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Items 1 - 7 of 7 |
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Intravenous regional anesthesia using lidocaine and magnesium.
Turan A, Memis D, Karamanlioglu B, Guler T, Pamukcu Z.
Trakya University Tip Fakultesi, Anesteziyoloji ve Reanimasyon AD, 22030 Edirne, Turkey. alparslanturan@yahoo.co.
We conducted this study to evaluate the effects of magnesium, when added to lidocaine for IV regional anesthesia (IVRA), on tourniquet pain. Thirty patients undergoing elective hand surgery during IVRA were randomly assigned to two groups. IVRA was achieved with 10 mL of saline plus 3 mg/kg lidocaine 0.5% diluted with saline to a total of 40 mL in group C or with 10 mL of 15% magnesium sulfate (12.4 mmol) plus 3 mg/kg lidocaine 0.5% diluted with saline to a total of 40 mL in group M. Injection pain, sensory and motor block onset and recovery time, tourniquet pain, and anesthesia quality were noted. Patients were instructed to receive 75 mg of IM diclofenac when the visual analog scale (VAS) score was >4, and analgesic requirements were recorded. Sensory and motor block onset times were shorter and recovery times were prolonged in group M (P < 0.05). VAS scores of tourniquet pain were lower in group M at 15, 20, 30, 40, and 50 min (P < 0.001). Anesthesia quality, as determined by the anesthesiologist and surgeon, was better in group M (P < 0.05). Time to the first postoperative analgesic request in group C was 95 +/- 29 min and in group M was 155 +/- 38 min (P < 0.05). Postoperative VAS scores were higher for the first postoperative 6 h in group C (P < 0.05). Diclofenac consumption was significantly less in group M (50 +/- 35 mg) when compared with group C (130 + 55 mg) (P < 0.05). We conclude that magnesium as an adjunct to lidocaine improves the quality of anesthesia and analgesia in IVRA.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781543 [PubMed - indexed for MEDLINE]
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Clonidine added to a continuous interscalene ropivacaine perineural infusion to improve postoperative analgesia: a randomized, double-blind, controlled study.
Ilfeld BM, Morey TE, Thannikary LJ, Wright TW, Enneking FK.
Department of Anesthesiology, University of Florida, Gainesville, FL, USA. bilfeld@ufl.edu
Although clonidine has been shown to increase the duration of local anesthetic action and prolong postoperative analgesia when included in single-injection nerve blocks, the only controlled investigation of the efficacy of this practice to improve analgesia for continuous perineural local anesthetic infusion failed to discern any clinically relevant benefits. For this study, we used a larger dose of clonidine in an attempt to improve analgesia. Patients (n = 20) undergoing moderately painful orthopedic surgery of the shoulder received an interscalene brachial plexus block (40 mL of mepivacaine 1.5%, epinephrine 2.5 microg/mL, and clonidine 50 microg) and a perineural catheter before surgery. After surgery, ropivacaine 0.2% or ropivacaine 0.2% plus clonidine 2 microg/mL was delivered via the catheter for 3 days (basal rate, 5 mL/h; patient-controlled bolus, 5 mL; lockout, 1 h). Investigators and patients were blind to random group assignment. The primary outcome variable was designated as the most intense pain during the day after surgery. Secondary end-points included additional pain scores, patient-controlled bolus doses, oral analgesic use, sleep quality, and catheter- or infusion-related complications. There were no statistically significant differences between groups for any of the variables investigated. We conclude that adding clonidine 2 microg/mL to a ropivacaine interscalene perineural infusion does not decrease breakthrough pain intensity the day after surgery. For the additional end-points, our negative findings are only suggestive of a lack of effect and require further study for verification.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781540 [PubMed - indexed for MEDLINE]
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Spinal opioid receptor like1 receptor agonist, but not N-methyl-D-aspartic acid antagonist, reverses the secondary mechanical allodynia induced by intradermal injection of capsaicin in rats.
Nozaki-Taguchi N, Yamamoto T.
Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.
Secondary mechanical allodynia induced by intradermal injection of capsaicin has been widely used to search for the underlying mechanisms of tissue injury induced mechanical allodynia. However, the capsaicin concentration dependency of the development of secondary mechanical allodynia and the underlying mechanisms of development and maintenance of capsaicin-induced mechanical allodynia are not fully understood. In the present study, we clarify the capsaicin concentration dependency for development and maintenance of secondary mechanical allodynia and the role of spinal opioid receptor like1 (ORL1) receptor and N-methyl-D-aspartate receptor in the development and maintenance of secondary mechanical allodynia induced by an intradermal capsaicin injection. Capsaicin 50 microL of 0.03% induced the most intense secondary mechanical allodynia. Intrathecal injection of nociceptin, an ORL1 receptor agonist, attenuated the maintenance of secondary mechanical allodynia but had no effect on the development of secondary mechanical allodynia. An intrathecal injection of MK801, an N-methyl-D-aspartate receptor antagonist, had no effect on the development and maintenance of secondary mechanical allodynia. These findings suggest that spinal ORL1 receptor should be the target of study for the treatment of secondary mechanical allodynia induced by tissue injury.
PMID: 15781527 [PubMed - indexed for MEDLINE]
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Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy.
Hadzic A, Karaca PE, Hobeika P, Unis G, Dermksian J, Yufa M, Claudio R, Vloka JD, Santos AC, Thys DM.
Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, 1111 Amsterdam Ave., New York, NY 10025, USA. ah149@columbia.edu
It has been suggested that use of peripheral nerve blocks (PNBs) may have some potential benefits in the outpatient setting. There have been no studies specifically comparing PNBs performed with short-acting local anesthetics with general anesthesia (GA) in patients undergoing outpatient knee surgery. We hypothesized that a combination of lumbar plexus and sciatic blocks using a short-acting local anesthetic will result in shorter time-to-discharge-home as compared with GA. Patients scheduled to undergo knee arthroscopy were randomized to receive a GA (midazolam, fentanyl, propofol, N(2)O/O(2)/desflurane via laryngeal mask airway) or lumbar plexus/sciatic block (PNBs; 2-chloroprocaine). Patients given GA also received an intraarticular injection of 20 mL 0.25% bupivacaine for postoperative pain control. Patients in the PNB group were given midazolam (up to 4 mg) and alfentanil (500-750 microg) before block placement and propofol 30-50 microg . kg(-1) . min(-1) for intraoperative sedation. Relevant perioperative times, postanesthesia care unit bypass rate, severity of pain, and incidence of complications were compared between the two groups. Fifty patients were enrolled in the study; 25 patients each received GA or PNBs. Total operating room time did not differ significantly between the 2 groups (97 +/- 37 versus 91 +/- 42 min). Seventy-two percent of patients receiving PNB met criteria enabling them to bypass Phase I postanesthesia care unit compared with only 24% of those receiving GA (P < 0.002). Time to meet criteria for discharge home (home readiness) and time to actual discharge were significantly shorter for patients given PNBs than for patients given GA (131 +/- 62 versus 205 +/- 94 and 162 +/- 71 versus 226 +/- 96, respectively). Under the conditions of our study, the combination of lumbar plexus and sciatic blocks with 2-chloroprocaine 3% was associated with a superior recovery profile compared with GA in patients having outpatient knee arthroscopy.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781509 [PubMed - indexed for MEDLINE]
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The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study.
Maxwell LG, Kaufmann SC, Bitzer S, Jackson EV Jr, McGready J, Kost-Byerly S, Kozlowski L, Rothman SK, Yaster M.
Department of Anesthesiology, The Children's Hospital of Philadelphia, Pennsylvania, USA.
Opioids are frequently associated with side effects such as nausea, vomiting, and pruritus. We hypothesized that a prophylactic, continuous small-dose naloxone infusion would reduce the incidence of opioid-induced side effects without affecting analgesia or opioid consumption. In this prospective, double-blind, randomized, controlled clinical trial, we studied 46 postoperative patients (M:F, 21:25), averaging 14 +/- 2.5 yr and 53 +/- 17 kg, at the start of morphine IV patient-controlled analgesia. Patients were randomized to either saline (control, n = 26) or naloxone 0.25 microg . kg(-1) . h(-1) (n = 20). We found that the incidence and severity of pruritus (77% versus 20%; P < 0.05) and nausea (70% versus 35%; P < 0.05) was significantly more frequent in the placebo group compared with the naloxone group. Morphine consumption (1.02 +/- 0.41 mg . kg(-1) . d(-1) versus 1.28 +/- 0.61 mg . kg(-1) . d(-1)), pain scores at rest (4 +/- 2 versus 3 +/- 2), and pain scores with coughing (6 +/- 2 versus 6 +/- 2) were not different. We conclude that, in children and adolescents, a small-dose naloxone infusion (0.25 microg . kg(-1) . h(-1)) can significantly reduce the incidence and severity of opioid-induced side effects without affecting opioid-induced analgesia. When initiating morphine IV patient-controlled analgesia for the treatment of moderate to severe pain, clinicians should strongly consider starting a concomitant small-dose naloxone infusion.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781505 [PubMed - indexed for MEDLINE]
The unpleasantness of tonic pain is encoded by the insular cortex.
Schreckenberger M, Siessmeier T, Viertmann A, Landvogt C, Buchholz HG, Rolke R, Treede RD, Bartenstein P, Birklein F.
Department of Nuclear Medicine, Johannes Gutenberg-University Mainz, Mainz, Germany. schreckenberger@nuklear.klinik.uni-mainz.de
OBJECTIVE: Muscle pain differs from skin pain with respect to quality, accuracy of localization, and unpleasantness. This study was conducted to identify the brain regions associated with the affective-motivational component of tonic skin and muscle pain. METHODS: Forty healthy volunteers were investigated in three groups with different F-18 fluorodeoxyglucose PET activation scans. A verbal rating scale (VRS) was used to quantify pain intensity and unpleasantness. One group was investigated during painful infusion of an acidified phosphate buffer (pH 5.2) into either muscle or skin for 30 minutes. Muscle and skin infusions were adjusted to achieve pain intensity rating of VRS = 40. The second group received sham stimulation of muscle and skin by infusion of non-acidified phosphate buffer (pH 7.3 to 7.4, pain intensity = 0). The third group underwent only one PET scan without sensory stimulation. RESULTS: Unpleasantness ratings were higher (VRS 38.3 vs 25.5) during IM compared to intracutaneous stimulation, despite the same pain intensity (VRS = 40). Sham stimulation revealed no pain or unpleasantness. Regional cerebral glucose metabolism during sham stimulation showed similar findings for intracutaneous and IM infusions with significant activations of the bilateral anterior cingulate, bilateral frontal (premotor) cortex, and the ipsilateral parietal operculum. The comparison of pain vs sham stimulation revealed activations of the bilateral insula for IM but not intracutaneous stimulation. The unpleasantness perception in skin and muscle stimulation was positively correlated to the bilateral insular metabolism. CONCLUSION: The data suggest that the insula represents one main structure where the unpleasantness of tonic pain perception is encoded.
PMID: 15824343 [PubMed - in process]
Nurses' willingness to maximize opioid analgesia for severe cancer pain, and its predictor.
Chang YJ, Yun YH, Park SM, Lee SW, Park HA, Ro YJ, Huh BY.
Cancer Information Branch, Research Institute, National Cancer Center, Goyang, South Korea.
GOALS OF WORK: The effectiveness of cancer pain management (CPM) is influenced by nurses' willingness to maximize opioid analgesia for severe cancer pain. The purposes of this study were to identify the willingness of nurses to provide maximum-dose opioids whenever needed for CPM and to determine its associated predictors. METHODS: This multicenter study was conducted among the entire total of registered nurses in seven large hospitals in Korea. Its overall response rate was 41.6%, and the data from 930 who responded (40.1%) were analyzed. We utilized a three-step, multidimensional, multiple logistic regression to identify the predictors of nurses' willingness. MAIN RESULTS: Only 255 nurses (27.4%) indicated that they recommended the maximum dose of opioids whenever it was needed. The respondents who were more likely to recommend morphine showed the following characteristics: older nurses (odds ratio, OR, 1.57; confidence interval, CI, 1.13-2.19); they knew the effectiveness of opioids for CPM (OR 1.53; CI 1.06-2.20); rarely concerned about a patient's addiction to opioids (OR 2.16; CI 1.48-3.15), or to a family member's addiction (OR 1.81; CI 1.20-2.73); prior experience with pain assessment tools (OR 1.62; CI 1.11-2.37); practical experience caring for cancer patients with pain over 51% (OR 1.55; CI 1.09-2.19). CONCLUSIONS: Our multicenter study suggested that in order to improve nurses' willingness to recommend opioids liberally in CPM: (1) attitudes about fear of opioid addiction must be changed; (2) the efficiency of opioids in CPM must be taught; and (3) implementation of pain assessment tools must be undertaken.
PMID: 15827729 [PubMed - as supplied by publisher]
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