Articles: analgesia.
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Three experiments with rat subjects assessed conditioned analgesia in a Pavlovian second-order conditioning procedure by using inhibition of responding to thermal stimulation as an index of pain sensitivity. In Experiment 1, rats receiving second-order conditioning showed longer response latencies during a test of pain sensitivity in the presence of the second-order conditioned stimulus (CS) than rats receiving appropriate control procedures. ⋯ Rats receiving paired morphine-shock presentations showed significantly shorter response latencies during a hot-plate test of pain sensitivity in the presence of the second-order CS than did groups of rats receiving various control procedures; second-order analgesia was attenuated. These data extend the associative account of conditioned analgesia to second-order conditioning situations and are discussed in terms of the mediation of both first- and second-order analgesia by an association between the CS and a representation or expectancy of the US, which may directly activate endogenous pain inhibition systems.
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Eight patients undergoing abdominal surgery received epidural analgesia with 0.5% plain bupivacaine at a fixed dose rate (8 ml/h) for postoperative pain relief. Mean sensory level of analgesia (pin prick) was assessed hourly and regressed from a mean preoperative level of T3.7 (+/- 0.3 SEM) to T10 (+/- 0.7) at an average of 8.9 +/- 1.4 h post skin incision (range 4-16 h). ⋯ Simultaneously, pain score decreased to 0.3 +/- 0.3. This synergistic effect of systemic morphine on the extent of neural blockade with epidural bupivacaine may have an important role in improving postoperative pain relief.
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The results of intraspinal narcotic analgesia (INA) in 43 patients with chronic nonmalignant pain syndromes are reviewed. A protocol has been established to improve proper patient selection and includes three phases of study. ⋯ In those patients qualifying for continuous delivery systems (CDS), 65% had good to excellent relief of pain while 34% were considered failures for a variety of reasons. Apparent tolerance development in many of the patients was, in fact, due to technical problems with the epidural catheter instead.
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Randomized Controlled Trial Clinical Trial
Continuous epidural infusion for analgesia after major abdominal operations: a randomized, prospective, double-blind study.
We performed a prospective, randomized, double-blind study of continuous epidural analgesia for 72 hours after major abdominal procedures. Patients were randomly assigned to one of five treatment groups: epidural morphine, epidural bupivacaine, a combination of morphine and bupivacaine, epidural saline solution, and no epidural catheter. All patients received supplemental morphine sulfate or meperidine hydrochloride, intramuscularly or intravenously, as needed. ⋯ The group that received the combination of morphine and bupivacaine did best on all measures; in most instances the difference between the results seen with the combination regimen and those seen with saline solution or no catheter were significant at the 0.05 level. With the exception of pruritus, complications were evenly distributed among all treatment groups, including noncatheterized controls. We conclude that epidural analgesia with the combination of morphine and bupivacaine is safe, is easily managed, and gives pain relief superior to that provided by traditional, systemic administration of narcotics.
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Anesteziol Reanimatol · Sep 1985
Review Comparative Study[Peridural analgesia using narcotic analgesics].