Epidural block with mepivacaine before surgery reduces longterm post-thoracotomy painPurpose: To examine the effect of continuous epidural block initiated before thoracic surgery upon early and long-term postoperative pain. Methods: In a double-blind stu.dy, 70 patients scheduled for thoracic surgery under general anesthesia were assigned randomly to receive continuous epidural block with mepivacaine 1.5% initiated either 20 rain before surgical incision (Pre group) or at completion of surgery (Post group). In both groups the initial dose was 4 ml, followed by a continuous infusion at 4 ml.hr -t until 72 hr after operation. Indomethacin suppositories, 50 mg, were administered on request as supplementary analgesics. Visual analogue scale at rest was assessed four hours after operation, and then every 24 hr after operation on postoperative days I through 7, and also days 14 and 30. At three and six months after operation, all patients were interviewed by telephone with respect to postoperative pain. The most severe pain was assessed using modified numerical rating scale. Results: By a visual analogue scale, postoperative pain was less in the Pre group than in the Post group at four hours, two and three days after operation (P < 0.05). By a numerical rating scale six months after operation, pain was less in the Pre group than in the Post group (P = 0.015). The percentage of pain-free patients was higher in the Pre group than in the Post group at three (P = 0.035) and six (P = 0.0086) months after operation. Conclusion: Continuous epidural block initiated prior to surgery may reduce long-term post-thoracotomy pain.
The management of trigeminal neuralgia in older patients who do not want neurolytic block and/or surgical treatment may be problematic. This paper describes three patients who had first and/or second division trigeminal neuralgia. The analgesic effects of infraorbital nerve block using 0.5% bupivacaine or 1% mepivacaine dissipated within a few days, however, the effects of nerve blocks using 4% tetracaine dissolved in 0.5% bupivacaine continued for more than 3 months. Hypesthesia was observed in two patients within a week following the block, but sensory level returned to normal within 2 weeks and there were no further complications in any patient.
We examined the antiallodynic effect of intrathecally administered serotonin receptor agonists including 5-HT(1A), 5-HT(1B), 5-HT(2) and 5-HT(3) receptor subtypes in a rat model using spinal nerve ligation at L5 and L6. Administration of the 5-HT(2) receptor agonist, alpha-methyl-5-hydroxytryptamine maleate (alpha-m-5-HT; 3-100 microg) or (+/-)-1-(4-iodo-2,5-dimethoxyphenyl)-2-aminopropane hydrochloride (DOI; 10-100 microg), showed dose-dependent antiallodynic actions with no associated motor weakness. The antiallodynic action of alpha-m-5-HT was more potent than that of DOI. The effects of 5-HT(2) agonists on tactile allodynia were reversed by intrathecal pretreatment with the selective 5-HT(2) antagonist ketanserin and with the mixed 5-HT(1) and 5-HT(2) antagonist methysergide. Neither the mixed 5-HT(1A) and 5-HT(1B) antagonist cyanopindolol nor the selective 5-HT(3) antagonist MDL72222 attenuated antiallodynic effects induced by 5-HT(2) agonists. In contrast, the selective 5-HT(1A) agonist 8-hydroxy-2-(di-n-propylamino)-tetralin hydrobromide (8-OH-DPAT; 1-50 microg), the 5-HT(1B) agonist 5-methoxy-3-(1,2,5,6-tetrahydro-4-pyridinil)-1H-indol (RU-24969; 10-100 microg) and the 5-HT(3) agonist 2-methyl-5-hydroxytryptamine maleate (2-m-5-HT; 30-300 microg) all lacked significant antiallodynic action with intrathecal administration. These results indicate that the 5-HT(2) receptor plays an essential role in spinal suppression of neuropathic pain by 5-HT.
Purpose: In this study we examined whether normocapnia maintained by hyperventilation after lower limb tourniquet deflation prevents an increase in cerebral blood flow velocity. Methods: Thirteen patients, undergoing elective orthopedic surgery, requiring a pneumatic tourniquet around the lower extremity, were divided into two groups. In group I, ventilation was controlled at tidal volume of I 0 mL'kg -i and respiratory rate of eight per minute after tourniquet release. In group 2, ventilation was controlled to maintain PETCO 2 between 30 and 35 mml-lg after tourniquet release. Arterial blood pressure, heart rate, peak and mean middle cerebral artery (MCA) flow velocity, and arterial blood gas were measured every minute for ten minutes after tourniquet release. The MCA blood flow velocity was measured using Transcranial Doppler ultrasonography (TCD). l~.~ults: In group I, the maximum peak MCA flow velocity was 53 -+ 6 cm'sec -t (50 96 +_ 6% increase compared with pre-release value), and achieved 3 _ 0.4 min after tourniquet release. In group 2, there was no increase either in mean or peak MCA velocity after tourniquet release. Concision: Normocapnia maintained by hyperventilation after tourniquet deflation prevents an increase in cerebral blood flow velocity.Objectis : VErifier si la normocapnie maintenue par.l'hyperventilation aprEs le d~gonflage d'un garrot autour du membre inf&ieur emp&he I'augmentation de la vitesse du flux sanguin c&6bral. MEthodr : Treize patients, admis pour une chirurgie orthop~dique n&essitant un garrot pneumatique autour du membre inf&ieur, ont Et~ r~partis en deux groupes. AprEs le rel~chement du garrot, on note que : clans le Groupe I, la ventilation Etait maintenue au volume courant de I 0 ml'kg -~ et la fr~quence respiratoire ~ huit par minute ; dans le Groupe 2, la ventilation ~tait contr61& pour maintenir la PE,CO2.entre 30 et 35 mmHg ; la tension art&ielle, la fr~quence cardiaque, la vitesse moyenne et maximale du flux de I'artEre c&~brale moyenne (ACM) et les gaz du sang art&iel Etaient mesur6s ~ chaque minute pendant dix minutes. La vitesse du flux de rACM a ~t~ mesurEe par &hographie-Doppler transcr~nienne (DTC). P.~.sLdtats : Dans le Groupe I, la vitesse maximale du flux de rACM a ~t6 de 53 _+ 6 cm.sec-' (50 % _ 6 % d'augmentation en comparaison des valeurs pr&6dant la lib&ation du garrot), eta ~t~ atteinte 3 _+ 0,4 min apr& le garrot. Dans le Groupe 2, il n'y a pas eu d'augmentation de la vitesse moyenne ou maximale du flux de I'ACM aprEs le garrot. Conclusion : ~ normocapnie maintenue par rhyperventilation apr& le d~gonflage du garrot peut emp&her une augmentation de la vitesse du flux sanguin c6r~bral.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.