Articles: analgesia.
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When rats were tested more than two weeks following surgery, lesions of the medial basal hypothalamus centered on the arcuate nucleus enhanced a form of foot-shock stress-induced analgesia (SIA) that was not blocked by injections of the opiate receptor blocker, naltrexone (6 mg/kg;). These arcuate nucleus lesions reduced the SIA produced by the same stressor when similar rats were tested 3-4 days following surgery. ⋯ We suggest that arcuate nucleus lesions disrupt a system important for the elaboration of opiate-mediated SIA (Expt. 4), perhaps by damaging the brain's beta-endorphin system. In response to damage to this opioid analgesic system, we hypothesize that the damaged brain initiates time-dependent compensatory changes in an undamaged non-opioid analgesic system, resulting in enhanced non-opiate-mediated SIA.
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Anesthesia and analgesia · Sep 1986
Epidural analgesic techniques in the management of cervical pain.
The injection of depot steroids into the cervical epidural space can maximize the conservative management of patients with cervical radiculopathy. We retrospectively studied 25 patients with cervical radiculopathy who received a total of 45 epidural injections of steroids. ⋯ The patient's history and a description of the pain and the corresponding neurological abnormalities present were of value in the selection of patients who were most likely to respond favorably to epidural steroids, whereas laboratory studies were not as useful. Anesthesiologists, many already familiar with the use of epidural steroid injection in the treatment of low back pain, should add to their armamentarium the use of such techniques in the management of patients with acute and chronic cervical radiculopathy.
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Acta Anaesthesiol Scand · Aug 1986
Randomized Controlled Trial Comparative Study Clinical TrialComparison of different methods of postoperative analgesia after thoracotomy.
Fifty-one patients scheduled for thoracotomy were included in a study involving five different methods of postoperative analgesia. Forty patients were randomly divided into: Group C, receiving intramuscular oxycodone on request following an intraoperative intercostal block; Group IC, intercostal blocks with 0.5% bupivacaine performed prior to surgery, 6 h later and on the first postoperative morning: Group EB, epidural bupivacaine as a continuous infusion of 0.25% bupivacaine (5 ml h-1); Group EM4 epidural morphine 4 mg injected prior to surgery and on the first postoperative morning. In addition, a fifth group (Group EM6) of 11 patients received 6 mg of epidural morphine timed as in Group EM4, but these patients were automatically scheduled to be observed in the ICU. ⋯ Postoperative blood-gas analyses contained slightly elevated PCO2 values (6.0-7.3 kPa) in all groups. Postoperatively, only Group EB was devoid of PCO2 values above 7.3 kPa. Urinary retention was a common complication in the patients receiving epidural analgesia, occurring most frequently in Group EM6; 10 of the 11 patients had to be catheterized.
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Ann R Coll Surg Engl · Jul 1986
Clinical Trial Controlled Clinical TrialAnalgesia in the acute abdomen.
In a prospective sequential double blind trial 288 patients with acute abdominal pain were given sublingual buprenorphine 200 mcg, sublingual buprenorphine 400 mcg, or placebo. Pain relief was proportional to the number of tablets administered; buprenorphine had no difference in effect compared to placebo. Physical signs altered in proportion to dosage, but this had no effect on clinical diagnosis. We conclude that patients with acute abdominal pain may be given buprenorphine without fear of masking the diagnosis.