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

When isobaric spinal anesthesia is applied the level of analgesia is of special interest. This level is influenced by many factors of varying importance. One major factor is the relation between cerebrospinal fluid (CSF) density and the density of local anesthetic solutions. The density of CSF changes with the concentrations of its constituents, e.g., glucose or protein. Because glucose concentrations in CSF change in parallel with blood glucose levels, this may have effects on CSF density and the spread of spinal anesthesia. In 43 patients in two groups (diabetic n = 32, non-diabetic n = 11) the influence of CSF density on the analgesia level achieved with isobaric spinal anesthesia was investigated with special reference to increased glucose levels in blood and CSF. The influence of body height and weight, age and CSF protein content were also studied. There were no statistically significant correlations between any of these factors and the extension of analgesia. The mean blockade level was 1.6 segments lower in the non-diabetic group: this difference was statistically not significant (P greater than 0.05). Anesthesia spread faster in the diabetic group, but this difference was also not significant (P greater than 0.05). For bupivacaine 0.5% alone a density of 1.0010 g/cc was found, while for bupivacaine 0.5% with epinephrine (1:200,000) the density measured was 1.0022 g/cc. There is no correlation (r2 = 0.083) between CSF glucose concentration and CSF density, other factors such as sodium, chloride or CO2, apparently being more important. With CSF density ranging between 1.000 and 1.003 g/cc there was no correlation with the blockade level (r2 = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Do elevated blood and cerebrospinal fluid glucose levels and other factors modify the density of cerebrospinal fluid and the spread of isobaric spinal anesthesia?]. 237 35

For investigations of CO2-stunning of feeder- and slaughter-pigs parameters of behaviour, blood-gas-analyses and electroencephalograms were chosen. The following results were obtained: 1. Blood-gas-analyses proved that the CO2-stunning does not produce unconsciousness due to a lack of oxygen. 2. The criterias of general anaesthesia: unconsciousness, muscle-relaxation and analgesia with total reversibility could be confirmed. 3. The violent convulsive symptoms were evaluated as reactions identical with the stage II of GUEDEL's scheme of anaesthesia. 4. Muscular agitation, which sometimes appeared a few seconds before the stage of excitation, was judged to belong either to the start of the excitation phase or to the end of Guedel's stage of analgesia, during which the sensitivity is decreased. Neither study of behavior nor objective measurements showed, during the first 10 to 20 seconds of exposure to the CO2, any sign of pain or suffering related to the Act for Prevention of Cruelty to Animals, and accordingly such suffering should not be ascribed to the CO2 stunning method.
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PMID:[CO2-stunning of swine for slaughter from the anesthesiological viewpoint]. 249 19

The efficacy of nalbuphine, an agonist/antagonist opioid, in preventing respiratory depression from epidural morphine analgesia after thoracotomy, was assessed in a randomized double-blind placebo controlled trial. After a standardized general anaesthetic and 0.15 mg.kg-1 of epidural morphine, patients received a bolus and then a 24 h infusion of nalbuphine (200 micrograms.kg-1 + 50 micrograms.kg-1.hr-1, 100 micrograms.kg-1 + 25 micrograms.kg-1.hr-1, or 50 micrograms.kg-1 + 12.5 micrograms.kg-1.hr-1) or placebo. Blood gases, analgesia, sedation, side effects, and blood nalbuphine concentrations were assessed every two hours for the next 24 h. Fifty-three per cent of placebo-treated patients had a PaCO2 greater than 50 mmHg and 89 per cent of these received naloxone. A 200 micrograms.kg-1 bolus of nalbuphine followed by a 50 micrograms.kg-1.hr-1 infusion achieved a mean steady state blood level of 38.2 ng.ml-1 and prevented CO2 retention greater than 50 mmHg in all but two patients, neither of whom required naloxone. There was no difference in the incidence of side effects among groups, and analgesia appeared to be unaffected by nalbuphine.
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PMID:Prevention of epidural morphine-induced respiratory depression with intravenous nalbuphine infusion in post-thoracotomy patients. 250 81

Two cases of subdural catheter placement following continuous spinal and continuous epidural anaesthesia are presented. In the first, despite an easy reflux of clear cerebrospinal fluid through the catheter, the injection of 4 ml bupivacaine 0.5 per cent with epinephrine 1:200,000 followed by 3 ml tetracaine 0.5 per cent showed a failure of spinal anesthesia. In the second, the administration through the catheter of 20 ml lidocaine 2.0 per cent CO2 plus epinephrine 1:200,000 and of ten ml bupivacaine 0.5 per cent lead to an insufficient, patchy and asymmetrical analgesia. The clinical signs observed in these two cases are compared with previous publications. The importance of an x-ray contrast study to confirm the diagnosis of subdural catheter insertion is stressed.
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PMID:[Accidental catheterization of the subdural space: a complication of continuous spinal anesthesia and continuous peridural anesthesia]. 258 70

The permeability of spinal dura mater (SDM) was examined for morphine and tetracaine hydrochloride in 7 suddenly died patients with profound morphological manifestations. Atherosclerosis was found to show an average 37% increase in SDM permeability. With this, the efficiency of postoperative epidural analgesia (EA) with morphine was studied in 32 surgical patients with concurrent atherosclerosis. EA was demonstrated to be not only beneficial for this category of patients, unlike control patients, but followed by a significant decrease in respiratory center sensitivity to CO2. It was concluded that the regularities found should be taken into account during EA with narcotic analgesics in patients with concurrent atherosclerosis.
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PMID:[The effect of concurrent atherosclerosis on the permeability of the dura mater and the efficacy of epidural analgesia with morphine and dicain]. 259 24

Since the first paravertebral blockade was carried out by Sellheim in 1905, this method has proved effective for the isolated blockade of spinal nerves. The efficacy of preoperative intercostal blockade (ICB) in combination with neuroleptanalgesia (NLA) or Pentothal-pentazocine-N2O anesthesia (Pe-Pz) was studied (unilateral analgesia for cholecystectomy). Group 1: NLA; group 2: NLA with ICB; group 3: Pe-Pz; group 4: Pe-Pz with ICB. The analgesic requirement differed significantly between groups 1 (0.33 mg fentanyl) and 2 (0.15 mg fentanyl) and groups 3 (63.5 mg pentazocine) and 4 (31.5 mg pentazocine). There were also significant differences in circulatory responses. The maximum deviation from the initial value at the beginning of the operation in group 1 compared to group 2 was pulse rate + 28.7% vs + 2.4%, mean arterial pressure (Part) + 24.6% vs + 3.1%, and systolic pressure (Psyst) + 33% vs +/- 0%; group 3 compared to group 4: pulse rate + 16.4% vs + 3.2%, Part + 24.5% vs 0.0%, and Psyst + 26.5% vs + 196. The times of action of ICB extended from 7.54 h to 11.33 h for partial analgeisa, time to the first dose of analgesic from 12.3 h to 16.9 h (etidocaine 0.5% and 1% respectively without and with epinephrine). The mean blood levels after 100 mg bupivacaine-CO2 rose to 1.16 micrograms/ml after 5 min and reached a maximum after 15 min (1.29 micrograms/ml) as compared to 0.98 micrograms/ml after addition of ornithine-vasopressin. These values are very much higher than those after the use of bupivacaine-HCl solution. Etidocaine and bupivacaine-HCl have comparable durations of analgesia. Toxicologically, both substances can be applied safely with consideration of all pharmacological data for ICB. Of a total of 3,485 intercostal blockades, 2,775 were applied perioperatively (pre- and postoperatively); 265 were carried out for trauma patients (rib fractures) and 445 for therapeutic indications (herpes zoster neuralgia, tumor pain, costovertebral pain). In 8 blocks 10% ammonium sulfate, in 4 blocks absolute alcohol, and in 19 blocks 5% phenol were used for neurolysis. In 2 cases a marginal pneumothorax was seen, which was resorbed spontaneously (0.06%). Altogether 16,270 single intercostal nerves were blocked. Single-session intercostal blockade can be combined as unilateral analgesia with general anesthesia. This combination is characterized by stable circulatory conditions with avoidance of hypertensive reactions. The long-lasting analgesia allows early mobilization and physiotherapy both postoperatively and posttraumatically in patients with unilateral thoracic and abdominal pain.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The single intercostal block--surgical and therapeutic indications]. 264 21

The side-effects of two opioid agonist-antagonists, nalbuphine and pentazocine, were assessed when used for patient-controlled postoperative analgesia. Forty ASA I or II patients scheduled for upper abdominal surgery were randomly allocated to two equal groups. The anaesthetic technique was the same for all the patients: premedication with atropine and diazepam, induction with thiopentone and suxamethonium and maintenance with fentanyl, pancuronium, nitrous oxide and halothane. Patient-controlled computer assisted analgesia (On-Demand Analgesia Computer) was started in the recovery room at least 2 h after the last administration of fentanyl. The parameters used were: a routine hourly dose (the half of that received during the previous hour), with on demand delivery of nalbuphine (15 micrograms.kg-1) or pentazocine (45 micrograms.kg-1) aliquots respectively, with a refractory period between two demands of 4 min and a total hourly maximum dose of 16 mg and 48 mg respectively. The following parameters were measured before the start of self-administration, and every hour afterwards for 24 h: systolic (Pasys) and diastolic blood pressures, heart rate, pressure-rate product (PRP), respiratory rate, end-tidal CO2 and pain (by way of a three point scale). Analgesia was assessed on a four-point scale every 6 h. The total doses of nalbuphine and pentazocine administered were 94 +/- 43 mg and 251 +/- 150 mg respectively. The only parameters significantly different between the two groups were Pasys and PRP, being higher in the pentazocine group. There were no significant differences in the side-effects (drowsiness, nausea, vomiting, headache, amnesia, logorrhoea and urine retention). All patients in both groups were satisfied with this technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of nalbuphine and pentazocine in the treatment of postoperative pain by self-administration]. 266 Jun 40

The authors studied the effects of epidural sufentanil (0.75 microgram.kg-1) after urologic surgery in 15 children ranging in age from 4 to 12 yr, and in weight from 14 to 47 kg. The onset and duration of analgesia were 3.0 +/- 0.3 and 198 +/- 19 min, respectively (mean +/- SEM). Side effects included pruritus (3/15), nausea and vomiting (5/15), drowsiness (10/15), and urinary retention (1/11). No apnea was observed. Periosteal analgesia and ventilation were studied in eight of the children (mean age 8.6 +/- 0.8 yr). There was significant periosteal analgesia of the tibia (30, 60, 90, and 120 min after injection) and of the radius (60, 90, and 120 min after injection). Resting respiratory rate and tidal volume did not change during the study. Resting minute-ventilation decreased from 6.3 +/- 0.5 l.min-1 preoperatively to 5.6 +/- 0.6 l.min-1 (P less than 0.05) postoperatively, before epidural sufentanil injection; it did not decrease further after epidural sufentanil. Similarly, end-tidal CO2 tension increased significantly from 37.2 +/- 0.7 mmHg preoperatively to 39.9 +/- 1.2 mmHg (P less than 0.05) postoperatively, before epidural sufentanil; epidural sufentanil did not cause a further significant increase in end-tidal CO2 tension. The slope of the CO2 ventilatory response curve decreased significantly from 1.68 +/- 0.12 l.min-1. mmHg-1 preoperatively to 1.10 +/- 0.13 l.min-1.mmHg-1 (P less than 0.01) postoperatively. There were further significant decreases to 0.68 +/- 0.10 and 0.89 +/- 0.16 l.min-1.mmHg-1 30 and 60 min after epidural sufentanil.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Analgesia and ventilatory response to CO2 following epidural sufentanil in children. 289 31

Sufentanil (mean total dose 2 micrograms/kg) was compared with fentanyl (mean total dose 15 micrograms/kg) as a supplement to 60% N2O anesthesia in 30 adult patients undergoing general surgical procedures. Comparisons were made with respect to stability of hemodynamic variables (heart rate and systolic and diastolic blood pressure), changes in stress hormones (cortisol, antidiuretic hormone, epinephrine, norepinephrine, and dopamine), recovery of alertness and orientation, time to extubation, postoperative analgesia, and measures of respiratory depression (resting end-tidal carbon dioxide tension [PETCO2], CO2 response curve for minute ventilation [delta VE/delta PETCO2]). Hemodynamic variables remained stable and similar in both groups throughout the study. Plasma hormone levels remained similar to baseline in both groups until 1 h postoperatively when epinephrine levels were significantly elevated in both groups (P less than 0.05). Recovery times, including time to extubation, were similar in both groups. Patients given sufentanil had less pain 30 min postoperatively than those given fentanyl, although at 60 min postoperatively pain levels were similar in both groups. Small but significant elevations in resting PETCO2 were seen in both groups postoperatively (P less than 0.05), but postoperative delta VE/delta PETCO2 responses were significantly depressed only in patients receiving fentanyl (P less than 0.05). The results of this study demonstrate that sufentanil-N2O anesthesia is as effective as fentanyl-N2O in attenuating the hemodynamic and hormonal responses to the stress of general surgery. Because continuous intraoperative PETCO2 monitoring was not employed in this study, intraoperative hypocapnea cannot be strictly excluded as a possible influence on the postoperative measures of ventilatory drive.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of sufentanil-N2O and fentanyl-N2O in patients without cardiac disease undergoing general surgery. 294 75

This study compared the respiratory effects of subcutaneous and epidural morphine, meperidine, fentanyl, and sufentanil in rats breathing air or 8% CO2 in air. A whole body plethysmographic technique was used to measure minute volumes of breathing. The ED50s of subcutaneously injected morphine, meperidine, fentanyl, and sufentanil in depressing the minute volume response to 8% CO2 in air were 2300 micrograms/kg, 8800 micrograms/kg, 20 micrograms/kg, and 2.3 micrograms/kg, respectively. These doses were nearly the same as the subcutaneous ED50s of these compounds in producing analgesia, found in an earlier study. Roughly equianalgesic doses of the four opiates after epidural injection, however, failed to cause any detectable respiratory effect. Fourfold greater doses increased significantly the incidence of low minute volumes with fentanyl and sufentanil, but soon after epidural injection, i.e., at the time that analgesia was produced. None of the epidurally injected opiates had a significant delayed effect on respiration. However, one of the seven rats treated epidurally with the higher dose of morphine developed depression of the minute volume response to 8% CO2 in air as late as 7 hours after the injection. We conclude that epidural injection, in contrast to subcutaneous injection, of analgesic doses of morphine, meperidine, fentanyl, and sufentanil produces no significant respiratory effects.
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PMID:Respiratory effects of epidural and subcutaneous morphine, meperidine, fentanyl and sufentanil in the rat. 297 66


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