Articles: analgesia.
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J. Pharmacol. Exp. Ther. · Mar 1991
Comparative StudyDifferential contribution of descending serotonergic and noradrenergic systems to central Tyr-D-Ala2-Gly-NMePhe4-Gly-ol5 (DAMGO) and morphine-induced antinociception in mice.
Differences in antinociceptive (inhibition of tail-flick response) action of morphine and Tyr-D-Ala2-Gly-NMePhe4-ol5 (DAMGO) were demonstrated by intracerebroventricular (i.c.v.) administration of these agonists along with intrathecal (i.t.) administration of a variety of antagonists: yohimbine, methysergide, naloxone and nor-binaltorphimine. Intracerebroventricular morphine analgesia was antagonized by either i.t. yohimbine or methysergide, whereas i.c.v. DAMGO analgesia was only antagonized by i.t. methysergide. ⋯ Morphine and DAMGO differ further because i.c.v. morphine activated a descending antianalgesic pathway mediated by spinal dynorphin A(1-17), whereas i.c.v. DAMGO at a high dose did not. Thus, morphine and DAMGO differ in their modes of antinociceptive action as measured by the tail-flick response.
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Seventeen years' experience of spinal cord stimulation in the treatment of chronic pain has shown it to be effective only in the case of neuropathic pain--in particular, pain due to lesions in peripheral nerves or posterior roots. In such cases, pharmacological treatment is often unsuccessful, and transcutaneous electrical nerve stimulation is only useful in certain cases. ⋯ Trial stimulation via a temporary extension lead for at least 4-5 days is a prerequisite of good long-term results. It is concluded that spinal cord stimulation is an indispensable tool for treating chronic neuropathic pain, and it merits to be used more frequently.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative study of the effects of air or saline to identify the extradural space.
Fifty women in labour were allocated randomly to receive either air or saline to assist in the identification of the extradural space by the loss of resistance technique. A study volume of 4 ml of air or saline was used before 0.5% bupivacaine 8 ml and the spread of analgesia was followed for 30 min. ⋯ All unblocked segments were blocked subsequently by further doses of bupivacaine. We conclude that air is more likely than saline to produce unblocked segments in the initiation of extradural analgesia in labour.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural diamorphine with adrenaline in labour: comparison with diamorphine and bupivacaine.
In a randomized double-blind study of 51 primigravida, we have examined the relative efficacies of bupivacaine, diamorphine or diamorphine with adrenaline given by the extradural route for relief of pain during labour. Group 1 (n = 18) received diamorphine 5 mg in 0.9% sodium chloride 8 ml; group 2 (n = 19) received diamorphine 5 mg in 0.9% sodium chloride 8 ml with 1:200,000 adrenaline; group 3 (n = 14) received 0.375% bupivacaine 8 ml. All patients received 0.375% bupivacaine 8 ml as a supplement after the initial analgesia had subsided. ⋯ There were no serious adverse effects in any group, but pruritus was a feature in the diamorphine groups. Diamorphine 5 mg may be used as an alternative to bupivacaine 0.375% 8 ml in the first stage of labour and provides a longer duration of action. The addition of adrenaline 1:200,000 appears to augment both the quality and duration of analgesia.