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Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery analgesia: A Randomized Double-Blinded Trial

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Open Journal of Obstetrics and Gynecology 2018年第9期8卷 780-789页

作者： Marcio Luiz Benevides Rubens Jardim Nochi Jr. Carlos Eduardo Solcia Valter Moreira Xavier Júnior Adalberto Francisco Buss Lima Department of Anesthesiology Hospital Geral Universitário Cuiabá Brazil

Brazil is one of the countries that carry out cesarean delivery in the world. The pain after cesarean delivery (CD) is one of the main concerns of parturient. Intrathecal Morphine (ITM) is widely used for the treatment of pain after CD;however, the optimal dose with minimal side effects is to be established. Objectives: To compare the analgesia and side effects resulted by three different doses of ITM as part of a multimodal regimen for post-cesarean delivery analgesia. Methods: One hundred ninety-four patients were sampled in this randomized, double-blinded, three-arm study (group 0.075: ITM 0.75 mg;group 0.1: ITM 0.1 mg and group 0.15: ITM 0.15 mg). All patients received intravenous dexamethasone, dipyrone and ketoprofen. The primary endpoint was pain intensity measured at rest and on movement, while the secondary endpoint was overall satisfaction with pain relief, the incidence of nausea and vomiting, intensity of pruritus, and the use of additional tramadol, antipruritic and antiemetic use within 24 hours after postoperation. Results: The three groups showed similar pain intensity at rest and on movement. The pain intensity on movement was significantly higher than at rest in the groups (p 0.001). There were no significant differences among the groups regarding secondary endpoint. Conclusions: Our findings suggest that in cases of an elective CD, 0.075 mg of ITM produces postoperative analgesia of similar quality that provided by 0.1 or 0.15 mg ITM. The patients should have a multimodal analgesia approach that includes: ITM, anti-inflammatory agents and access to additional systemic analgesic if necessary.

关键词： Spinal Anesthesia Cesarean Delivery Intrathecal Morphine Postoperative Pain Multimodal analgesia

THE EFFECT OF SPINAL TRANSECTION ON ACUPUNCTURE analgesia AND MORPHINE analgesia

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Chinese Science Bulletin 1986年第10期31卷 710-715页

作者：韩济生张敏任民峰 Department of Physiology Beijing Medical College Department of Physiology Beijing Medical College Department of Physiology Shandong medical College. Department of Pharmacology Institute of Basic Medical SciencesChinese Academy of Medical Sciences Beijingail flick latency (TFL) towards thermal irradiation has been widely used as a nociceptive index in studying pain and analgesia including acupuncture analgesiaand in the screening of narcotic analgesics. While tail flick is basically a spinal reflexit is under the tonic control of higher centers.In this note high level spinal transection was performed on rats in an attempt to analyze the central mechanism of acupuncture analgesia at the spinal anal supraspinal levels.

Tail flick latency (TFL) towards thermal irradiation has been widely used as a nociceptive index in studying pain and analgesia, including acupuncture analgesia,and in the screening of narcotic analgesics. While tail flick is basically a spinal reflex,it is under the tonic control of higher *** this note, high level spinal transection was performed on rats in an attempt to analyze the central mechanism of acupuncture analgesia at the spinal anal supraspinal levels.

关键词： analgesia acupuncture reflex tonic flick latency attempt irradiation morphine screening

THE COMMON BASIS OF ELECTRO-ACUPUNCTURE analgesia AND MORPHINE analgesia

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Chinese Science Bulletin 1980年第10期25卷 872-877页

作者：张祖喧张媛贞余启祥李春宝陈荣三 Acupumcture Anesthesia Research Group Department of Biology Nanjing University Coordination Chemistry Institute Department of Chemistry Nanjing University

The correlation of 12 metal ions with electro-acupuncture analgesia in mice was studied. It was found that a decrease of calcium ion (Ca2+) content in the brain could enhance the analgesic effect of electro-acupuncture, while an increase of Ca2+ content could lower or even cancel its effect. Other cations, such as potassium, sodium, lithium, copper, strontium, barium, zinc, cobalt, ferrous, magnesium and aluminum, had no effect on electro-acupuncture analgesia.

关键词： analgesia acupuncture analgesic ferrous magnesium cancel lithium potassium barium weighing

The Patient-Reported Outcome of Intra-Operative Direct Vision Pectoral Nerve Block for Postoperative analgesia for Breast Surgery

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Surgical Science 2021年第8期12卷 274-285页

作者： Manas Kumar Dube Jeffrey Wu Rishabha Deva Sharma Yvonne Chang Kishore Makam Breast Surgery King’s Mill Hospital Mansfield UK Internal Medicine University Hospital of Coventry and Warwickshire Coventry UK Breast Surgery Royal United Bath Hospital Bath UK Clinical Education George Eliot Hospital Nuneaton UK Breast Surgery George Eliot Hospital Nuneaton UK

Background and Aims: Pectoral nerve blocks gained increasing recognition for adequate postoperative pain relief following breast surgery. Traditionally, anaesthetist administered preoperatively under ultrasound guidance, which added significantly to the total procedure time. We studied the effectiveness of intraoperative direct vision pectoral nerve block and reduction of total theatre time. Methods: We provided questionnaires to the eligible patients who underwent a mastectomy and or axillary node clearance from August 2018 to May 2019. All the patients had an intra-operative pectoral 1 and serratus plane (Pecs) block. Participants documented pain score twice daily, episodes of nausea or vomiting and type and dose of analgesia for the first seven postoperative days. We compiled and grouped the results into postoperative days 1 - 2 and 3 - 7 for data analysis. Results: Patients reported generally low levels of pain, with a median pain score of 1.75 out of 10 for postoperative days 1 - 2 (IQR 4). The score decreased to 0.7 for days 3 - 7 postoperatively (IQR 3) suggesting that most patients had generally minimal levels of pain apart from a few outliers. The average injection time for PECs blocks was 5 minutes, significantly less than USS guided techniques of 20 - 30 minutes. Conclusions: Our data suggest that nerve blocks under direct vision offer satisfactory efficacy in postoperative analgesia with minimal nausea and vomiting. This is in addition to substantial benefits in operative efficiency and reduction of total procedure time.

关键词： Breast Cancer analgesia Pectoral Nerve Block

Renal function after laparoscopic cholecystectomy and analgesia with tramadol and dipyrone or ketorolac

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Health 2013年第11期5卷 35-41页

作者： Tiago Pechutti Medeiros Pedro Thadeu Galvao Vianna Leopoldo Muniz da Silva Lidia Raquel de Carvalho Gilberto Elias Wady Leandro Gobbo Braz Yara Marcondes Machado Castiglia Graduate Program in Anesthesiology Botucatu Medical SchoolUNESP-Universidade Estadual PaulistaBotucatuBrazil Department of Anesthesiology Botucatu Medical SchoolUNESP-Universidade Estadual PaulistaBotucatuBrazil Sao Luiz Hospital Sao PauloBrazil Department of Biostatics Institute of BiosciencesUNESP-Universidade Estadual PaulistaBotucatuBrazil Mercy Hospital Sao CarlosBrazil

Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of analgesia with tramadol combined with either dipyrone or ketorolac on the postoperative renal function of patients submitted to LC. Methods: Pre-and post-operatively (PO), estimated glomerular filtration rates (GFR), obtained by two formulas dependent on blood Cr and one on blood cystatin C values, and tubular enzymuria—alkaline phosphatase (AP), γ-glutamiltransferase (γ-GT)— were determined in well hydrated patients who underwent LC and analgesia with tramadol combined with either dipyrone (Dipyrone, n = 63) or ketorolac (Ketorolac, n = 63). Upon discharge from the post-anesthetic care unit (PACU), pain (through Verbal Numerical Scale—VNS) and need for rescue analgesia with morphine were evaluated. Results: There was hemodilution PO, which made GFR profile analysis more difficult—those dependent on Cr increased and statistically correlated, but those dependent on cystatin C did not change. There was a significant PO increase in AP in the Dipyrone and Ketorolac groups, and in the product of the both enzymes in the Ketorolac group. Upon PACU discharge, the Dipyrone group showed signifi cantly higher VNS scores than the Ketorolac group. All patients received morphine PO, and the total dose needed for pain control differed between groups, but without statistical significance. Conclusions: The association of tramadol with dipyrone or ketorolac in well hydrated patients submitted to LC had similar analgesic effectiveness in the PACU. Postoperatively, the effect on GFR may have been masked by hemodilution, and enzymuria was discreetly enhanced when ketorolac was used.

关键词： Kidney Function Tests Pneumoperitoneum Biological Markers Cystatin C Ketorolac analgesia

THE INVOLVEMENT OF SEROTONERGIC TRANSMISSION IN PERIAQUEDUCTAL GREY FOR ELECTROACUPUNCTURE analgesia AND MORPHINE analgesia IN RABBITS

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Chinese Science Bulletin 1984年第1期29卷 116-122页

作者：康保娥周仲福韩济生 Department of Physiology Beijing Medical College

The implication of central serotonergic mechanism in mediating acupuncture analgesia and morphine analgesia has been well documented, although the precise mechanism(s) and site(s) of action have not been fully understood. In the present study, cinanserin was injected into periaqueductal grey(PAG), the key link in endogenous analgesia system, to block serotonin (5-HT) receptors to see its

关键词： analgesia morphine acupuncture understood endogenous implication naloxone serotonin rabbit saline

Labour analgesia effects on foetal heart rate. A mini-review

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Open Journal of Obstetrics and Gynecology 2011年第3期1卷 113-120页

作者： Nicole Maria Anna Adela Engel Marc Van de Velde Jan Gerrit Nijhuis M. A. E. Marcus 不详

Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.

关键词： Labour analgesia Foetal Heart Rate Changes Epidural analgesia Combined Spinal Epidural Intravenous analgesia

ENHANCEMENT OF ELECTRO-ACUPUNCTURE analgesia BY INTRAVENTRICULAR PRASEODYMIUM CHLORIDE

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Chinese Science Bulletin 1984年第4期29卷 537-542页

作者：张祖暄葛鸣童静波王新光陈荣三 Department of Biology Nanjing University Coordination Chemistry Research Institute Nanjing University

Intracisternally administered lanthanum chloride was found to produce analgesic effects as measured by the mouse tail-flick method and the characteristics of the analgesic effects were similar to those of morphine and electro-acupuncture. It was also found that the actions of Pr3+ in vitro resembled those of La3+, but the former exerted dual action on transmitter release of the neuromuscular synapse. In the present study, the relationship between Pr8+ and Ca2+ as well as the effects of them on electro-acupuncture analgesia are observed and at the same time, the analgesic effects of 10 kinds of lanthanides are compared.

关键词： analgesia analgesic acupuncture morphine transmitter naloxone lanthanum flick weighing immediately

Monitoring salivary amylase activity is useful for providing timely analgesia under sedation

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World Journal of Gastrointestinal Endoscopy 2014年第6期6卷 240-247页

作者： Masaya Uesato Yoshihiro Nabeya Takashi Akai Masahito Inoue Yoshiyuki Watanabe Daisuke Horibe Hiroshi Kawahira Hideki Hayashi Hisahiro Matsubara Department of Frontier Surgery Chiba University Graduate School of Medicine Division of Gastroenterological Surgery Chiba Cancer Center Department of Endoscopic Diagnostics and Therapeutics Chiba University Hospital Research Center for Frontier Medical Engineering Chiba University

AIM:To detect the criteria and cause of elevated salivary amylase activity(sAMY)in patients undergoing endoscopic submucosal dissection(ESD)under ***:A total of 41 patients with early gastric cancer removed via ESD under deep sedation(DS)were *** perioperative sAMY,which was shown as sympathetic excitements(SE),was *** time at which a patient exhibited a relatively increased rate of sAMY compared with the preoperative baseline level(IR,%)≥100%(twice the actual value)was assumed as the moment when the patient received *** the 41 patients,we focused on 14 patients who exhibited an IR≥100% at any time that was associated with sAMY elevation during ESD(H-group)and examined whether any particular endoscopic procedures can cause SE by simultaneously monitoring the sAMY *** a patient demonstrated an elevated sAMY level above twice the baseline level,the endoscopic procedure was immediately *** the impossible case of discontinuance,analgesic medicines were *** study was performed ***:A total of 26 episodes of sAMY eruption were considered moments of SE in the *** baseline level of sAMY significantly increased in association with an IR of>100% at 5 min,with a significant difference(IR immediately before elevation/IR at elevation of sAMY=8.72±173/958±1391%,P<0.001).However,effective intervention decreased the elevated sAMY level immediately within only 5 min,with a significant difference(IR at sAMY elevation/immediately after intervention=958±1391/476±1031,P<0.001).The bispectral indices,systolic blood pressure and pulse rates,which were measured at the same time,remained stable throughout the *** endoscopic insertion or over insufflation was performed during 22 of the 26 *** of the gastric wall tension and/or the administration of analgesic medication resulted in the immediate recovery of the elevated sAMY level,independent of body ***:By detecting tw

关键词： Salivary amylase activity Endoscopic submucosal dissection analgesia Anesthesia Sedation Sympathetic excitement Gastric wall tension