Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Changes of plasma catecholamines during surgery performed in the presence of a combined electrical stimulation analgesia were studied in 11 patients undergoing open heart surgery and in 5 patients undergoing abdominal operations. Stimulation was applied through 2 needles attached subcutaneously to each ear. In 8 of the 11 patients undergoing open heart surgery an up to 20 fold increase in the level of adrenaline in plasma was observed intraoperatively indicating a massive activation of the adrenal medulla. Adrenaline remained elevated also in the postoperative period. The level of noradrenaline did not increase either during the intra- or during the postoperative period. In contrast no changes in adrenaline or noradrenaline could be demonstrated in the remaining 3 patients in whom the concentration of the catecholamines was in the lower normal range. In 5 patients with abdominal surgery noradrenaline was elevated additionally to the increase of adrenaline in the intra- and postoperative period. The increase in the activity of the sympathetic nervous system was associated in these patients with an increase in heart rate and systolic as well as diastolic blood pressure. On the basis of these results the use of a combined electrical stimulation analgesia for abdominal surgery in patients at risk and for open heart surgery is questioned.
 ...
PMID:[Plasma catecholamines in open heart surgery and abdominal operations using a combined electrical stimulation analgesia (author's transl)]. 39 25

Plasma epinephrine and norepinephrine concentrations during labor and immediately after delivery were compared to those of the third trimester in 21 uncomplicated pregnancies of married primigravid women, 20 to 32 years old. Third-trimester catecholamine concentrations were similar to those of normal, nonpregnant subjects; samples were obtained under identical conditions. Compared to third-trimester levels, significant elevations of plasma epinephrine and norepinephrine were found in three phases of labor (at 3 to 5 cm. and 9 to 10 cm. of cervical dilatation and immediately after delivery). Epinephrine values returned to normal within three to 21 minutes after delivery; norepinephrine values remained high or continued to rise in this time interval. Maternal analgesia and anesthesia influenced plasma catecholamine levels.
 ...
PMID:Endogenous plasma epinephrine and norepinephrine in last-trimester pregnancy and labor. 90 Jan 69

A questionnaire on the use of adrenaline in obstetric analgesia was completed by 87 obstetric anaesthetists: 71% of consultants in teaching hospitals were prepared to use adrenaline mixed with local anaesthetics compared with 33% of consultants in district hospitals; they had a similar duration of obstetric anaesthetic experience. Test doses containing adrenaline were not commonly used in labour, but were more often used prior to elective Caesarean section. Adrenaline was used with either lignocaine or bupivacaine; few consultants used both solutions. Contraindications to the use of adrenaline in the nonuser group were in decreasing order of rank: neurological damage, pregnancy-induced hypertension, stenotic valvular heart disease, sickle cell disease or trait of fetal distress. Overall, the contraindications related to the systemic absorption of adrenaline were most common.
 ...
PMID:Use of adrenaline in obstetric analgesia. 146 45

We compared the analgesia, side effects, and plasma concentrations of buprenorphine and fentanyl in a double-blind study of 78 parturients receiving one of these drugs by patient-controlled epidural infusion after elective cesarean section with epidural anesthesia. Patients were randomized to three epidural infusion groups: group 1 (n = 26), 3 micrograms/mL buprenorphine with 0.015% bupivacaine and 1 microgram/mL epinephrine; group 2 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine and 1 microgram/mL epinephrine; and group 3 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine. Plasma for determination of opioid concentrations was obtained in some subjects in each group at intervals up to 48 h during the infusion and in some subjects from each group at intervals after the infusion was stopped. Pain relief was similar and satisfactory in all three groups. The median overall satisfaction scores were high for all three groups. Pruritus was more common in the fentanyl groups (P less than 0.05). However, vomiting was more disturbing to the patients and seen only with buprenorphine. No patient had a respiratory rate less than 12 breaths/min. Epinephrine use was associated with a slower infusion rate (P less than 0.05, group 2 vs 3). All patients were able to ambulate without difficulty. Mean opioid plasma concentrations did not exceed 1.5 ng/mL. Thus, epidural patient-controlled analgesia in all three groups provided excellent analgesia, permitted ambulation, and was without serious side effects. Epidural buprenorphine offered no advantages over epidural fentanyl.
 ...
PMID:Epidural patient-controlled analgesia after cesarean section: buprenorphine-0.015% bupivacaine with epinephrine versus fentanyl-0.015% bupivacaine with and without epinephrine. 850 57

Premature infants are capable of mounting physiologic and metabolic responses to pain. Systemic and local anesthesia reduce stress responses to major and minor surgical procedures. We evaluated the effects of local anesthesia (5 mg/kg lidocaine) preceded by either 1 mg/kg secobarbital (S) intravenously or by 2 micrograms/kg fentanyl (F) intravenously on the stress response to Broviac catheter placement. Twenty-nine premature infants ages 5 to 30 days, weighing between 650 and 1350 gm, were randomly assigned to either S or F groups. Age, birthweight, sex, race, and severity of illness were similar among S and F groups. Heart rate and blood pressure remained unchanged throughout the procedure. Oxygen saturation (O2sat) declined significantly in both groups during skin preparation and wound closure, but not during incision, dissection, or tunneling. In spite of fractional inspired oxygen adjustments made in 13 of 14 S- and 3 of 15 F-treated patients, decline in O2sat was more common and more pronounced (p less than 0.01) in S-treated babies. Hyperglycemic responses occurred in all S- and in none of the F-treated patients (p less than 0.001). Norepinephrine plasma concentrations did not change during Broviac catheter placement in either F or S group. Epinephrine concentrations were more elevated in S- than in F-treated patients, although these differences were not statistically significant. Low-dose fentanyl analgesia effectively complements local lidocaine anesthesia during Broviac catheter placement. Sedatives neither abolish metabolic responses to surgical stress nor prevent profound and persistent oxygen desaturation.
 ...
PMID:Analgesia versus sedation during Broviac catheter placement. 174 75

Epidural sufentanil was administered to 57 women after Caesarean section, under epidural anaesthesia, to provide postoperative analgesia. Each patient received a 30 micrograms dose at the first complaint of pain and this dose was repeated when pain recurred. Epinephrine (1:200,000) was added to the local anaesthetic, sufentanil, both, or neither. The time of onset of analgesia, efficacy, duration of analgesia and the incidence of side-effects were recorded. This dose of epidural sufentanil provided satisfactory postoperative analgesia and no serious side-effects were observed. The onset of analgesia was rapid (4-6 min), but the duration of action was brief (4-5 hr). The addition of 1:200,000 epinephrine had no statistically significant influence on any of the measured variables. Pruritus occurred commonly but never required treatment. Drowsiness was experienced frequently and was felt by some patients to inhibit their interaction with their neonates. Respiratory depression, as defined by a respiratory rate less than 10 bpm, was not observed. A number of patients noted a transient period of euphoria 5-8 min after administration of the epidural sufentanil. The authors feel that epidural sufentanil provides satisfactory analgesia after Caesarean section, but the brief duration of action and the high incidence of drowsiness limit its acceptability for routine use in obstetric patients.
 ...
PMID:Epidural sufentanil for post-caesarean section analgesia: lack of benefit of epinephrine. 197 Nov 98

Alpha-agonists are frequently added to local anaesthetic agents to prolong the duration of spinal or extradural anaesthesia. Adrenaline and phenylephrine have been employed most commonly for this purpose. Recent controlled studies indicated that the alpha-adrenoceptor agonist clonidine, when administered spinally, has a dose-dependent antinociceptive effect. Clonidine seems to be as effective as adrenaline to prolong the duration of local anaesthetic blocks and is useful to decrease the incidence of tourniquet pain under spinal anaesthesia. As they improve the intensity and duration of opioid analgesia, intraspinal alpha-agonists have also a synergic analgesic effect with spinal opioids. Alpha-agonist effects are due: 1) to an activation of the post and/or presynaptic alpha 2-adrenoceptors in the substantia gelatinosa of the spinal cord, 2) to a local vasoconstriction by stimulating vascular smooth muscle alpha-receptors which decrease the rate of absorption of local anaesthetics from the subarachnoid or extradural space, 3) to a co-activation of the spinal opioid and alpha-adrenergic receptors at the spinal cord level. However, spinally administered alpha-agonists have side effects, which include vasoconstriction in the spinal cord, hypotension, bradycardia or tachycardia, somnolence and respiratory depression. To minimize such complications, great care may be needed, which is described in this review, assessing the minimal required amount of alpha-agonists and effective clinical monitoring. The development of this technique in the management of subarachnoid and extradural anaesthesia and of chronic pain is discussed.
 ...
PMID:[Intrathecal and epidural administration of alpha adrenergic receptor agonists]. 197 1

The experience with sacral anesthesia is reported on a total of 513 proctologic patients. From them, 105 cases were submitted to the sacral anesthesia without extradural morphine application, and 308 cases were anesthesized with simultaneous extradural administration of morphine. Easy in applicability, the sacral anesthesia is such an analgesic procedure which results in no complications and may be employed mainly in elder patients. The anesthetics prolonged in action (those similar in type with Bupivacain, Marcain) together with extradural morphine administration are also effective in respect with postoperative analgesia. An average time of postoperative analgesia represents 53 +/- 23.4 hrs. when 2 mg/kg Bupivacain, 0005% Epinephrine and 5 mg Morphinum hydrochloricum are applied, respectively.
 ...
PMID:[Sacral anesthesia in proctology]. 226 11

A descriptive analysis of the progression of epidural block with repeated doses of 0.25% bupivacaine was performed, assessing pain relief (visual analog scoring), dermatomal spread of sensory and motor block, and the associated management and outcome of labor. The influence of epinephrine 1:200,000 on these observations was also assessed by the random assignment of study patients into two groups, one receiving 10 ml of 0.25% bupivacaine plain (n = 28) and another group receiving 10 ml of 0.25% bupivacaine with commercially added epinephrine 1:200,000 (n = 27). Only primigravid patients were studied. Data comparisons were considered significant at p less than 0.05. With repeated doses of 0.25% bupivacaine, administered within fixed dosing intervals of 60-90 minutes, there was an increasing spread of sensory block toward sacral dermatomes while the upper level of sensory block did not change. Sacral sensory analgesia was present in only 3.5% of patients after the first dose of bupivacaine but was evident in 63.2% of patients following the fourth epidural injection. A similar increase in the number of patients with significant motor weakness was also seen as the number of top-up doses increased. A comparison of patients receiving plain solutions and epinephrine containing bupivacaine showed similar demographic profiles between the groups. Both groups received a similar dose of bupivacaine and experienced comparable management and outcome of labor. Epinephrine in a 1:200,000 concentration did not influence the changing characteristics of the epidural block over time. The duration of labor was not significantly different between groups (10.3 +/- 5.2 hours for the plain group and 11.0 +/- 4.7 hours for the epinephrine group).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Sacralization of epidural block with repeated doses of 0.25% bupivacaine during labor. 229 81

Epidural injection of drug combinations may decrease toxicity by decreasing the dose of each component, but may also result in detrimental drug interactions. In this study interactions among bupivaciane, fentanyl, epinephrine, 2-chloroprocaine, and lidocaine for epidural analgesia during labor were examined. In part 1 of the study, healthy parturients received in a random manner either 10 ml of 0.25% bupivacaine with 5 micrograms/ml fentanyl (n = 50), or 10 ml of this combination with 3.33 micrograms/ml freshly added epinephrine (n = 50). Epinephrine prolonged the median duration of pain relief (180 vs. 138 min, P less than 0.05) without affecting duration of first or second stages of labor, or neonatal Apgar scores. Blood pressure decreased slightly more in those receiving epinephrine, although the incidence of hypotension requiring treatment did not differ between groups. Part 2 of the study evaluated the possibility that local anesthetic used for confirming catheter tip location may interfere with the analgesic action of this bupivacaine-fentanyl-epinephrine (BFE) combination. In 50 additional parturients, a test dose of either 2-chloroprocaine (n = 25) or lidocaine (n = 25) was injected through the epidural catheter and was followed by injection of the BFE mixture. The lidocaine test dose group had a greater duration of analgesia than the 2-chloroprocaine test dose group (median duration of 164 vs. 91 min, P less than 0.05). The authors conclude that the addition of epinephrine 3.33 micrograms/ml significantly increases the duration of analgesia obtained from 0.25% bupivacaine with 5 micrograms/ml fentanyl. However, prior injection of 2-chloroprocaine, but not lidocaine, significantly decreases the duration of analgesia achieved with this BFE mixture.
 ...
PMID:Labor analgesia with epidural bupivacaine plus fentanyl: enhancement with epinephrine and inhibition with 2-chloroprocaine. 232 78


1 2 3 4 5 6 Next >>