Increase in the threshold of pain and touch sensation in the human face with clonidine plus 30% nitrous oxide

Siiba, Shunji; Nakanishi, Osamu; Ishikawa, Toshizo; Hirakawa, Teruyuki; Kawahara, Hiroshi; Imamura, Yoshiki

doi:10.1016/s1079-2104(99)70211-8

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Nor was there any effect of N 2 O administration or video glasses compared with the control situation. Previously, some studies have shown a significant effect of N 2 O on pain tolerance and on pain threshold with electrical stimulation of the dental pulp (Dworkin et al, 1983) and on tactile stimulation with Von Frey filaments and pressure pain to the skin (Siiba et al, 1999) while others have failed to show a significant difference between compressed air and N 2 O on labour pain (Carstoniu et al, 1994). As mentioned by Sprehn et al (1994), there are only a limited number of controlled, clinical studies on the pain alleviating effect of N 2 O, which is quite surprising in consideration of the widespread use of the method.…”

Section: Discussionmentioning

confidence: 99%

“…A non‐dental, painful skin stimulus, Von Frey filament (Voerman et al, 1999), which is a standardised method used in similar studies (Siiba et al, 1999) with good reproducibility (Bell‐Krotoskij and Tomancik, 1987), was incorporated in this study as a control to the dental stimulus. The patients were stimulated five times in a row on the upper lip with the Von Frey filament (SemmesWeinstein Monofilament, Stoelting, IL, USA) before and during the treatment.…”

Section: Methodsmentioning

confidence: 99%

“…In accordance, recent experimental studies on the modulation of pain and unpleasantness induced by the cold pressor test have documented a positive effect of distraction by the use of video glasses (Bentsen et al, 1999, 2000). Regarding nitrous oxide (N 2 O), it has been shown to have an hypoalgesic effect on cold pressor pain (Pirec et al, 1995) and to increase the threshold of tolerable pain and touch sensation in the face (Siiba et al, 1999). There are, however, a limited number of clinically controlled studies on the hypoalgesic effect of N 2 O (Sprehn et al, 1994).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the effect of video glasses and nitrous oxide analgesia on the perceived intensity of pain and unpleasantness evoked by dental scaling

Bentsen

Wenzel

Svensson

2003

European Journal of Pain

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The aim of this study was to evaluate whether distraction induced by video glasses had an effect on the perceived intensity of pain and unpleasantness during dental scaling compared with the effect of nitrous oxide (N(2)O) analgesia. The pain stimulus was dental scaling (removal of dental calculus) with an ultrasonic scaler. As a standardised, non-dental painful stimulus, Von Frey filaments were used. A total of 26 patients with superficial chronic periodontitis were enrolled in this randomised, controlled clinical study. The effect of video glasses was compared with N(2)O in one session and the effect of video glasses versus a control situation in another. The patients rated the intensity of pain and unpleasantness evoked by dental scaling and Von Frey filament stimulation on 100-mm visual analogue scales (VAS). For dental scaling, there was no effect of video glasses on the perceived pain (p=0.85) or unpleasantness (p=0.73) nor of N(2)O (p=0.69 and p=0.51, respectively) compared with the control situation. Similarly, no significant difference was found between VAS scores in the video glasses and N(2)O session (p=0.48, p=0.58). A significant effect of video glasses and N(2)O(p<0.008) was found on the perceived pain intensity produced by Von Frey filament stimulation compared with the control situation, but no significant difference was seen between these methods (p=0.07). Post-treatment interviews of the patients revealed that 81% of the patients in the video and 65% in the N(2)O session stated that the method had some beneficial effect on their overall experience of the treatment situation. In conclusion, administration of video glasses or N(2)O did not affect the perceived intensity of pain and unpleasantness evoked by dental scaling.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of the effect of video glasses and nitrous oxide analgesia on the perceived intensity of pain and unpleasantness evoked by dental scaling

Bentsen

Wenzel

Svensson

2003

European Journal of Pain

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“…These findings are confirmed and reinforced by a large body of literature. 12, 13,15,[49][50][51][52][53][55][56][57][58]67,69,70 Clonidine is a mixed alpha agonist drug possessing peripheral ␣1 and ␣2 activity as well as imidazoline agonist effects. In low doses it primarily produces central ␣2 effects.…”

Section: Discussionmentioning

confidence: 99%

Oral Clonidine Pretreatment Prior to Venous Cannulation

Hall

Rezvan

Tatakis

et al. 2006

Anesthesia Progress

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Clonidine is a preferential alpha-2 agonist drug that has been used for over 35 years to treat hypertension. Recently, it has also been used as a preoperative medication and as a sedative/anxiolytic drug. This randomized, double-blind, placebo-controlled crossover clinical trial characterized the effects of oral clonidine pretreatment on intravenous catheter placement in 13 patients. Parameters measured included the bispectral index (BIS), Observer's Assessment of Alertness/Sedation Scale (OAA/S), frontal temporal electromyogram (EMG), 30-Second Blink Count (Blink), Digit Symbol Substitution Test (DSST), State Anxiety Inventory (SAI), fingertip versus forearm skin temperatures, and multiple questionnaires. Oral clonidine significantly decreased SAI scores, OAA/S, EMG, and Blink, but did not cause statistically significant BIS or DSST reductions. Subjects preferred oral clonidine pretreatment prior to venipuncture compared to placebo. Questionnaires also indicated that clonidine provided minimal sedation, considerable anxiolysis, and some analgesia. Fingertip versus forearm skin temperature differentials were decreased. Reduced fingertip versus forearm temperature differentials suggest increased peripheral cutaneous blood flow prior to venous cannulation. Oral clonidine pretreatment not only helped control patient anxiety and pain but also provided cardiovascular stability.Key Words: Clonidine; Venous cannulation; BIS; SAI; DSST.I ntravenous (IV) catheters have become the accepted standard of care for general anesthesia and IV sedation. 1 Catheterization of peripheral veins can be made more comfortable using a variety of techniques, including local anesthesia infiltration, 2,3 nitrous oxide inhalation, 2,4,5 ethyl chloride topical, 4,6 eutectic mixture of local anesthetics (lidocaine-prilocaine) cream, 7,8 tetracaine patches, 9 and even midazolam nasal spray. 10 The goals of these methods are pain and anxiety reduction with minimal invasiveness and lack of significant complications. An additional benefit of some cannulation pretreatments is cutaneous vasodilation.Previous medical anesthesia/sedation studies have indicated that clonidine administration prior to surgery decreases pain 11,12 and anxiety 12 and also stabilizes blood pressure and heart rate by reduction of central sympathetic outflow. [13][14][15] Additional investigations have shown that clonidine pretreatment also increases skin temperature 16 and decreases the difference between fingertip and forearm temperatures. 17 These results suggest an increase in cutaneous blood flow. 18 The purpose of this randomized, double-blind, placebo-controlled crossover clinical trial was to characterize the sedative/anxiolytic effects and changes in skin temperatures of oral clonidine pretreatment prior to IV catheter placement. METHODSThe study protocol and informed consent form were approved by The Ohio State University Institutional Review Board. Inclusion criteria were (a) adults with American Society of Anesthesiologists ASA1 or ASA2 health status, (b) severe ...

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“…It has also been used to prevent and/or treat many conditions, including syncope (Hilz et al, 2002) and chronic pain (Puke and Wiesenfeld-Hallin, 1993). Recently, clonidine has been utilized as a pre-operative medication to provide anxiolysis (Beer et al, 2001), sedation (Karhuvaara et al, 1991;Ramesh et al, 1997;Khan et al, 1999), analgesia (Siiba et al, 1999), hemodynamic stability (Laisalmi et al, 2001), saliva control (Arya et al, 1997), and antiemetic effects (Frank et al, 1999). It also possesses sedative (Flacke et al, 1987;Murai et al, 1995), anesthetic (Flacke et al, 1987), and analgesic (Flacke et al, 1987;Samso et al, 1996) sparing properties that reduce the dosages of other medications.…”

Section: Introductionmentioning

confidence: 99%

Oral Clonidine Pre-treatment and Diazepam/Meperidine Sedation

et al. 2006

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Clonidine has recently been used as a pre-operative medication and sedative/anxiolytic drug. Its extended duration of action makes it suitable for longer procedures. In this randomized, crossover, placebo-controlled clinical trial, we characterized the effects of oral clonidine pre-treatment on intravenous diazepam/meperidine sedation using the bi-spectral index (BIS) in 13 participants. Clonidine significantly increased the numbers of BIS-depressed readings and percent memory loss during sedation, while reducing total diazepam and post-operative analgesic dosages by 44% and 55%, respectively. Systolic, diastolic, and mean arterial blood pressures, as well as pulse rates, were reduced. Respiratory rate, oxygen saturation, end-tidal CO(2), and recovery from sedation were unchanged. Participants, surgeons, and sedationists preferred clonidine over the placebo. Clonidine pre-treatment increased and prolonged sedation and amnesia and stabilized vital signs while significantly decreasing diazepam and post-operative analgesic usage. These results suggest that pre-operative clonidine administration could be a useful supplement to intravenous sedation for dental procedures of long duration.

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Increase in the threshold of pain and touch sensation in the human face with clonidine plus 30% nitrous oxide

Cited by 5 publications

References 16 publications

Comparison of the effect of video glasses and nitrous oxide analgesia on the perceived intensity of pain and unpleasantness evoked by dental scaling

Comparison of the effect of video glasses and nitrous oxide analgesia on the perceived intensity of pain and unpleasantness evoked by dental scaling

Oral Clonidine Pretreatment Prior to Venous Cannulation

Oral Clonidine Pre-treatment and Diazepam/Meperidine Sedation

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