UMLS:C0344307 - FACTA Search

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

Recent studies have shown that, in the presence of inflammation, the local administration of opioids results in analgesia. The analgesic efficacy of local anesthetics and morphine administered intraarticularly was compared in patients undergoing arthroscopic knee surgery under epidural anesthesia. We compared postoperative pain scores (VAS) and opioid requirements among 47 patients receiving, in a randomized, double-blinded fashion, one of three intraarticular medications (20 ml): normal saline with 100 micrograms epinephrine (group 1, n = 16); 0.25% bupivacaine with 100 micrograms epinephrine (group 2, n = 15); and 3 mg morphine sulfate and 100 micrograms epinephrine in normal saline (group 3, n = 16). VAS scores were similar in the groups preoperatively and on arrival in the recovery room. At the end of the first postoperative hour, the residual sensory blockade was minimal in all three groups (mean = 3.8-4.1 segments) and almost total recovery occurred in all three groups before the second postoperative hour. The VAS in group 3 was not significantly different than group 1 at any time interval. Intraarticular bupivacaine (group 2) provided significantly better analgesia than did saline or morphine (group 1 or 3) in the first 2 postoperative hours (ANOVA, P < .05). Subsequent VAS scores were not significantly different in the three groups. While no patient in group 2 requested analgesics during the first postoperative hour, nine patients in group 3 required systemic analgesics (P < .01). We conclude that no evidence for a peripheral opiate-receptor mediated analgesia could be demonstrated in patients undergoing arthroscopic knee surgery under epidural anesthesia.
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PMID:Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. 146 65

The most frequently used postoperative analgesia techniques are intramuscular injection (IM) and patient controlled analgesia (PCA). Recently, the use of epidural catheter injection (EPI) has been done with success. This study was done to prospectively compare these three techniques for postoperative analgesia after extensive operations upon the colon and rectum. Patients were randomized to one of three analgesia groups--IM, intramuscular morphine sulfate; PCA, patient controlled morphine sulfate, and EPI, epidural morphine sulfate. Data collected included age, time to first bowel movement, amount of narcotic, number achieving 75 per cent of preoperative forced vital capacity, postoperative pruritus, headache, nausea and vomiting, respiratory depression, atelectasis or pneumonitis. A visual analog pain scale was used to evaluate postoperative pain severity (0, no; 1, partial; 2, marked, and 3, total relief). Sixty-eight patients were eligible for study (IM, 19; PCA, 22; EPI, 23, and excluded, four). The EPI group required significantly less daily narcotic compared with either the IM or PCA groups (17.0 +/- 6.12 milligrams; 67.8 +/- 26.8 milligrams; 40.5 +/- 20.6 milligrams, respectively, less than 0.05 ANOVA) and total narcotic (81.3 +/- 31.3 milligrams; 355.4 +/- 147.7 milligrams; 215.3 +/- 105.4 milligrams, respectively, p less than 0.05 ANOVA). EPI achieves excellent pain control in more patients with a significantly lower dose of narcotics and significantly fewer pulmonary complications. Therefore, epidural analgesia is the optimal method of postoperative analgesia after extensive abdominal operations.
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PMID:Epidural analgesia. 173 72

The central nervous system effect of acetaminophen (paracetamol) and acetylsalicylic acid was investigated in healthy volunteers according to a crossover, double-blind, and placebo-controlled design. Ten subjects received, by intravenous route, a placebo, 1 gm acetaminophen, and 1 gm acetylsalicylic acid. Analgesia was assessed by measurement of the subjective pain threshold and the objective nociceptive flexion reflex threshold in response to selective transcutaneous electrical stimulations. A close correlation was observed between subjective and objective pain thresholds. Acetaminophen increased both thresholds for more than 4 hours (24% and 23% of baseline value at 120 minutes, respectively; p less than 0.001, ANOVA). In contrast, acetylsalicylic acid had no noticeable effect on either threshold. These findings show that acetaminophen-induced analgesia is centrally mediated, in contrast to aspirin. The time delay between plasma concentration kinetics and acetaminophen analgesic effect is another argument in favor of its direct action on the central nervous system.
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PMID:Central analgesic effect of acetaminophen but not of aspirin. 201 24

Experimental data indicate that clonidine can induce marked analgesia. We characterized this effect in healthy volunteers and investigated possible links with the opioid peptide system by means of naloxone antagonism. According to a cross-over, double-blind, placebo-controlled design, 10 subjects received oral and i.v. placebo or clonidine (0.2 mg p.o.) or clonidine and naloxone (2.8 mg i.v. in 5 h). Analgesia was assessed by measurement of the subjective pain threshold (visual analog scale) and the objective nociceptive flexion reflex (R III) threshold after transcutaneous electrical stimulations. A correlation was observed between subjective and objective thresholds (r: 0.78). Oral clonidine alone or with naloxone increased subjective and objective pain thresholds for at least 4 hours (p less than 0.01, ANOVA). Naloxone tended to reinforce clonidine analgesia. Only moderate and well tolerated side-effects were observed.
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PMID:Objective assessment of clonidine analgesia in man and influence of naloxone. 218 59

Benzodiazepines are widely used as neuroleptics in anaesthesia, but they give rise to drowsiness at the end of surgery. Anexate is an imidazobenzodiazepine with specific antagonistic activity for benzodiazepines. We have administered 0.2 mg i.v. of the drug to 20 adult patients after anaesthesia with tiopentale (250 mg), pancuronium bromide (0.07 mg.kg-1), flunitrazepam (2 mg) and fentanyl (0.10 mg); after the first dose fentanyl was administered (0.10 mg) about every 30 minute. Analgesia was supplemented with nitrous oxide 66%. Blood pressure and heart rate did not changes significantly after Anexate; respiratory volume increased significantly in all cases (ANOVA P less than 0.001). Consciousness was rapidly resumed in all cases and patients demonstrated to be oriented in time and space soon after Anexate. In 14 out of 20 patients drowsiness reappeared after about 30 minute and further doses of 0.1 mg of the drug (to a maximum of 0.4 mg in some cases) were necessary. Side effects were rare and slight, their occurrence depending on the speed of administration. In our opinion a total dose of 0.3 to 0.4 mg Anexate is need to fully antagonize the sedative effect of 2 mg flunitrazepam.
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PMID:[Clinical evaluation of the efficacy of Ro 15-1788, Anexate after balanced intravenous anesthesia with flunitrazepam and fentanyl]. 251 85

The stainless steel cannulas were implanted to male rabbits of 2.0-2.6 kg, under Na-pentobarbital anaesthesia with the aid of a stereotaxic instrument. Co-ordinates of the locations of the implantations were P 9.5, LR 1.0, H 10.0 mm (under outer surface of the skull) on both sides of periaqueductal gray (PAG). After 1 wk, nociception was assessed by measuring the latency of the escape response (ERL) elicited by strong radiant heat focused on the nose of rabbits. The analgesic effect of morphine (4 mg/kg, iv) was blocked by injecting angiotensin II (AII, 0.1 microgram) into PAG (P less than 0.01, ANOVA), but not by injecting the same dose of AII into the vicinity of PAG (P greater than 0.05, ANOVA). Morphine tolerance was induced by iv infusion of morphine for 2 d, the dose being 50 mg/(kg.8 h) on d 1 and 75 mg/(kg.8 h) on d 2. On d 3, the degree of tolerance was checked by the analgesia induced by iv morphine 4 mg/kg. Tolerance was partly reversed by injecting AII anti-serum 2 microliters into PAG(P less than 0.01, ANOVA). The results suggest that AII in PAG is antagonistic to morphine analgesia and is involved in the development of morphine tolerance.
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PMID:[Antagonism to morphine analgesia and involvement in morphine tolerance of angiotensin II in periaqueductal gray of the rabbits]. 262 10

The investigation was carried out in 80 patients scheduled for transurethral resection of prostate (TUR-P). All patients were ASA I or II, and received no premedication. Before anesthesia, elastic bandages were applied to both lower extremities and 6 mL/kg of G/S (5% Glucose in 0.9% saline solution) was administered by intravenous infusion. The patient was placed in the lateral position and dural puncture was performed at the L3-4 interspace using a standard midline approach with a 23 gauge spinal needle. The patients were allocated randomly to four groups, each group consisting of 20 patients. Three mL of 0.5% Bupivacaine was administered in group A; 3 mL of 0.5% Bupivacaine with 1 mL 10% G/W (Glucose water) in group B; 2 mL of 0.5% Bupivacaine with 1 mL 10% G/W in group C and 3 mL of 0.5% Bupivacaine in 8% glucose in group D. Assessment of the sensory and motor blockade and measurement of arterial pressure and heart rate were performed after injection. All data were analyzed by ANOVA. A p value of less than 0.05 was considered statistically significant. The results showed that the duration of analgesia with plain Bupivacaine was shorter than with hyperbaric Bupivacaine (2.59 +/- 0.81 h vs 3.12 +/- 0.72 h, P less than 0.05). The maximum cephalad spread of analgesia was lower with plain Bupivacaine (T 9 +/- 2 vs T 7 +/- 2, P less than 0.05). Patients receiving either 3 mL or 4 mL of hyperbaric bupivacaine were similar in regard to duration and maximum cephalad spread of analgesia, but the effect on the cardiovascular system was more severe in the group receiving 4 mL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spinal anesthesia with bupivacaine for transurethral resection of prostate: effects of specific gravity, volume and dose]. 279 18

Tiapride was used as premedication on a series of 16 patients subsequently submitted to general anesthesia with ketamine. In order to compare the effects of tiapride on the incidence of visionary dreams, hallucinations and dyslepsic syndrome brought about by, this series was compared with 2 further series of patients premedicated with dihydrobenzoperidol plus fentanyl (15 patients) and diazepam plus haloperidol (11 patients). Effectiveness was evaluated by means of a 10 point recovery scale (1: rate of sedation; 2: anterior amnesia; 3: comprehensiveness and collaboration test; 4: space sense and time orientation; 5: Bender test; 6: dysleptic syndrome; 7: sick feeling and vomit; 8: subjective status; 9: recovery quality; 10: dreams and hallucinations) at 15, 30 and 60 minutes after the administration of the different premedications. General tolerance was evaluated by continuous quantification of vital signs: pulse rate, EKG and systolic, diastolic and mean blood pressures. The effects were analysed with ANOVA one-way, Newman-Keuls and t-paired tests. Premedication with 7.5 mg/kg of tiapride significantly reduced the incidence of dreaming, provided the necessary sedation and appropiate postoperative analgesia and rapid recovery of psychomotor coordination with no obvious alterations in haemodynamic parameters attributable to the selective blocking action of the dopaminergic receptors. The association tiapride-ketamine may be useful in anesthesia for day-case surgery.
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PMID:[A tiapride and ketamine combination in short duration anesthesia]. 279 22

Efficient analgesia may be the major objective in the cardiovascular risk patient following myocardial infarction, acute occlusion of peripheral vessels, or dissection/perforation of major abdominal vessels. It was the purpose of the study to investigate the haemodynamic and respiratory side effects of eight different opioids in 57 circulatory risk patients prior to major vascular surgery. METHODS. Patients were randomly allocated to eight groups, each receiving a different opioid within a clinical, equipotent dose range (buprenorphine, fentanyl, morphine, nalbuphine, pentazocine, pethidine, tramadol, alfentanil). A complete haemodynamic and blood gas status was obtained prior to as well as 5, 10, 15, and 20 min following opioid administration. Monitoring included a complete invasive haemodynamic and blood gas status. Statistical evaluation was performed by 1- and 2-factorial ANOVA (P < 0.05). RESULTS. Significant time effects (changes from baseline at the time of measurement) were observed for heart rate and total peripheral resistance, while significant group (group-specific differences in the course of values at the different times of measurements) and time effects were noted for mean pulmonary artery pressure, pulmonary capillary wedge pressure, stroke volume index, and PaO2. No major effects were observed following morphine, fentanyl, alfentanil, tramadol, and nalbuphine. Buprenorphine caused distinct respiratory depression accompanied by an increase in pulmonary vascular tone. Pentazocine and pethidine caused a significant increase in MPAP and peripheral vascular resistance while pethidine also produced marked respiratory depression. CONCLUSIONS. For interpretation of the results, factors such as respiratory depression, histamine release, secretion of endogenous catecholamines, and hypoxia-induced pulmonary vasoconstriction have to be discussed. Tramadol, an opioid with moderate potency, seems to offer some advantages due to its minor cardiovascular and respiratory side effects.
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PMID:[Different opioids in patients at cardiovascular risk. Comparison of central and peripheral hemodynamic adverse effects]. 784 Apr 3

The spread and intensity of lumbar epidural anaesthesia are unpredictable. Moreover, segments L5 and S1 are frequently missed. In this study the effect of 30 degrees trunk elevation on the spread and intensity of lumbar epidural sensory and motor blockade and on the cardiovascular system were studied. METHODS. After oral premedication with 7.5 mg midazolam, 30 patients 20 to 40 years of age, ASA 1-2, were randomly allocated to one of two groups according to their body position during injection of 20 ml 2% lidocaine (3 + 8 + 9 ml) into a lumbar epidural catheter (L2/3 or L3/4) and during the following 30 min: supine horizontal position or supine 30 degrees trunk elevation with 30 degrees leg elevation (hammock position). The patients received 500 ml Ringer solution before the epidural injection, followed by more Ringer solution. Systolic and diastolic blood pressures and heart rate were monitored noninvasively every 5 min; 30 min after the epidural injection the spread of analgesia (dullness of pinprick) and anaesthesia (no sensation of pinprick) as well as motor block according to Bromage were tested. A spread of anaesthetic segments including T12 to L3 was considered adequate for hip surgery, L3 to L5 for knee surgery, and L3 to S2 for foot surgery. Student's t-test, ANOVA, chi-square (Wilcoxon), and Mann-Whitney tests were used for statistical analysis. P < 0.05 was considered statistically significant. RESULTS. The median cephalad level of analgesia was lower in patients with the hammock position than those with the horizontal position (L1 vs T10; P < 0.05). There was no significant difference in the cranial level of anaesthesia (L2 vs L1) (Table 2). No significant difference was seen in the number of patients having adequate anaesthesia for hip surgery. Anaesthesia in the segments L5 and S1 was seen in 2/15 patients in the horizontal position and 8/15 patients in the hammock position (P < 0.05). The hammock position resulted in a higher percentage of patients having adequate anaesthesia for knee surgery (60% vs 13%; P < 0.05) and foot surgery (53% vs 13%; P < 0.05) (Table 3). Motor block was more profound in patients in the hammock position (Table 4). Blood pressure and heart rate did not change significantly in patients in the horizontal position (Fig. 1); there was a decrease in both systolic (7 mmHg) and diastolic (5 mmHg) blood pressures in patients in the hammock position. Heart rate did not change significantly (Fig. 2). No patient needed vasopressor support; the body position could be maintained in all patients during the observation period. One or two epidural reinjections according to the spread of anaesthesia 30 min after the first injection and to the scheduled operation resulted in adequate anaesthesia in every patient. DISCUSSION. More patients in the hammock position developed adequate anaesthesia in the relevant segments for knee and foot operations than patients in the horizontal position. These included the frequently missed segments L5 and S1. Patients in the hammock position had a clinically insignificant drop in systolic and diastolic blood pressure. In contrast to the young and healthy patients in this study, more severe cardiovascular changes might result in geriatric and/or ill patients subjected to a hammock position. For this reason, use of the technique in geriatric and/or ill patients requires special attention.
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PMID:[30 degree trunk elevation of the patient and quality of lumbar epidural anesthesia. Effects of elevation in operations on the lower extremities]. 827 91

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