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

Three-day-old Sprague-Dawley rat pups were intracisternally infused with a single dose of oxytocin (1 microgram/2 microliters) or saline, or were untreated. As adults, these animals were observed for novelty-induced grooming, analgesia measured by the hot-plate test, and behavior in the open field. Oxytocin treatment during infancy resulted in an elevation of novelty-induced grooming when compared to saline and untreated animals. There were no significant oxytocin treatment effects on analgesia response or open-field behaviors. Oxytocin given early in life may have permanent effects on certain behavioral responses to stress.
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PMID:Neonatal administration of oxytocin increases novelty-induced grooming in the adult rat. 258 97

The perinatal mortality in 1498 patients with one or more previous cesarean section scars delivered between 1972 and 1982 was analyzed. Repeat elective cesarean section was performed in 654 (44%) patients and 844 (56%) were subjected to a "trial of scar." Successful vaginal delivery occurred in 702 (83%) patients and 142 (17%) had emergency repeat operations. There were 46 perinatal deaths, giving a perinatal mortality rate (PMR) of 30.3/1000. It was lowest in patients who electively had a cesarean section (10.6/1000). The corrected PMR was twice as high in the trial of scar group. The PMR for the overall hospital population (27,072 babies) during the study period was 22.5/1000. There were four perinatal deaths in association with dehiscence of the uterine scar. The PMR in trial of scar patients decreased from 40/1000 to less than 20/1000 without a major change in policy. Meanwhile the unit cesarean section rate increased from 5 to 10%, but the repeat section rate was consistent at around 38.5%. Regional analgesia was used in 192 patients, for repeat section in five and trial of scar in 187. Oxytocin was given to 546 (65%) patients. Scar rupture is considered the major contraindication to a trial of scar, but emphasis was not laid on the possible increased perinatal mortality with this procedure before the 1980s. In view of the improvement in the PMR and the added risk to the mother with cesarean delivery, we advocate a policy of trial of scar with informed consent in selected cases.
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PMID:Delivery following cesarean section and perinatal mortality. 291 Mar 25

In a 30-month period, 261 of 557 (46.8%) patients underwent a trial of labor. Of these, 215 patients (82.4%) achieved vaginal delivery. The major controversial issues regarding vaginal delivery in patients with a prior cesarean section are oxytocin administration, the inclusion of patients with recurring indications, and the use of epidural analgesia. Oxytocin was not used in this study. When our results were compared to those of others who used oxytocin liberally we found that oxytocin augmentation was not a major factor in increasing significantly the success and vaginal delivery rate. We believe that oxytocin usage should be reserved for selected patients with well-defined indications. When the primary cesarean section was for cephalopelvic disproportion, 66.6% delivered vaginally. This success rate justifies the inclusion of these patients in a trial of labor. Epidural analgesia proved to be a safe and efficient procedure. There was no maternal or perinatal mortality related to trial of labor.
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PMID:Trial of labor without oxytocin in patients with a previous cesarean section. 356 82

Oxytocin concentrations were determined in serial peripheral plasma samples collected from clinically normal women during pregnancy and labor. Measurable concentrations of this hormone were detected in all maternal plasma samples during pregnancy, but there were wide differences in values between patients. Serial samples from individual patients revealed a pattern of gradual rise of oxytocin levels with advancing gestation and the increase in concentration was statistically significant. There were no significant differences in oxytocin levels at any stage of labor, with or without epidural analgesia. Oxytocin levels at the onset of the second stage did not differ statistically from those at crowning. Comparison of cross-sectional data showed no significant difference between the mean oxytocin concentration in early labor and in late pregnancy. Oxytocin surges occurred, but not in a regular pattern. Plasma oxytocin concentration did not increase after pelvic examination, sweeping of the membranes, low amniotomy or after cervical vibration. After spontaneous vaginal delivery, umbilical arterial plasma levels of oxytocin were consistently higher than plasma concentrations from the umbilical vein. The fetal arterio-venous difference was less pronounced at elective cesarean section. At spontaneous vaginal delivery, with and without epidural anesthesia, plasma levels from the umbilical artery were significantly higher than the maternal levels. After vaginal delivery, oxytocin levels in cord plasma were significantly higher than at elective abdominal delivery. Some methodological aspects with regard to blood sampling and to plasma oxytocin radioimmunoassay procedures are discussed. From the results presented it is concluded that the human fetus can be an important source of oxytocin and that neurohumoral birth reflexes described in animals do not occur systematically in man.
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PMID:Plasma oxytocin in human pregnancy and parturition. 389 56

A prospective study of 1,000 consecutive primigravid deliveries has shown that active management in labour can ensure that every woman is delivered within 24 hours. Emphasis is laid on the importance of a correct initial diagnosis of labour based on objective criteria. Amniotomy followed by oxytocin infusion is advocated to simulate the progress of normal labour unless this is evident from an early stage.Oxytocin, the dose of which is limited only by foetal distress, cannot be used effectively unless three popular fallacies are rejected. Firstly, that prolonged labour is often an expression of cephalo-pelvic disproportion; secondly, that oxytocin may rupture the primigravid uterus; and, thirdly, that there is a valid therapeutic distinction between hypotonic and hypertonic uterine action.Stimulation, properly supervised, is safe to mother and child, it eliminates the problem of occipitoposterior position, results in a sharp decline in forceps delivery, and obviates the need for massive analgesia.
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PMID:Prevention of prolonged labour. 577 78

Recent neuroanatomical and behavioral evidence has indicated that vasopressin (VP) increases pain thresholds. In the present study intracerebroventricular (ICV) administration of both arginine VP (AVP: 75-500 ng) and 1-deamino-8-D-arginine vasopressin (DDAVP: 150-500 ng) elevated tail flick latencies. Oxytocin (OXY, ICV), also elevated tail-flick latencies (150-1000 ng); however this increase was accompanied by "barrel-roll" seizure activity. VP analgesia was eliminated by pretreatment with 1-deamino-penicillamine-2(O-methyl)tyrosine-AVP (dPTyr(me)AVP: 500 ng, ICV), a VP antagonist, but not naloxone (1 or 10 micrograms, ICV), suggesting that VP modulates nonciceptive thresholds through its own binding sites. Conversely, pretreatment with naloxone (1 micrograms, ICV) but not dPTyr(me)AVP (1 microgram, ICV) attenuated the analgesic efficacy of systemic morphine (10 mg/kg), further dissociating VP and central opiate analgesic processes. Finally, systemic pretreatment with dexamethasone potentiated VP analgesia. These data support the notion that VP is a specific non-opioid pain inhibitor.
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PMID:Vasopressin analgesia: specificity of action and non-opioid effects. 649 25

The potency of opiates for suppressing oxytocin release relative to their potency as analgesics was tested in lactating rats. Oxytocin release was evoked by the sucking of the young in urethane-anaesthetized and unanaesthetized rats, and was detected by the characteristic behaviour of the young and milk yield respectively. The tail-flick test, using noxious radiant heat, was used to assess analgesia. Intraperitoneal injection of morphine (1 mg kg-1 and 5 mg kg-1) significantly reduced milk yield in unanaesthetized rats. Urethane-anaesthetized rats displayed a pattern of reflex milk-ejection responses similar to that found in conscious rats. This reflex was significantly inhibited in a dose-related, naloxone-reversible manner by buprenorphine (ED50 0.18 mg kg-1), meptazinol (ED50: 14.0 mg kg-1), morphine (ED50: 0.67 mg kg-1), pentazocine (ED50: 15.0 mg kg-1) and pethidine (ED50: 7.9 mg kg-1). Although intraperitoneal injection of morphine (5 mg kg-1) abolished the increase in intramammary pressure occurring at reflex milk-ejection, that evoked by intravenous oxytocin (0.5-1 mu) was unaffected. Each opiate also caused significant, dose-related, naloxone-reversible increases in tail-flick latency. The ED50 doses were buprenorphine (ED50: 0.14 mg kg-1), meptazinol (ED50: 12.5 mg kg-1), morphine (ED50: 5.0 mg kg-1), pentazocine (ED50: 12.5 mg kg-1) and pethidine (ED50: 6.1 mg kg-1). The order of potency for analgesia and for suppression of oxytocin release were identical, namely: buprenorphine greater than morphine greater than pethidine greater than meptazinol greater than pentazocine. The results obtained with lactating rats suggest that secretion of the hormone oxytocin is substantially reduced during opiate-induced analgesia.
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PMID:A comparison of analgesia and suppression of oxytocin release by opiates. 654 45

A descriptive study of 300 consecutive spontaneous labors in primigravid patients whose pregnancies were of 37 or more weeks' gestation with a singleton fetus in the vertex presentation, showed a cesarean section rate of 13%, a forceps delivery rate of 49%, and a spontaneous delivery rate of 38%. Oxytocin was used in 17% and epidural analgesia was used in 75% of the patients. The median rate for cervical dilatation for those women with spontaneous deliveries was 2 cm/hr (interquartile range = 1.5 to 3.3 cm/hr) and for those delivered with forceps, 1.2 cm/hr (interquartile range = 0.9 to 1.8 cm/hr). When labor was prolonged by 4 hours or more, the cesarean section rate rose to 34%. Oxytocin was used in only 41% of these patients. Of 23 women delivered by cesarean section for dystocia/disproportion, only nine received oxytocin. From the low incidence of low Apgar scores in all labor groups from this series, there would not appear to be a fetal advantage to earlier intervention. Although the suggestion from this study is that oxytocin administration when labor is prolonged by 4 hours will reduce the need for cesarean section, the true value of such an intervention can be tested only by a randomized controlled trial.
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PMID:The outcome of prolonged labor as defined by partography and the use of oxytocin: a descriptive study. 684 52

The effect of systemically administered oxytocin and a specific oxytocin antagonist, 1-deamino-2-D-Tyr(OEt)-4-Thr-8-Orn-oxytocin, on heat pain sensitivity was examined in rats. Intraperitoneal (i.p.) oxytocin at 1 mg/kg, but not at 0.1 and 0.3 mg/kg, significantly increased response latencies on the hot-plate test. However, the rats displayed clear signs of sedation, motor impairment and vasoconstriction after 1 mg/kg oxytocin. Skin temperature on the plantar surface of the hind paws was also significantly decreased by this dose of oxytocin. The oxytocin antagonist (1 mg/kg i.p.) did not influence response latency. Since increased response latency was not the only behavioral effect of oxytocin, we conducted electrophysiological experiments to examine the effect of systemic oxytocin on the nociceptive flexor reflex in decerebrate, spinalized, unanesthetized rats. Oxytocin at 0.1 mg/kg i.p. did not influence flexor reflex magnitude, mean blood pressure or heart rate. Oxytocin at 0.3 and 1 mg/kg caused a gradual increase in blood pressure with stronger effect observed with 1 mg/kg. Neither 0.3 nor 1 mg/kg oxytocin significantly influenced the flexor reflex magnitude and heart rate. We thus conclude that systemic oxytocin did not produce analgesia in rats and the observed increase in response latency in the hot-plate test may result from the sedative and vasoconstrictive effects of this peptide. Furthermore, since the oxytocin antagonist did not significantly alter response latency on the hot-plate test, it is unlikely that endogenous oxytocin exerts a tonic effect on the pain threshold in rats.
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PMID:Is systemically administered oxytocin an analgesic in rats? 809 May 16

Recent clinical attention has focused upon the rising rate of caesarean sections being performed and whether patients with a previous caesarean section should be allowed a vaginal delivery. In this paper, the worldwide trend of caesarean section and the role of trial of scar following single and multiple caesarean surgery is reviewed. The role of oxytocin and regional epidural analgesia is evaluated as well as perinatal and maternal mortality. On the basis of the available data, there is no justification for the current clinical practice of almost 99% prevalence of elective repeat caesarean section in some hospitals in the North America. Oxytocin and epidural analgesia, when carefully monitored, are safe and reasonable in these patients. Watchful waiting has always been an essential virtue in obstetric management and should not be replaced by hopeful expectancy. This aspect of the art of obstetrics would appear to require rejuvenation if we are to stem the rising tide of caesarean sections.
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PMID:Post caesarean section delivery. 828 13


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