Articles: analgesia.
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The electrical current thresholds for pain (ECTP) in the skin of the neck and tail were measured in rats with chronically implanted lumbar subarachnoid catheters. The effects of a benzodiazepine antagonist and a gamma-aminobutyric acid (GABA) antagonist on the analgesic effects of equivalent doses of midazolam, fentanyl, and ketocyclazocine were studied. These were the minimum doses producing maximal segmental analgesia when given intrathecally (i.e., they all caused a significant and maximum increase in ECTP in the tail, which was similar for all three drugs, but no significant change in the ECTP in the neck). ⋯ Segmental analgesia following midazolam was also significantly attenuated (P less than 0.05) when the selective GABA antagonist bicuculline was given intrathecally at the same time as midazolam. The highest dose of bicuculline used (50 pmol) caused no significant attenuation of the segmental analgesic effects of either ketocyclazocine or fentanyl. The authors concluded that the segmental analgesia produced by intrathecal midazolam is mediated by the benzodiazepine-GABA receptor complex that is involved in other benzodiazepine actions.
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From research reports published over the last 20 years, it appears that moderate to severe uncontrolled pain may be the norm for hospitalized patients despite recent advances in the management of pain. Research on the extent of under-management of pain and the factors associated with it is examined and summarized in this paper. ⋯ A clinical decision making model is also reviewed and it is suggested that this model could be applied to pain management problems. Further, it is suggested that this model may be very useful in developing educational interventions to improve health practitioners' clinical skills in pain management.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Jul 1990
Epidural analgesia and its effect on umbilical artery flow velocity waveform patterns in uncomplicated labour and labour complicated by pregnancy-induced hypertension.
Umbilical artery flow velocity waveforms were obtained using continuous-wave Doppler ultrasound to examine the effect of epidural analgesia on peak systolic/least diastolic ratio (A/B ratio) in 38 women in uncomplicated labour, and 12 women with pregnancy-induced hypertension (PIH). In the uncomplicated group there was no significant change in A/B ratio after epidural analgesia, but in the PIH group there was significant correlation between the fall in mean blood pressure and the fall in A/B ratio at 30 min after induction of epidural analgesia (r = 0.85, p less than 0.001). This suggests that epidural analgesia in PIH is associated with a reduction in placental resistance and may be beneficial to the fetus.