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)

In a randomized double-blind study etidocaine 1.5% without a vasoconstrictor (n = 10), with adrenaline 1:200,000 (n = 10) and with ornipressine 1 IU/10 ml (n = 10) were administered epidurally to 30 orthopaedic patients. Sensory blockade was tested with electric pain stimuli; motor blockade was assessed with dynamometry during isometric plantar flexion of the foot and with the Bromage score; the intraoperative analgesia was determined as well. The development of sensory and motor blockade became faster and more intensive by addition of the two vasoconstrictors. The intraoperative analgesia, insufficient without vasoconstrictors, however, not to full satisfaction. Adrenaline improved the effects of etidocaine more than did ornipressine . The sole use of etidocaine without and with vasoconstrictors is not recommended for epidural anaesthesia for surgery of the lower extremities. It is the local anaesthetic of choice for intensifying motor blockade during already achieved analgesia.
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PMID:[Peridural anesthesia with etidocaine. Clinical studies on the effect of vasoconstrictors on sensory and motor blockade]. 637 74

Intrathecal ketamine, which has not previously been described in man, has been administered to 16 patients with war injuries of the lower limbs. The first five received varying doses from 5 to 50 mg in a volume of 3 ml of 5% dextrose, to determine a dose-response curve (Group 1). The optimal dose was then administered to a further 11 patients who received ketamine 50 mg in a volume of 3 ml in 5% dextrose with the addition of adrenaline 0.1 mg (Group 2). A distinct sensory level was obtained in all patients. In Group 2, nine of the eleven patients obtained satisfactory surgical analgesia and two required supplementation with local anaesthetic. Central effects (drowsiness, dizziness, and nystagmus) also occurred in nine patients, but they remained conscious throughout; one patient experienced no central effects, and one patient developed dissociative anaesthesia. Central effects were more intense the higher level of block. There were no significant changes in mean systolic arterial blood pressure, pulse, or respiratory rates. Surgical analgesia for the blocked dermatomes lasted for a mean of 58 minutes (range 45-90), and recovery was complete and uncomplicated; mild generalised analgesia persisted for a further one to three hours following return of sensation. Ketamine alone did not produce motor block, but addition of adrenaline resulted in complete motor block, and may have intensified sensory blockade. Motor loss persisted for the same duration as surgical analgesia. Adrenaline neither delayed the onset of central effects, nor reduced their intensity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intrathecal ketamine for war surgery. A preliminary study under field conditions. 649 99

Sufficient placental blood flow is mandatory for the well-being of the fetus. The delicate balance between uterine perfusion pressure and uterine vascular resistance can be critically disturbed during epidural anaesthesia. Maternal hypotension is common when extensive block for Caesarean Section is used. If hypotension as well as aortocaval compression is avoided and sufficient preload (Ringer's lactate) is used intervillous blood flow (IBF) will not significantly change. Ephedrine given to prevent or treat maternal hypotension will not adversely effect IBF. Lumbar epidural analgesia used for pain relief during labor (10 ml dose of local anaesthetic (1.a.] will significantly (p less than 0.05) improve IBF in healthy parturients. Epinephrine (less than or equal to 50 micrograms), added to the local anaesthetic, will not decrease IBF. IBF can be severely reduced in pregnancy-induced hypertension (PIH) since the fetus is chronically asphyxiated it is crucial to avoid any further decrease in IBF. Extensive sympathetic blockade (T8) using epidural analgesia (10 ml dose of 1.a.) has been shown to significantly (p less than 0.01) improve IBF in parturients with PIH by decreasing uteroplacental vascular resistance.
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PMID:Regional anaesthesia and uterine blood flow. 649 7

A variety of environmental stimuli have been demonstrated to produce behavioral analgesia. Of these, footshock has been shown to be capable of differentially eliciting opiate or non-opiate analgesia dependent upon the body region shocked; front paw and hind paw shock produce opiate and non-opiate analgesia, respectively. In addition, footshock can be used as a conditioned stimulus to elicit classically conditioned opiate analgesia. A question which arises is whether such plain inhibition is mediated by neural or hormonal pathways. Evidence exists which suggests that endogenous opioids in the pituitary and adrenal medulla may be involved in the production of environmentally induced analgesia. Furthermore, epinephrine administration has previously been shown to produce pronounced pain inhibition. However, the present series of experiments demonstrate that the pituitary-adrenal cortical and sympathetic-adrenal medullary axes are neither necessary nor sufficient for the production of footshock induced analgesia (FSIA). Hypophysectomy failed to attenuate front paw FSIA, hind paw FSIA or classically conditioned analgesia indicating that pituitary beta-endorphin or other pituitary factors are not necessary for the production of analgesia. Adrenal opioids and peripheral catecholamines are also not critical since front paw FSIA was potentiated by adrenalectomy or total sympathetic blockade. Furthermore, pituitary and sympathetic activation are not sufficient for the production of analgesia since low thoracic spinalization allows normal hormonal response to front paw shock yet abolishes shock-induced inhibition of the spinally mediated tail flick reflex. These results provide strong evidence that front paw FSIA, hind paw FSIA and classically conditioned analgesia are mediated by neural, rather than hormonal pathways and provide further parallels between these forms of environmental analgesia, morphine analgesia and brain stimulation produced analgesia.
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PMID:Footshock induced analgesia is dependent neither on pituitary nor sympathetic activation. 711 94

A solution of 0.75% bupivacaine (Marcaine) in 8.25% dextrose was compared with a similar solution of tetracaine (Pontocaine), the drug most used for spinal anesthesia in the USA. The study employed a randomized double-blind method and a standardized technique for spinal anesthesia in 435 patients. For perineal and lower extremity surgery, 7.5 mg of the local anesthetic was injected, and for intra-abdominal gynecologic surgery, 12 mg was administered. With the 7.5-mg dose, in only one of 121 patients was anesthesia unsatisfactory when bupivacaine was used; anesthesia was unsatisfactory in 19 of 114 patients when tetracaine was used. With the 12-mg dose, 12 patients given bupivacaine and 14 given tetracaine had unsatisfactory analgesia. With both doses, the motor blockade lasted significantly longer with tetracaine. Epinephrine added to the local anesthetic solution significantly increased the duration of action of both drugs. It also prolonged the duration of postoperative analgesia of tetracaine significantly more than the duration of bupivacaine. Bupivacaine 0.75% in 8.25% dextrose is a safe, reliable local anesthetic solution for spinal anesthesia.
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PMID:Spinal anesthesia: bupivacaine compared with tetracaine. 719 47

Adrenal medullary chromaffin cells are a potential source of neuroactive substances for transplantation into the CNS to alleviate neurochemical deficits. In particular, work in our laboratory has suggested that adrenal medullary transplants in the spinal subarachnoid space can alleviate pain by providing sustained local delivery of catecholamines and opioid peptides. One of the major limitations for clinical application of neural transplantation is the availability of donor material in sufficient quantities. This limitation may be overcome by the use of xenogeneic donors if long-term graft rejection can be prevented. The purpose of this study was to assess whether xenogeneic chromaffin cells immunologically isolated by semipermeable membranes could survive and continue to reduce pain when transplanted into the CNS. Isolated bovine chromaffin cells were encapsulated by semipermeable polymer membranes and implanted into the rat spinal subarachnoid space. Pain sensitivity was assessed at several intervals up to 3 months following implantation. Results indicated that encapsulated bovine chromaffin cell implants, but not empty control capsules, could repeatedly reduce pain sensitivity with nicotine stimulation for the duration of the study. This response was dose related, indicating that pharmacologic integrity of the transplanted chromaffin cells is retained. The analgesia induced by encapsulated chromaffin cell implants could be attenuated by the opiate antagonist naloxone and the alpha-adrenergic antagonist phentolamine, suggesting the involvement of both opioid peptides and catecholamines in mediating this response. In addition, in vitro neurochemical studies of recultured capsules revealed sustained release of Met-enkephalin and catecholamines from encapsulated cells 3 months following implantation into the spinal subarachnoid space.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transplants of immunologically isolated xenogeneic chromaffin cells provide a long-term source of pain-reducing neuroactive substances. 768 73

Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may-in part-be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS). Thirty male patients (age < 65 years, ejection fraction > 0.5) were randomized into 3 groups; the HF group receiving a high dose fentanyl (55 micrograms.kg-1) anaesthesia, the HF+TEA group with the same fentanyl dose+TEA with 10 ml bupivacain 5 mg.ml-1, followed by 4 ml every hour, and the LF+TEA group receiving fentanyl 15 micrograms.kg-1 + TEA. Adrenalin, noradrenalin, systemic vascular resistance (SVR), glucose, cortisol, lactate and free fatty acids were followed during the operation and for 20 h postoperatively. A significant increase in adrenalin, noradrenalin and SVR was found in the HF group whereas this increase was blocked in both epidural groups. An increase in glucose and cortisol was noticed in all groups, but the increase was delayed in the epidural groups. Our results suggest that a more effective blockade of the stress response during ACBS is obtained when TEA is added to general anaesthesia than with high dose fentanyl anaesthesia alone.
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PMID:Thoracic epidural analgesia in aortocoronary bypass surgery. II: Effects on the endocrine metabolic response. 788 7

The efficacy of epinephrine for prolonging the duration of lidocaine spinal anesthesia remains controversial. Seven volunteers were randomized in a double-blind manner to receive two 50-mg lidocaine (in dextrose 7.5%) spinal anesthetics with and without epinephrine (0.2 mg). Sensory analgesia was assessed with transcutaneous electrical stimulation (TES) equivalent to surgical incision and compared to standard pinprick dermatomal levels. Motor block was assessed with surface electromyography (EMG) and isometric force dynamometry. Intravenous fluids were administered by a standardized regimen, and time until ability to void was determined. Addition of epinephrine significantly prolonged duration of surgical anesthesia in the lumbar and sacral dermatomes by an average of 16-29 min (P = 0.03), but not in thoracic dermatomes. Although there was a trend toward prolongation of motor block with addition of epinephrine, this did not reach statistical significance. Epinephrine significantly prolonged duration until ability to void from 153 +/- 27 to 234 +/- 50 min (P = 0.0001). Thus, addition of epinephrine to lidocaine may be indicated to prolong duration of anesthesia for lower body operations. However, delayed recovery of ability to void may also prolong time until discharge after ambulatory surgery.
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PMID:The effects of epinephrine on lidocaine spinal anesthesia: a cross-over study. 789 27

Epidural opioids provide a potent analgesia not devoided of side effects. In addition, epidural administration of lipid soluble opioids has no clear advantage over the IV route. Combination of epidural opioids with other analgesics may strengthen analgesia and may decrease the incidence of side effects because of a reduction in the amount of opioid administered. Improvement in analgesia quality is documented when local anaesthetics are associated to opioids. Low concentrations of local anaesthetics may potentiate the effect of opioids on ions membrane channels at the level of the dorsal horn of the spinal cord. Alpha adrenergic agonists provide an alternative to local anaesthetics, allowing to improve pain control achieved with opioids. Epinephrine decreases plasma absorption of opioids and is especially useful to prolong the effect of short acting lipid soluble opioids. Alpha adrenergic agonists atc on alpha-2-adrenergic receptors of the spinal cord dorsal horn to depress pain nociceptive transmission. This effect potentiates the one of opioids at this level. Clonidine, which is a selective alpha-2-adrenergic agonist has been demonstrated to improve and to prolong analgesia produced by opioids in postoperative patients. Clonidine administration induces side effects, like sedation, bradycardia and hypotension, but allows to highly reduce the opioid dose. None of the combined techniques of analgesia implies that monitoring of the side effects of opioids has to be reduced.
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PMID:[Is there an advantage to using opioid combinations by the peridural route?]. 790 34

Extradural clonidine produces analgesia in adults. To assess its efficacy in children, we randomized 45 pediatric patients aged 1-7 yr presenting for a subumbilical surgery into three groups of 15 each. After halothane and N2O/O2 induction, and with a double-blind protocol, caudal anesthesia was performed with 1 mL/kg of 0.25% bupivacaine. Epinephrine 1/200,000 was added in one group (EG), 1 microgram/kg of clonidine in another group (CG), and no additional medication in the last group (BG). Postoperative analgesia was evaluated using the Broadman "objective pain/discomfort scale" (OPS) at 1-h intervals until the first analgesic administration. There were no differences among the groups in age, weight, duration of surgery, baseline systolic arterial pressure, and heart rate. The mean (+/- SD) duration of analgesia was longer in the CG (987 +/- 573 min) than in the EG (377 +/- 341 min) and BG (460 +/- 439 min); P < 0.01. The maximal OPS scores were lower in the CG than in the EG and BG (2.3 +/- 1.6 vs 3.4 +/- 1.4 and 3.4 +/- 1.8, respectively; P < 0.05). More patients in the CG (n = 7) than in the EG (n = 1) and BG (n = 2) required no postoperative analgesia; P < 0.05. No differences were found among the groups for the minimal respiratory rate and minimal Spo2 values in the postoperative phase, and there were no differences among the groups for heart rate and systolic arterial pressure during the 3 h after caudal anesthesia. We conclude that the duration of postoperative analgesia with caudal bupivacaine was significantly increased by the addition of 1 microgram/kg of clonidine.
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PMID:Clonidine in pediatric caudal anesthesia. 813 84


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