Articles: pain.
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Thirty-five patients were delivered by electric Caesarean section under general or epidural anaesthesia. For postoperative analgesia they received narcotic analgesics as required and either transcutaneous nerve stimulation or an inactive stimulator. ⋯ The epidural patients did not receive any additional benefit from active stimulation, but had the same amount of pain and the same analgesic requirement as patients receiving active stimulation following general anaesthesia. The possible causes for the failure of transcutaneous nerve stimulation after epidural anaesthesia and their implications are discussed.
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The involvement of serotonergic mechanisms in diffuse noxious inhibitory controls (DNIC) acting on dorsal horn convergent neurones has been studied in the anaesthetized rat. 35 neurones activated by transcutaneous electrical stimulation of their hindpaw receptive fields giving clear large A-fibre and C-fibre responses were recorded. These activities were conditioned by DNIC, evoked by either noxious heat applied to the tail or noxious pinch of the nose. ⋯ These results indicate an important role for descending serotonergic pathways in DNIC. The functional role of this system is discussed.
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Ketamine hydrochloride 4 mg in 10 ml 5% dextrose water was administered epidurally to 7 patients suffering from intractable pain in the back, lower abdomen and legs. Pain relief was obtained in all cases. ⋯ No adverse side-effects were noted and no detectable neurological damage resulted. Intraspinal ketamine offers and advantage over the opiates, in that respiratory depression is unlikely to occur.