Analgesic Effects Of Different Doses Research Articles

Observation on the Analgesic Effect of Different Doses of a Combination of Esketamine and Dexmedetomidine Administered for Percutaneous Endoscopic Transforaminal Discectomy: A Randomized, Double-Blind Controlled Trial.

Percutaneous endoscopic transforaminal discectomy (PETD) is an effective method for treating lumbar disc herniation, and is typically performed under local anesthesia. However, inadequate analgesia during the procedure remains a concern, prompting the search for a medication that can provide optimal pain control with minimal impact on the respiratory and circulatory systems. The aim of this study was to observe the effects of different doses of esketamine combined with dexmedetomidine on reducing visual analog scale (VAS) scores during surgical interventions. One hundred two patients who underwent PETD were randomly divided into a control group (group C: normal saline + dexmedetomidine), an E1 group (0.1 mg kg-1 esketamine + dexmedetomidine), and an E2 group (0.2 mg kg-1 esketamine + dexmedetomidine). The primary outcome was the maximum visual analogue scale (VAS) (score: 0 = no pain and 10 = worst pain) at six time points. The secondary outcomes included the Assessment of Alertness/Sedation Scale (OAA/S) score and mean arterial pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) at 11 time points. The incidence of adverse reactions during and 24 h after the operation and patient satisfaction with the anesthesia were also recorded. Compared with those in group C, the VAS scores of patients in groups E1 and E2 were lower at T6, T7, and T9 (P < 0.05). From T4 to T10, the OAA/S scores of the E1 and E2 groups were both lower than those of group C (P < 0.05), and at the T4-T6 time points, the OAA/S score of the E2 group was lower than that of group E1 (P < 0.05). At T4 and T5, the HR and BP of patients in groups E1 and E2 were greater than those in group C (P < 0.05). Compared with those in group C, the incidences of intraoperative illusion, floating sensation, postoperative dizziness, and hyperalgesia in groups E1 and E2 were significantly greater (P < 0.01). There was no significant difference in patient RR, SpO2, or postoperative satisfaction with anesthesia among the three groups (P > 0.05). The combination of esketamine and dexmedetomidine can reduce VAS scores during certain stages of this type of surgery; it has minimal impact on respiration and circulation. However, this approach is associated with increased incidences of postoperative dizziness and psychiatric side effects, which may also affect patients' compliance with surgical instructions from medical staff. Patient satisfaction was not greater with dexmedetomidine combined with esketamine than with dexmedetomidine alone. http://www.chictr.org.cn . Identifier: ChiCTR2300068206. Date of registration: 10 February 2023.

Analgesic Efficacy and Safety of Tapentadol Immediate Release in Bunionectomy: A Meta-Analysis.

The aim of this systematic review and meta-analysis was to evaluate the analgesic effect of different doses of tapentadol immediate release (IR) and its adverse effects after a bunionectomy. Pubmed, Cochrane, Lilacs, Medline, and Imbiomed were used to identify abstracts of scientific publications related to the keywords of this systematic review (PROSPERO ID CRD42023437295). Moreover, the risk of bias in all included articles was assessed using the Cochrane Collaboration risk of bias tool. Data on the sum of pain intensity, total pain relief, global assessment, and adverse effects were extracted. The statistical method of inverse variance with means difference was used to evaluate the numerical data and the Mantel-Haenszel and Odd Ratio test to analyze the dichotomous data. In addition, the number needed to treat, the number needed to harm, and the 95% confidence intervals were calculated. A qualitative evaluation (n = 2381) was carried out according to the conclusions of the authors. Tapentadol (n = 1772) was more effective in relieving postoperative pain than the placebo (n = 609) after a bunionectomy. In addition, the analgesic efficacy of IR tapentadol (n = 1323) versus the placebo (n = 390) was evaluated in a total of 1713 patients using a global evaluation of the treatments. All three doses of IR tapentadol showed better results compared to the placebo after a bunionectomy. Finally, the adverse effects have a direct relationship with the dose, and the greatest number of adverse effects are most observed with tapentadol IR 100 mg (n = 2381). It is concluded that tapentadol IR (100 mg) leads to the best satisfaction score in this meta-analysis.

The optimal dose of intravenous dexamethasone in peripheral nerve blocks: A protocol for systematic review and meta-analysis.

Although intravenous dexamethasone prolongs the duration of analgesia for peripheral nerve blocks (PNB), the optimal dose of dexamethasone is not yet determined. This protocol aims to compare the analgesic effects of different doses of intravenous dexamethasone on PNB. We will search PubMed, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and Web of Science to identify randomized controlled trials that compared the effects of different doses of intravenous dexamethasone for PNB. The duration of analgesia will be defined as the primary outcome. Secondary outcomes will include pain scores, analgesics consumption >48 hours, and the incidence of adverse effects. RevMan 5.3 software will be used for data analysis. This study will explore the optimal dose of intravenous dexamethasone for the prolongation of analgesia in PNB. The results of this study will provide evidence for the dose selection of intravenous dexamethasone in PNB.

A Comparison of Analgesic Effect of Different Doses of Intrathecal Nalbuphine Hydrocloride with Bupivacaine and Bupivacaine alone for Lower Abdominal and Orthopedic Surgeries

Objective: To compare the analgesic effect of different doses of nalbuphine when added to bupivacaine in spinal anaesthesia. To compare the onset of sensory blockade (time taken form 3, 5 min and then every 5 min until the end of the procedure. Methods: 100 ASA grade 1 and 2 patients grouped into group A, group B, group C and group D randomly. Age group of 18-60 years. Patient undergoing elective lower abdominal and orthopedic surgery received with Group A : included 25patients with 0.5% hyperbaric bupivacaine 3 cc (15mg) + N.S. 0.2 ml. Group B: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 0.8mg nalbuphine + N.S. 0.2 ml. Group C: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 1.6mg nalbuphine + N.S. 0.2 ml. Group D: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 2.4 mg nalbuphine + N.S. 0.2 ml. Results: The mean sensory onset of study subjects in group A, B, C and D were 8.4±0.5, 5±0.9, 5.6±1 and 8.2±1.4 respectively and this difference was statistically significant. The mean motor onset of study subjects in group A, B, C and D were 10.2±0.7, 6.8±0.9, 6.1±1.2 and 8.6±1.1 respectively and this difference was statistically significant. The mean sensory duration of study subjects in group A, B, C and D were 176.8±29.3, 282±6.8, 300.2±6.6 and 286.2±9.8 respectively and this difference was statistically significant. The mean time for maximum sensory level of study subjects in group A, B, C and D were 11.5±1, 8.8±0.8, 5.6±1.6 and 8.2±1.2 respectively and this difference was statistically significant. The mean T 10 time of study subjects in group A, B, C and D were 8.5±0.5, 8.7±0.7, 5.6±1.6 and 8.6±1 respectively and this difference was statistically significant. The mean time for 2 segment regression of study subjects in group A, B, C and D were 76.6±2, 92.2±2.3, 95.8±3 and 90.6±4.4 respectively and this difference was statistically significant. The mean motor duration of study subjects in group A, B, C and D were 179.8±8.9, 184.6±6, 203.2±7 and 187±9.9 respectively and this difference was statistically significant. The mean analgesic duration of study subjects in group A, B, C and D were 175.8±4.1, 271.1±7.8, 303.8±9.9 and 279±10.7 respectively and this difference was statistically significant. Conclusion: We came to conclusion that 0.5% hyperbaric bupivacaine (15mg) with nalbuphine (0.8mg, 1.6 mg, 2.4 mg) in subarachnoid block. Therefore addition of 1.6 mg nalbuphine to 15mg of 0.5% hyperbaric bupivacaine 15 mg in subarachnoid block can be considered safe with minimum complication, and provides excellent quality and longer duration of postoperative analgesia with good sedation compared with 0.8 mg and 2.4 of nalbuphine. So it is useful for prolonged duration of postoperative analgesia.

Infusion of aerial parts of Salvia chudaei Batt. & Trab. from Algeria: Chemical, toxicological and bioactivities characterization

Ethnopharmacological relevanceSalvia chudaei Batt. & Trab. from Algeria is traditionally used to relieve several dysfunctions, including inflammatory and pain-related situations. Aim of the studyThis work aimed to confirm scientifically the referred properties. For that, the phenolic composition and antioxidant activity were evaluated as well as acute toxicity, anti-inflammatory and analgesic effects of different doses of the infusion of S. chudaei aerial parts. Materials and methodsInfusion of aerial parts of S. chudaei was prepared and screened for phenolic composition by generalized methods TPC and TFC then by LC-DAD-ESI/MSn. DPPH and FRAP were used to evaluate antioxidant activity. Using mice, acute toxicity, anti-inflammatory by carrageenan-induced paw edema, and analgesic by acetic acid-induced writhing and formalin-induced pain activities were tested. ResultsThe infusion showed 2018 mg GAE/100g DW of phenolics and 1956 mg ECE/100g DW of flavonoids. Phenolic profile by LC-DAD-ESI/MSn revealed the presence of ten compounds: syringic acid hexoside derivative, kaempferol-O-diglucuronide, kaempferol-O-deoxyhexoside-hexoside, kaempferol-O-glucuronide, apigenin-O-diglucuronide, caffeic acid, 4-O-caffeoylquinic acid, eriodictyol-O-glucuronide, rosmarinic acid hexoside, and rosmarinic acid. This acid was the major compound representing 54% of the total content of the identified compounds and an absolute content of 18 mg/g of extract. Additionally, the infusion exhibited a good antioxidant activity (DPPH: 81 μmol TE/g DW, FRAP: 438 μmol FSE/g DW). By oral administration to mice, the infusion showed a significant (p<0.05) dose-dependent reduction of carrageenan-induced inflammation and inhibition of formalin-induced pain (late and early phase) and acetic acid-induced writhing compared with the control. On the other hand, infusion up to 8 g/kg b.w. showed no signs of toxicity or mortality. ConclusionThis study reveals, for the first time, that the infusion of the aerial parts of S. chudaei is not toxic in a single dose and has remarkable antioxidant, anti-inflammatory, and analgesic activities, supporting the use of this species in folk medicine.

Efficacy of different doses of flurbiprofen axetil on post-cesarean analgesia with butorphanol

Objective To study the analgesic effect of different doses of flurbiprofen axetil on post-cesarean analgesia with butorphanol. Methods Three hundreds patients undergoing elective cesarean section were randomly allocated into three group by random number table (n=100). After fetus delivery, three groups were all received patient controlled intravenous analgesia (PCIA) with butorphanol 12 mg diluted by normal saline (NS) into 100 ml (background infusion 2 ml/h, patient control analgesia (PCA) 2 ml, lockout interval 15 min). After the baby was removed, 50 mg and 100 mg flurbiprofen axetil were slowly injected intravenously in group Ⅱ and group Ⅲ, respectively. The Visual Analogue Scale(VAS) scores of incision pain, Ramesay sedation score, total PCA times and the degree of satisfaction about post-operative analgesia were measured at 4, 8, 12 h and 24 h after surgery respectively. Weight of lochia 6 h after surgery and the time of milk secretion were recorded. Other side effects such as hypoxemia, nausea, vomiting including neonatal complications were also recorded. Results There were no statistical differences in demographics among three groups. The data of all patients were collected and no patient needed extra analgesia. Compared with group Ⅰ, the VAS scores and the consumption of butorphanol of 4, 8, 12, 24 h were lower in the group Ⅱ and group Ⅲ, while the degree of satisfaction was higher(P 0.05). There were no statistical differences in Ramsay sedation scores (P>0.05). Conclusions Flurbiprofen axetil could provide better analgesic effect on post-cesarean analgesia with butorphanol (100 mg was superior to 50 mg). Furthermore, it did not influence uterine contraction or the time of milk secretion. Key words: Flurbiprofen axetil; Butorphanol; Cesarean section; Analgesia

Investigation of analgesic dose of nalbuphine combined with remifentanil after radical gastrectomy.

Clinical analgesic effect of different doses of nalbuphine combined with remifentanil on postoperative gastric cancer patients was explored. One hundred cases of gastric cancer patients treated from December 2014 to December 2016 in the Xiangyang No. 1 People's Hospital were selected and separated into group A and group B. The dose in group A was 0.2 mg/kg of nalbuphine plus 0.2 µg/kg of remifentanil, and 0.3 mg/kg of nalbuphine plus 0.1 µg/kg of remifentanil in group B. Analgesia was performed by self-controlled intravenous injection. The Visual Analogue Scale (VAS) pain scores and the Brinell Comfort Score (BCS) at 2, 6, 12, 24 and 48 h after operation, and the incidence of adverse reactions were compared between the two groups. The VAS scores in group A were higher than those in group B, but the BCS scores in group A were lower (P<0.05). Postoperative patient-controlled intravenous analgesia (PCIA) press times in group A were lower than those in group B (P<0.05); the incidence of adverse reactions such as nausea and vomiting in group A was higher than that in group B (P<0.05). The analgesic effect of intravenous analgesia scheme of 0.3 mg/kg of nalbuphine and 0.1 µg/kg of remifentanil on gastric cancer patients after operation is better than that of 0.2 mg/kg of nalbuphine and 0.2 µg/kg of remifentanil, which reduces the incidence of adverse reactions, has greater security, and can be promoted.

Postoperative Analgesic Effects of Different Doses of Epidural Hydromorphone Coadministered with Ropivacaine after Cesarean Section: A Randomized Controlled Trial

Purpose Single dose of epidural hydromorphone has been introduced to serve as an alternative method for postcesarean section analgesia. However, optimal dose of epidural hydromorphone remains unknown. Hence, we evaluated and compared the analgesic and adverse effects of postoperative different doses of epidural hydromorphone coadministered with ropivacaine after cesarean section. Methods Eighty term parturients with elective cesarean section under epidural anesthesia were allocated into four groups. Epidural analgesia was administered with an epidural bolus of either 0 mg (group H0), or 0.2 mg (group H1), or 0.4 mg (group H2), or 0.6 mg (group H3) hydromorphone coadministered with ropivacaine. The primary outcome was the visual analogue pain scores (VAPSs) and rescue opioid consumption (PCIA with sulfentanil) in 24 hours. Adverse effects such as respiratory depression, pruritus, nausea, and vomiting were recorded. Results The VAPSs of group H1 at 2, 4, 6, 12 h and 24 h after surgery was similar to group H0. The VAPSs of group H2 at 4 and 6 h postoperatively were significantly decreased when compared to group H0. But, the VAPSs of group H2 at 2, 12, and 24 h postoperatively were similar to those of group H0. The VAPSs of group H3 at 4, 6, 12 h, and 24 h after surgery were significantly decreased when compared to those of group H0. The total sulfentanil consumption in 24 hours was 90 ± 26 μg in group H0, 75 ± 29 μg in group H1, 54 ± 32 μg in group H2, and 15 ± 16 μg in group H0. Adverse effects were comparable in the four groups. Conclusions Epidural administration of 0.6 mg hydromorphone coadministered with ropivacaine after cesarean section provided satisfactory pain relief with less sulfentanil consumption. This trial is registered with ChiCTR-IPR-16010026.

Activation of the P2X7 receptor in midbrain periaqueductal gray participates in the analgesic effect of tramadol in bone cancer pain rats.

BackgroundCancer pain is a well-known serious complication in metastatic or terminal cancer patients. Current pain management remains unsatisfactory. The activation of spinal and supraspinal P2X7 receptors plays a crucial role in the induction and maintenance mechanisms of various kinds of acute or chronic pain. The midbrain periaqueductal gray is a vital supraspinal site of the endogenous descending pain-modulating system. Tramadol is a synthetic, centrally acting analgesic agent that exhibits considerable efficacy in clinically relieving pain. The purpose of this study was to determine whether the activation of P2X7 receptor in the ventrolateral region of the periaqueductal gray (vlPAG) participates in the analgesic mechanisms of tramadol on bone cancer pain in rats. The bone cancer pain rat model was established by intratibial cell inoculation of SHZ-88 mammary gland carcinoma cells. The analgesic effects of different doses of tramadol (10, 20, and 40 mg/kg) were assessed by measuring the mechanical withdrawal threshold and thermal withdrawal latency values in rats by using an electronic von Frey anesthesiometer and radiant heat stimulation, respectively. Alterations in the number of P2X7 receptor-positive cells and P2X7 protein levels in vlPAG were separately detected by using immunohistochemistry and Western blot assay. The effect of intra-vlPAG injection of A-740003 (100 nmol), a selective competitive P2X7 receptor antagonist, on the analgesic effect of tramadol was also observed.ResultsThe expression of P2X7 receptor in the vlPAG on bone cancer pain rats was mildly elevated, and the tramadol (10, 20, and 40 mg/kg) dose dependently relieved pain-related behaviors in bone cancer pain rats and further upregulated the expression of P2X7 receptor in the vlPAG. The intra-vlPAG injection of A-740003 pretreatment partly but significantly antagonized the analgesic effect of tramadol on bone cancer pain rats.ConclusionsThe injection of tramadol can dose dependently elicit analgesic effect on bone cancer pain rats by promoting the expression of the P2X7 receptor in vlPAG.

Effect of the patient-controlled intravenous analgesia with different doses of dezocine in patients undergoing major abdominal surgery

Objective To investigate the analgesic effect of different doses of dezocine on a patient-controlled intravenous analgesia(PCIA) for pain control after major abdominal surgery.Methods Sixty patients (ASA Ⅰ orⅡ) undergoing major abdominal surgery were randomly divided into three groups of A,B,and C (n=20).Patients received a dezocine loading dose of 0.12 mg/kg at 20 min before the end of surgery.The background infusion of dezocine is 0.012,0.014 mg·kg1·h1 and 0.016 mg·kg1·h-1 in group A,B,and C,respectively.Visual analogue scores (VAS),Ramsay score,the analgesic consumption,the total number of patient controlled analgesia (PCA),the effective number of PCA,and the side effects (nausea,vomiting,dizziness and respiratory depression) were recorded at 6,12,24,48 h postoperatively.Results At 6,12,24,48 h postoperatively,the VAS scores in group C [(1.8±1.1),(1.5±0.8),(1.3±0.9),(1.1±0.9)] were significantly lower than those of group A[(3.0±1.1),(2.4±0.9),(2.0±0.7),(1.8±0.8)] and B [(2.8±1.0),(2.3±0.6),(1.8±0.8),(1.7±0.7)](P＜0.05).Meanwhile,the Ramsay scores were higher in group C[(2.2±0.6),(2.3±0.6)] than those in group A [(1.7±0.7),(1.8±0.6)] and B[(1.8±0.6),(1.9±0.6)](P＜0.05) at 6 h and 12 h after surpery.The scores of satisfaction of postoperative analgesia,analgesic consumption,the total and effective number of PCA were also lower in group C than the other groups (P＜0.05).Moreover,there is no statstical difference on the incidence of adverse effects among the three groups.Conclusions Patient-controlled intravenous analgesia with 0.016 mg·kg-1·h-1 dezocine shows the best analgesic effect,and the similar incidence of side effects. Key words: Dezocine; Patient-controlled intravenous analgesia; Abdominal operation

A comparison of analgesic effect of different doses of intrathecal nalbuphine hydrochloride with bupivacaine and bupivacaine alone for lower abdominal and orthopedic surgeries

Background: Nalbuphine is a synthetic opioid with mixed agonist-antagonist action, when added as adjuvant to intrathecal bupivacaine acts on kappa receptors in the dorsal horn of the spinal cord producing analgesia. Aim: To evaluate the onset of sensory block, hemodynamic changes, duration and quality of analgesia, and adverse effects of different doses of nalbuphine with bupivacaine for spinal anesthesia. Materials and Methods: Randomized double blind study done on 100 patients undergoing lower abdominal and lower limb orthopedic surgeries under subarachnoid block. Patients were randomly allocated to four groups receiving either intrathecal 15 mg of bupivacaine + 0.5 mL normal saline alone or 15 mg of bupivacaine with either of nalbuphine 0.8, 1.6, and 2.5 mg + 0.5 mL normal saline. Results: The mean visual analogue scale score in group A is 4.08 ± 0.5 and in groups B, C, and D are 3.4 ± 0.4, 3.5 ± 0.5, and 3.5 ± 0.5, respectively. The duration of analgesia in group A is 190.4 ± 20.0 and in groups B, C, and D were 322.4 ± 31.1, 319 ± 39.8 and 317.8 ± 47.5. The quality of analgesia was good in 72%-76% and excellent in 16%-28% in groups B, C, and D and poor 28% to satisfactory 72% in group A. Conclusion: Addition of 0.8 mg of nalbuphine to 0.5% bupivacaine for subarachnoid block provides excellent analgesia with longer duration of action compared with 1.6 and 2.4 mg of nalbuphine.

Antinociceptive effects of oral and intraperitoneal administration of alcoholic Datura stramonium seeds extract in male rats

The present study is a designed protocol for investigation of the analgesic effect of oral and intraperitoneal (i.p.) administration of alcoholic Datura stramonium (DS) seed extract as a rich source of alkaloid substances. Male NMRI rats were divided into control and treatment groups. The treatment rats received different doses of the DS seed extract, which was prepared from alcoholic smashed seeds. Then, the animals from each group were subjected to pain scoring experiments such as hot plate and formalin tests. The results of the experiments i.e., antinociceptive effect of DS seeds extract in i.p (5, 10, 25, 50, 100, 200 and 250 mg/kg) and oral application methods (200, 400 and 800 mg/kg) were compared with other groups, morphine sulfate and naloxone as positive and negative control groups, respectively. We found the 30 and 100 mg/kg of the extract as intraperitoneal ED50 in the hot plate and formalin tests, respectively. However, the extract over than 100 mg/kg, i.p could potentially alleviate the pain in hot plate and both phases of formalin test. Besides, there was a marked antinociceptive effect for the extract (over than 400 mg/kg) in oral method in hot plate and both phases of formalin tests. In our following experiments the effective doses of morphine sulfate as positive control test were obtained over than 15 mg/kg; i.p. and the acquired LD50 was close to 2300 mg/kg. In summary, comparing the analgesic effect of different doses of morphine sulfate with DS seed extract in i.p and oral conditions and considering to the extract LD50, we conclude that the DS seeds extract have a potent, absorbable, and nearly safe ingredient which can exert a potential analgesic effect in acute and chronic pain.

Lidocaína com vasoconstrictor isolada e associada ao fentanil via peridural em cães

O objetivo deste estudo cego foi avaliar os efeitos cardiorrespiratórios e analgésicos de diferentes doses de fentanil associado à lidocaína com vasoconstrictor via peridural em cães. Foram avaliados 28 cães adultos, distribuídos em quatro tratamentos: 5mg kg-1 de lidocaína isolada (L) e associada ao fentanil nas doses de 2,5, 5 e 7mg kg-1 (F2,5, F5 e F7, respectivamente). Quinze minutos antes da punção peridural, todos os animais foram tranquilizados por via intravenosa (IV) com acepromazina (0,05mg kg-1), além de um bolus (IV) de fentanil (2,5mg kg-1), administrado imediatamente antes da injeção peridural. Foram avaliados: frequência cardíaca (FC), eletrocardiograma (ECG), pressão arterial sistólica (PAS), frequência respiratória (f), gases sanguíneos, período de latência, duração e extensão do bloqueio sensitivo. Houve redução da FC após a anestesia peridural em relação ao basal em F2,5, F5 e F7. A FC foi superior no L em relação ao F5 e F7 aos 30 e 60 minutos após a anestesia peridural. O período de latência não variou entre os grupos, enquanto a duração do bloqueio foi superior no F5. Bloqueio sensitivo até a 6ª vértebra lombar foi observado em quatro animais no L. Bloqueio sensitivo até a 1ª vértebra lombar foi observado em cinco cães no F2,5 e F7 e em seis cães no F5. Conclui-se que a adição do fentanil à lidocaína determinou bloqueio sensitivo mais cranial em relação ao uso isolado desse anestésico local. Paralelamente, bloqueio anestésico mais duradouro foi determinado pela adição de 5mg kg-1 de fentanil à lidocaína em relação aos demais tratamentos.

Comparisons of analgesic effects of different doses of morphine and morphine plus methylprednisolone after knee surgery

In this double-blind randomized study, the analgesic effects of morphine alone and with methylprednisolone were examined in 72 patients undergoing arthroscopic knee surgery. At the end of arthroscopy, patients were allocated randomly to one of four groups to receive intra-articular administrations of saline, morphine 1 mg, morphine 5 mg or morphine 1 mg with methylprednisolone 40 mg. Preoperative and postoperative pain levels at rest and during movement (active flexion of the knee) were measured by a visual analogue scale (VAS). Postoperative analgesic requirements to alleviate pain were evaluated. Pain scores were significantly lower for the patients who received 5 mg morphine and 1 mg morphine with 40 mg methylprednisolone than for those who received saline or 1 mg morphine. This was accompanied by a decrease in the postoperative consumption of analgesics and prolongation of the duration of pain relief. This study confirms that the analgesic effect of morphine given intra-articularly is dose dependent and that combination of methylprednisolone with morphine has an additive effect on analgesia.

Spinal serotonergic system is partially involved in antinociception induced by Trigonella foenum-graecum (TFG) leaf extract

It has been reported that Trigonella foenum-graecum (TFG) extract exerts analgesic, anti-inflammatory and anti-pyretic effects in different experimental models. The major objective of this paper was to investigate the site and mechanism of the analgesia induced by Trigonella foenum-graecum extract. We studied the analgesic effects of different doses of Trigonella foenum-graecum extract after i.p., i.t. and i.c.v. administration in formalin test, using male NMRI rats (200–250 g). Trigonella foenum-graecum extract showed analgesic effects in i.p. (1 g/kg) and i.t. (0.5, 1, and 2 mg/rat) ( P < 0.05 in all groups) but not in i.c.v. (1 and 3 mg/rat) administrations. Based on the similarities between the effects of Trigonella foenum-graecum extract with those of nonsteroidal anti-inflammatory drugs (NSAIDs) and the role of 5-HT system in analgesic effects of NSAIDs, we tried to investigate the role of spinal 5-HT system in analgesic effects of Trigonella foenum-graecum extract. After lesioning of spinal 5-HT system by 5,7-dihydroxytryptamine (5,7-DHT), it was shown that the analgesic effect of Trigonella foenum-graecum extract (0.5 and 3 mg/rat) in the second phase of formalin test, was abolished completely and reduced relatively after using a low-dose (0.5 mg/rat) and a high-dose (3 mg/rat), respectively ( P < 0.05). So, the antinociception partially remained ( P < 0.05) after using the latter dose. Meanwhile, administration of naloxone (2 mg/kg, i.p.) had no effect on the Trigonella foenum-graecum extract (1 g/kg, i.p.) analgesia. In conclusion, this study confirms the central action of Trigonella foenum-graecum extract and that spinal 5-HT system is partially involved in the analgesia induced by it in the second phase of formalin test and also indicates for co-existence of other analgesic mechanism(s).

Anesthetic dose and analgesic effects of sub-Tenon’s anesthesia in cataract surgery

Purpose To compare the analgesic effects of different doses of sub-Tenon’s anesthesia in cataract surgery by assessing patient response to visceral stimulus. Setting Inouye Eye Hospital, Tokyo, Japan. Methods A prospective study was done of 1019 eyes of 1019 patients having phacoemulsification and posterior chamber intraocular lens implantation. They received a 1.0 mL (391 eyes), 2.0 mL (366 eyes), or 3.0 mL (262 eyes) anesthetic infiltration into the sub-Tenon’s space. Pain scores were recorded when the anterior chamber was irrigated with an acetylcholine chloride solution to attain miosis after lens implantation. Results The distribution of pain scores was significantly different among the 3 groups ( P < .0001, Kruskal–Wallis test). Multiple comparison revealed that the 3.0 mL anesthetic infiltration offered significantly higher analgesic effects than the 2 lower doses. The 3.0 mL sub-Tenon’s anesthesia effectively blocked the visceral stimulus. Conclusion For cataract surgery, 3 mL is the optimal dose of anesthetic solution in sub-Tenon’s anesthesia.