opioid analgesia. The remainder received a single dose of intramuscular codeine phosphate. The advantages and risks of anaesthesia for cleft lip in the neonatal period are reviewed. Recommendations for safe practice include the selection of gestationally mature infants with no intercurrent illness, avoidance of opioid analgesia, adequate staffing ratios of experienced postoperative nursing care, appropriate monitoring including oximetry and apnoea detectors.
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PMID:Neonatal cleft lip repair: a retrospective review of anaesthetic complications. 904 72

An 18-residue-long fragment of vasoactive intestinal polypeptide [VIP(11-28)-NH2] that is known to be analgesic was synthesized by solid-phase t-Boc methodology on a 4-methylbenzhydrylamine resin. Circular dichroism spectroscopy gave evidence that the peptid acquires about 60% helical structure in 50/50 methanol/phosphate buffer, pH 6.0, and 65% (+/-5%) helicity in 80/20 methanol/phosphate buffer pH 7.0, A 2.0 mM solution of VIP (11-28) NH2 in 80% methanol, 20% phosphate buffer pH 7.0 was subjected to 2-dimensional nuclear magnetic resonance (NMR) studies The NMR results suggested formation of an extended helical structure extending from residue 11 to 27 essentially the same region found to be helical in a VIP(1-28)-NH2 and log. This finding suggests that the sequence required for analgesia assumes a helical structure at the receptor.
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PMID:Solution structure of vasoactive intestinal polypeptide (11-28)-NH2, a fragment with analgesic properties. 904 28

The management of pain and anxiety in pediatric patients with burns includes the challenge of striking a balance between inadequate versus excessive medication. Ketamine provides effective sedative, analgesic, and amnestic properties for children and has been used intravenously with good results. With its recent availability as an elixir, we speculated that ketamine given orally may provide effective analgesia and sedation during wound care procedures with a wide safety margin. To test this hypothesis, 19 pediatric patients with burns undergoing a wound care procedure were randomized to receive either ketamine oral suspension or 300 mg acetaminophen with codeine phosphate and diphenhydramine, our prior standard for analgesia and sedation. Intensity of pain was determined with use of a color slide algometer and demonstrated more than 400% reduction in pain with the use of ketamine (p < 0.05). The Ramsey scale was used to quantitate sedation and demonstrated that ketamine improved sedation by 360% (p < 0.05). These results substantiate improved analgesia and sedation with oral ketamine as compared to a commonly used narcotic and sedative in facilitating wound care procedures in pediatric patients with burns. These findings suggest that expanded use of ketamine oral suspension may be.
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PMID:Superiority of oral ketamine as an analgesic and sedative for wound care procedures in the pediatric patient with burns. 906 85


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