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Comment on:
Manipulative therapy for patients with shoulder symptoms.
Galgano RC.
Publication Types:
PMID: 15684217 [PubMed - indexed for MEDLINE]
Prevention of shoulder stiffness after rotator cuff repair.
Trenerry K, Walton JR, Murrell GA.
Department of Orthopaedic Surgery, St. George Hospital Campus, University of New South Wales, Sydney, Australia.
Predisposing factors for shoulder stiffness after rotator cuff repair have yet to be determined. The potential for recovery of range of motion and amelioration of pain in patients with this complication also remains unclear. Accordingly, data collected prospectively for 209 patients with a primary rotator cuff repair were retrospectively reviewed. Two groups, Group A (early motion recovery) and Group B (shoulder stiffness), were selected according to passive shoulder range of motion outcomes 6 weeks postoperatively. Both groups were compared for 10 descriptive and clinical characteristics, and for passive range of motion, muscle force, and functional outcomes obtained 0, 6, 12, 24, and 76 weeks postoperatively. Of the potential prognostic factors examined, restriction of range of motion for the preoperative hand behind the back best predicted shoulder stiffness at 6 weeks postoperatively. For patients with postoperative shoulder stiffness, pain had subsided by 24 weeks postoperatively, whereas range of motion steadily improved between 6 weeks and 76 weeks postoperatively. Results of the current study support a predictive role for restriction of range of motion for the preoperative hand behind the back, and affirms the potential for nearly complete recovery of range of motion and amelioration of pain in patients who have shoulder stiffness after rotator cuff repair.Level of Evidence: Prognostic study, Level I-1 (prospective study).
Publication Types:
PMID: 15662309 [PubMed - indexed for MEDLINE]
ABT-594 (a nicotinic acetylcholine agonist): anti-allodynia in a rat chemotherapy-induced pain model.
Lynch JJ 3rd, Wade CL, Mikusa JP, Decker MW, Honore P.
Neuroscience Research, Global Pharmaceutical Research and Development, Abbott Laboratories, Department R4N5, Bldg. AP9A-LL, 100 Abbott Park Road, Abbott Park, IL 60064-6115, USA.
ABT-594 ((R)-5-(2-azetidinylmethoxy)-2-chloropyridine) represents a novel class of broad-spectrum analgesics whose primary mechanism of action is activation of the neuronal nicotinic acetylcholine receptors. The present study characterized the effects of ABT-594 in a rat chemotherapy-induced neuropathic pain model, where it attenuated mechanical allodynia with an ED(50)=40 nmol/kg (i.p.). This anti-allodynic effect was not blocked by systemic (i.p.) pretreatment with naloxone but was blocked completely with mecamylamine. Pretreatment with chlorisondamine (0.2-5 mumol/kg, i.p.) only partially blocked the effects of ABT-594 at the higher doses tested. In contrast, central (i.c.v.) pretreatment with chlorisondamine completely blocked ABT-594's anti-allodynic effect. Taken together, the data demonstrate that ABT-594 has a potent anti-allodynic effect in the rat vincristine model and that, in addition to its strong central site of action, ABT-594's effects are partially mediated by peripheral nicotinic acetylcholine receptors in this animal model of chemotherapy-induced neuropathic pain.
PMID: 15713428 [PubMed - in process]
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Characterization of the complex morphinan derivative BU72 as a high efficacy, long-lasting mu-opioid receptor agonist.
Neilan CL, Husbands SM, Breeden S, Ko MC, Aceto MD, Lewis JW, Woods JH, Traynor JR.
Department of Pharmacology, University of Michigan, 1301 Medical Science Res. Bldg III, Ann Arbor, MI 48109, USA.
The development of buprenorphine as a treatment for opiate abuse and dependence has drawn attention to opioid ligands that have agonist actions followed by long-lasting antagonist actions. In a search for alternatives to buprenorphine, we discovered a bridged pyrrolidinomorphinan (BU72). In vitro, BU72 displayed high affinity and efficacy for mu-opioid receptors, but was also a partial delta-opioid receptor agonist and a full kappa-opioid receptor agonist. BU72 was a highly potent and long-lasting antinociceptive agent against both thermal and chemical nociception in the mouse and against thermal nociception in the monkey. These effects were prevented by mu-, but not kappa- or delta-, opioid receptor antagonists. Once the agonist effects of BU72 had subsided, the compound acted to attenuate the antinociceptive action of morphine. BU72 is too efficacious for human use but manipulation to reduce efficacy could provide a lead to the development of a treatment for opioid dependence.
PMID: 15363957 [PubMed - indexed for MEDLINE]
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Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients.
McLain RF, Kalfas I, Bell GR, Tetzlaff JE, Yoon HJ, Rana M.
The Cleveland Clinic Spine Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. mclainr@ccf.org
OBJECT: Despite a history of safety and efficacy, spinal anesthesia is rarely used in lumbar surgery. Application of regional anesthetics is widely preferred for lower-extremity surgery, but general anesthesia is used almost exclusively in spine surgery, despite evidence that spinal anesthesia is as safe and may offer some advantages. METHODS: In this case-controlled study the authors analyzed outcomes obtained in 400 patients in whom either spinal anesthesia or general anesthesia was induced to perform a lumbar decompression. Patients were matched for anesthesia-related class, preoperative diagnosis, surgical procedure, and perioperative protocols. All aspects of surgery, recovery, postanesthesia care, and pain management were uniform irrespective of the anesthetic type. Case complexity was equivalent. An independent observer performed analysis of the data. Data from the intraoperative period through hospital discharge were collected and compared. Two hundred consecutive patients meeting inclusion criteria were included in each group. Patients were treated for either lumbar stenosis or herniated nucleus pulposus. Demographically, both groups were well matched. Anesthetic and operative times were longer for patients receiving a general anesthetic (p < 0.05), in whom more nausea and greater requirements for antiemetics and pain medication were also present during recovery (p < 0.05). Overall complication rates and, specifically, the incidences of urinary retention were significantly lower in spinal anesthesia--induced patients (p < 0.05). There were no neural injuries in either group, and the incidence of spinal headache was lower in patients receiving a spinal anesthetic (1.5% compared with 3%). CONCLUSIONS: Spinal anesthesia was as safe and effective as general anethesia for patients undergoing lumbar laminectomy. Potential advantages of spinal anesthsia include a shorter anesthesia duration, decreased nausea, antiemetic and analgesic requirements, and fewer complications. Successful surgery can be performed using either anesthesia type.
PMID: 15658121 [PubMed - indexed for MEDLINE]
Pain relief during labor.
Camann W.
Publication Types:
PMID: 15716567 [PubMed - in process]
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