The analgesic properties of ethyl alcohol administered i.v. were investigated, using elevation of the pain threshold for applied somatic stimuli as an index. Alcohol proved markedly superior to saline in this respect and produced an effect equivalent to that of i.v. morphine.
Extradural lumbar (epidural) analgesia has been used for the relief of pain in labour at the Westminster Hospital for the past fifteen years. The success of this procedure over such a long period of time has been due to the closest co-operation between the staffs of the departments of Anaesthetics and Obstetrics and the strict adherence to the essentials of asepsis and sound technique.The drug in common use to begin with was lignocaine hydrochloride 1.5 % without adrenaline. This produced good analgesia, but suffered from the disadvantage that its effect rarely lasted for a period of longer than ninety minutes and that it exhibited significant waning in the duration of its action with subsequent doses. In the past local analgesia has been administered for the relief of pain in labour by various workers by the spinall, caudal2 and lumbar extradural routes using both the 'single shot'3 and 'continuous' methods4 but all these techniques have necessitated a great deal of supervision by both the anaesthetic and obstetric staff which has been due in no small measure to the frequency with which the analgesia must be reinforced by maintenance doses of the local anaesthetic agent.Bupivicaine, ('Marcain' -1-n-butyl-DL-piperidine-2-carboxylic acid-2,6-dimethylamilide hydrochloride), is a local anaesthetic agent closely related to carbocaine. It is four times as toxic as carbocaine5.6, but has considerably greater potency, so that the toxicity/potency ratio is similar for the two drugs. The most outstanding property claimed for bupivicaine is its duration of action which has been shown to be markedly longer than that of other local anaesthetic agents7-12. No evidence of neurotoxic effects have been observedl3, with this agent nor have disturbances in the blood picture or in liver function been demonstrated 14.The advent of bupivicaine promised to increase the duration of the periods between 'topping up' doses and it was, therefore, decided to institute a trial of this drug to assess its usefulness in lumbar extraduralanalgesia in labour, and at the same time to note any toxic effects in either the mother or the newly born infant.
1. Previous clinical and experimental reports have suggested that the systemic administration of ethyl alcohol permits lower body temperatures before the onset of hypothermic cardiac arrest. 2. In the investigations described here, the effect of ethyl alcohol on the temperature at which cardiac arrest occurred in rats, guinea-pigs and isolated rat hearts was studied. Comparison was also made of the difference between pulmonary ventilation with air and with 5% carbon dioxide in oxygen. 3. The results demonstrated that both the administration of ethyl alcohol and ventilation with 5% carbogen reduced the cardiac arrest temperature of rats. Ethyl alcohol did not influence the cardiac arrest temperature of guinea-pigs nor of isolated rat hearts.
Transphenoidal ablation of the pituitary gland by the injection of alcohol is used for the relief of wide-spread cancer pain. A technique is described in which a cryoprobe is passed through a transphenoidal needle and a number of lesions produced within the gland. It is suggested that this method of pituitary ablation may prove to be as effective but accompanied by fewer complications than the injection of alcohol.
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