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Anesth Analg 2002 May;94(5):1253-8
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
[Medline record in process]
Capsaicin can produce a selective and long-lasting neural blockade. Resiniferatoxin (RTX) is an ultrapotent vanilloid agonist with a unique spectrum of activities different from that of capsaicin. We sought to determine whether a single application of RTX to a peripheral nerve could completely prevent the long-lasting mechanical hyperalgesia caused by carrageenan injection. In rat experiments, RTX (0.001%) was administered percutaneously to the sciatic and saphenous nerves before the intraplantar injection of carrageenan. Responses to noxious mechanical (pressure on the paw) and thermal (hot plate) stimulations and changes in paw circumference were measured at various time intervals for 8 days after treatment. The administration of RTX resulted in mechanical and thermal hypoalgesia (for 2 and 8 days, respectively). Inflammatory hyperalgesia was completely prevented by the precarrageenan injection of RTX. Inflammatory enhancement of paw circumference was reduced by RTX (12.0 +/- 2.4 mm versus 6.9 +/- 3.4 mm, P < 0.005). We suggest that the selective nature of the effect of vanilloid agonists on nociception could provide an opportunity for prolonged neural blockade when early mobilization and/or preservation of protective sensation are required. IMPLICATIONS: We report that an ultrapotent vanilloid agonist resiniferatoxin can provide a selective and long-lasting neural blockade. Applied to the sciatic and saphenous nerves, it completely prevented pain hypersensitivity caused by prolonged inflammatory process (injection of carrageenan into the paw).
PMID: 11973200, UI: 21969017
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Anesth Analg 2002 May;94(5):1188-93
Departments of Anesthesiology and Pain Management and Otolaryngology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
Non-opioid analgesics are often used to supplement opioids for the management of perioperative pain. In this randomized, double-blinded, placebo-controlled study, we examined the effects of acetaminophen and a cyclooxygenase type-2 inhibitor, celecoxib, when administered alone or in combination, before elective otolaryngologic surgery in 112 healthy outpatients. Subjects were assigned to 1 of 4 study groups: Group 1, placebo (vitamin C, 500 mg per os [PO]); Group 2, acetaminophen 2000 mg PO; Group 3, celecoxib 200 mg PO; or Group 4, acetaminophen 2000 mg and celecoxib 200 mg PO. All patients received a standardized anesthetic technique. During the postoperative period, pain was assessed using a 10-point verbal rating scale. Recovery times, the need for rescue analgesics, side effects, and patient satisfaction scores were also recorded. The combination of acetaminophen and celecoxib was significantly more effective than placebo in reducing postoperative pain. Celecoxib, when administered alone or in combination with acetaminophen, improved patients' satisfaction with their postoperative analgesia. With the combination of acetaminophen and celecoxib, an additional expenditure of $6.16 would be required to obtain complete satisfaction with postoperative pain management in one additional patient who would not have been completely satisfied if he/she had received the placebo. However, oral celecoxib or acetaminophen alone was not significantly more effective than placebo in reducing postoperative pain when administered before surgery. We conclude that oral premedication with a combination of acetaminophen (2000 mg) and celecoxib (200 mg) was highly effective in decreasing pain and improving patient satisfaction after outpatient surgery. IMPLICATIONS: Oral premedication with a combination of acetaminophen (2000 mg) and celecoxib (200 mg) was effective in decreasing pain and improving patient satisfaction after otolaryngologic surgery. However, acetaminophen (2000 mg) or celecoxib (200 mg) alone was not significantly more effective than placebo in reducing postoperative pain.
PMID: 11973187, UI: 21969004
Anesth Analg 2002 May;94(5):1173-1177
Departments of Anesthesiology, Perioperative and Pain Medicine, and || Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
[Record supplied by publisher]
Postoperative vomiting (POV) after strabismus surgery in children results in discomfort and prolonged hospital stays. Opioids increase the incidence of POV. Remifentanil has a context-sensitive half-life of 3 to 4 min, and how this short half-life influences POV in those patients is unknown. We conducted a prospective, double-blinded study in 81 ASA status I or II children from 2 to 12 yr of age undergoing elective strabismus surgery under general anesthesia. Patients were randomized to receive either remifentanil (bolus 1 &mgr;g/kg; infusion 0.1-0.2 &mgr;g. kg(-1). min(-1)) or fentanyl (2 &mgr;g/kg, and 1 &mgr;g/kg every 45 min). POV episodes were recorded for 25 h. Pain scores were obtained by using an objective pain scale for 60 min during recovery. The number of patients who experienced POV did not differ significantly between groups (49% vs 48%). However, in the Remifentanil group, POV episodes were significantly less frequent (0.95 vs 2.2 episodes). In contrast, fentanyl was associated with lower pain scores during the first 30 min of recovery. We conclude that children undergoing strabismus surgery under balanced anesthesia with remifentanil, compared with fentanyl, showed less frequent POV. However, early postoperative analgesia was better with fentanyl. IMPLICATIONS: Opioids increase the incidence of postoperative vomiting (POV). Remifentanil is characterized by the shortest half-life of all opioids used in anesthetic practice. Therefore, we studied the effect of remifentanil on POV compared with the longer-acting opioid fentanyl in children undergoing strabismus surgery.
PMID: 11973184
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Anesthesiology 2002 Apr;96(4):1035
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PMID: 11964622, UI: 21961265
Anesthesiology 2002 Apr;96(4):1019-20
Hospital General Universitario de Valencia, Valencia, Spain.
PMID: 11964612, UI: 21961255
Anesthesiology 2002 Apr;96(4):841-8
Department of Anesthesiology and Critical Care Medicine, and the Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
BACKGROUND: Phantom and stump pains, common sequelae of limb amputations, are significant impediments to rehabilitation of amputees. The pathophysiology and optimal treatment of postamputation pain states are unclear. While stump pain may result from neuromas in the stump, phantom pain is thought to be related to cortical reorganization. The authors hypothesized that morphine and lidocaine may have differential effectiveness on stump and phantom pains. METHODS: The authors conducted a randomized double-blind, active-placebo-controlled, crossover trial to compare the analgesic effects of intravenous morphine and lidocaine on postamputation stump and phantom pains. An intravenous bolus followed by an intravenous infusion of morphine (0.05 mg/kg bolus + 0.2 mg/kg infusion over 40 min), lidocaine (1 mg/kg bolus + 4 mg/kg infusion) and the active placebo, diphenhydramine (10 mg bolus + 40 mg infusion), were performed on three consecutive days. Phantom and stump pain ratings and sedation scores were recorded at 5-min intervals using a 0-100 visual analog scale. Pain measures were initiated 30 min before drug infusion and continued until 30 min after the end of infusion. Subjects' self-reported pain relief and satisfaction were assessed at the end of each infusion. RESULTS: Thirty-one of 32 subjects enrolled completed the study. Eleven subjects had both stump and phantom pains, 11 and 9 subjects had stump and phantom pain alone, respectively. Baseline pain scores were similar in the three drug groups. Compared with placebo, morphine reduced both stump and phantom pains significantly (P < 0.01). In contrast, lidocaine decreased stump (P < 0.01), but not phantom pain. The changes in sedation scores for morphine and lidocaine were not significantly different from placebo. Compared with placebo, self-reported stump pain relief was significantly greater for lidocaine (P < 0.05) and morphine (P < 0.01), while phantom pain relief was greater only for morphine (P < 0.01). Satisfaction scores were significantly higher for lidocaine (mean +/- SD: 39.3 +/- 37.8, P < 0.01) and morphine (45.9 +/- 35.5, P < 0.01) when compared with placebo (9.6 +/- 21.0). CONCLUSIONS: Stump pain was diminished both by morphine and lidocaine, while phantom pain was diminished only by morphine, suggesting that the mechanisms and pharmacological sensitivity of stump and phantom pains are different.
PMID: 11964590, UI: 21961233
Ann Fr Anesth Reanim 2002 Feb;21(2):126-32
Departement d'anesthesie-reanimation, hopital Necker Enfants-Malades, 75743 Paris, France. christiane.buisson@nck.ap-hop-paris.fr
Pain management in paediatric neurosurgery must be a daily concern for surgeons and anaesthetists. Pain assessment in infants and small children is difficult to perform because of limitations associated with these patients. The association of safe and effective analgesics allows good pain relief together with good safety conditions. However, neuropathic pain, which may occur following neurosurgical procedures, will require further studies.
PMID: 11915471, UI: 21913614
Cephalalgia 2002 Apr;22(2):117-124
School of Psychology, Murdoch University, Perth, Western Australia.
The aim of this study was to determine whether scalp tenderness and photophobia, two well-recognized symptoms of migraine, develop during the motion sickness induced by optokinetic stimulation. To investigate whether motion sickness has a general influence on pain perception, pain was also assessed in the fingertips. After optokinetic stimulation, nausea increased more and headache persisted longer in 21 migraine sufferers than in 15 non-headache controls. Scalp tenderness increased during optokinetic stimulation in nauseated subjects, and pain in the fingertips increased more and photophobia persisted longer in migraine sufferers than controls. These findings suggest that the disturbance responsible for nausea also sensitizes trigeminal nociceptive neurones or releases inhibitory controls on their discharge. A low nausea threshold and a propensity for sensitization to develop rapidly in nociceptive pathways may increase susceptibility to migraine.
PMID: 11972579
JAMA 2002 Apr 24;287(16):2067
PMID: 11966364, UI: 21964479
N Engl J Med 2002 Apr 18;346(16):1194-9
Division of Cardiology, Washington Hospital Center and the Washington Cancer Institute, Washington, DC 20010, USA. ron.waksman@medstar.net
BACKGROUND: Intracoronary radiation therapy is effective in reducing the recurrence of in-stent stenosis in native coronary arteries. We examined the effects of intravascular gamma radiation in patients with in-stent restenosis of saphenous-vein bypass grafts. METHODS: A total of 120 patients with in-stent restenosis in saphenous-vein grafts, the majority of whom had diffuse lesions, underwent balloon angioplasty, atherectomy, additional stenting, or a combination of these procedures. If the intervention was successful, the patients were randomly assigned in a double-blind fashion to intravascular treatment with a ribbon containing either iridium-192 or nonradioactive seeds. The prescribed dose, delivered at a distance of 2 mm from the source, was 14 to 15 Gy in vessels that were 2.5 to 4.0 mm in diameter and 18 Gy in vessels with a diameter that exceeded 4.0 mm. The primary end points were death from cardiac causes, Q-wave myocardial infarction, revascularization of the target vessel, and a composite of these events at 12 months. RESULTS: Revascularization and radiation therapy were successfully accomplished in all patients. At six months, the restenosis rate was lower in the 60 patients assigned to the iridium-192 group than in the 60 assigned to the placebo group (21 percent vs. 44 percent, P=0.005). At 12 months, the rate of revascularization of the target lesion was 70 percent lower in the iridium-192 group than in the placebo group (17 percent vs. 57 percent, P<0.001), and the rate of major cardiac events was 49 percent lower (32 percent vs. 63 percent, P<0.001). CONCLUSIONS: The results of our study support the use of gamma-radiation therapy for the treatment of in-stent restenosis in patients with bypass grafts.
PMID: 11961147, UI: 21959377
Pain 2002 Apr;96(3):411-2
Department of Anaesthetics, Imperial College School of Medicine, St. Mary's Hospital, Praed Street, W2 1NY, London, UK
PMID: 11973023, UI: 21970160
Pain 2002 Apr;96(3):410-1
Department of Anesthesiology, Intensive Care and Pain Medicine, Klinikum Kassel, Moenchebergstrasse 41-43, D-34125, Kassel, Germany
PMID: 11973022, UI: 21970159
Pain 2002 Apr;96(3):409-10
Pain Research Institute, Clinical Sciences Building, University Hospital Aintree, L9 7AL, Liverpool, UK
PMID: 11973021, UI: 21970158
Pain 2002 Apr;96(3):408-9
1001 Adelaide Street North, Suite 205, Ontario N5Y 2M6, London, Canada
PMID: 11973019, UI: 21970156
Pain 2002 Apr;96(3):407-8
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, DK-8000, Aarhus, Denmark
PMID: 11973018, UI: 21970155
Pain 2002 Apr;96(3):406-7
The Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Building 10, 20892-1258, Bethesda, MD, USA
PMID: 11973017, UI: 21970154
Pain 2002 Apr;96(3):403-5
Department of Environmental Medicine and Hospital Epidemiology, University Hospital Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
PMID: 11973015, UI: 21970152
Pain 2002 Apr;96(3):375-83
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Arhus, Denmark
PMID: 11973012, UI: 21970149
Pain 2002 Apr;96(3):365-73
Department of Rehabilitation Medicine, Box 356490, University of Washington, 98195, Seattle, WA, USA
PMID: 11973011, UI: 21970148
Pain 2002 Apr;96(3):347-51
Department of Occupational and Environmental Medicine, Orebro University Hospital, 701 85, Orebro, Sweden
PMID: 11973009, UI: 21970146
Pain 2002 Apr;96(3):343-5
Pain Center, Teikyo University School of Medicine, Ichihara Hospital, Anesaki 3426-3, Ichihara, 299-0111, Chiba, Japan
PMID: 11973008, UI: 21970145
Pain 2002 Apr;96(3):335-42
aDepartment of Clinical and Health Psychology, University of Florida, P.O. Box 100165 HSC, 32610-0165, Gainesville, FL, USA
PMID: 11973007, UI: 21970144
Pain 2002 Apr;96(3):329-33
Department of Neurology, The Medway Hospital and King's College Hospital, Mapother House, De Crespigny Park, SE5 8AZ, London, UK
PMID: 11973006, UI: 21970143
Pain 2002 Apr;96(3):325-8
Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, 10021, New York, NY, USA
PMID: 11973005, UI: 21970142
Pain 2002 Apr;96(3):319-24
Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, B-9000, Ghent, Belgium
PMID: 11973004, UI: 21970141
Pain 2002 Apr;96(3):279-84
The Center on Aging and Cognition: Health, Education, and Training (CACHET), Institute for Social Research, University of Michigan, 426 Thompson Street, Room 5241, 48106-1248, Ann Arbor, MI, USA
PMID: 11973000, UI: 21970137
Pain 2002 Apr;96(3):269-77
Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
PMID: 11972999, UI: 21970136
Pain 2002 Apr;96(3):261-7
Pain Clinic, Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
PMID: 11972998, UI: 21970135
Pain 2002 Apr;96(3):253-60
Department of Neurology, GlaxoWellcome Research and Development Ltd, Gunnels Wood Road, SG1 2NY, Stevenage, UK
PMID: 11972997, UI: 21970134
Pain 2002 Apr;96(3):239-45
Arthritis Research Campaign (ARC) Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, M13 9PT, Manchester, UK
PMID: 11972995, UI: 21970132
Pain 2002 Apr;96(3):227-37
Dental Research Center, School of Dentistry, University of North Carolina, 27599-7455, Chapel Hill, NC, USA
PMID: 11972994, UI: 21970131
Pain 2002 Apr;96(3):221-5
Departments of Internal Medicine and Anatomy and Neurosciences, University of Texas Medical Branch, 77555-0632, Galveston, TX, USA
PMID: 11972993, UI: 21970130
Pediatrics 2002 Apr;109(4):590-3
Section of Behavioral and Developmental Pediatrics, University of Chicago, Comers Children's Hospital, Chicago, Illinois 60637-1470, USA. lag@uchicago.edu
CONTEXT: This study identifies a behavioral and nonpharmacologic means of preventing newborn pain. OBJECTIVE: To determine whether breastfeeding is analgesic in newborn infants undergoing heel lance-a routine, painful, hospital procedure. DESIGN: A prospective, randomized, controlled trial. SETTING: Hospital maternity services at Boston Medical Center, Boston, Massachusetts, and Beverly Hospital, Beverly, Massachusetts. PARTICIPANTS: A random sample of 30 full-term, breastfed infants. INTERVENTIONS: Infants in the intervention group were held and breastfed by their mothers during heel lance and blood collection procedures for the Newborn Screening Program Blood Test. Infants in the control group experienced the same blood test while receiving the standard hospital care of being swaddled in their bassinets. OUTCOMES MEASURES: Crying, grimacing, and heart rate differences were analyzed between the breastfeeding and the control infants before, during, and after blood collection. RESULTS: Crying and grimacing were reduced by 91% and 84%, respectively, from control infant levels during the blood collection. Heart rate was also substantially reduced by breastfeeding. CONCLUSIONS: Breastfeeding is a potent analgesic intervention in newborns during a standard blood collection.
PMID: 11927701, UI: 21925309
Spine 2002 Feb 15;27(4):343-6
Anesthesiology and Reanimation, Celal Bayar University Medical Faculty, Manisa, Turkey.
STUDY DESIGN: A prospective and controlled study of perioperative use of combined local anesthetic and corticosteroid in lumbar disc surgery. SUMMARY OF BACKGROUND DATA: The anti-inflammatory mechanism of corticosteroids is considered to be caused by the inhibition of phospholipase A2, which plays an important role in the pain mechanism of lumbar disc problems. Although some authors have demonstrated that the use of intramuscular bupivacaine during lumbar discectomy resulted in a marked reduction of postoperative back pain, others have reported that the key intervention was probably the administration of epidural corticosteroid. The coadministration of these two drugs in lumbar disc surgery for the relief of postoperative back pain has yet not been studied adequately. OBJECTIVES: Assessment of the combined use of perioperative corticosteroids and bupivacaine for the relief of postoperative pain after lumbar disc surgery. METHODS: Forty-four selected patients had acute-onset single-level unilateral herniated nucleus pulposus that were refractory to conservative management. All patients underwent lumbar disc surgery under standard general anesthesia. Before surgical incision, the skin and subcutaneous tissues were infiltrated with 10 mL of 1% lidocaine with 1:200,000 adrenaline to produce local vasoconstriction. During wound closure, 20 mL 0.9% saline in Group 1 (n = 22) and 20 mL 0.25% bupivacaine in Group 2 (n = 22) were injected into the paravertebral muscles and subcutaneus tissues. In addition, a piece of autologous fat taken from the wound was first soaked in 40 mg of methylprednisolone for 10 minutes, then placed over the exposed nerve root, and the remaining steroid was flushed into the wound in Group 2. The wound was closed after drug administration in both groups. In the postoperative period, all patients received 100 mg of meperidine intramuscularly when needed and were allowed to receive a second dose at least 4 hours later than the first dose for postoperative analgesia. Postoperative back pain intensity, heart rate, and mean arterial pressure were assessed 1, 3, 6, and 12 hours after the conclusion of surgery. RESULTS: Visual analog scale pain scores for the postoperative recordings were lower in Group 2 than in Group 1, but these findings were not statistically significant. Patients in Group 1 received 77.3 +/- 48.8 mg meperidine, and those in Group 2 received 31.8 +/- 45.5 mg meperidine, for pain medication in the first 12 hours (P < 0.05). Heart rate and mean arterial pressure were not significantly different between the two groups in all recording periods. CONCLUSION: It is concluded that the perioperative use of bupivacaine and corticosteroids during lumbar discectomy maintains effective postoperative analgesia and decreases opioid usage without complications.
PMID: 11840097, UI: 21829549
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