Kind Of Analgesia Research Articles

Efficacy of Nefopam in multimodal analgesia in dogs

Pain that occurs in a surgical patient in the area of surgical intervention is called surgical pain. Postoperative analgesia is one of the most important components in the system of general intensive care, which creates comfortable living conditions for the surgical patient. In veterinary practice, the central non-opioid analgesic Nefopam has become available, which has a structural affinity for diphenhydramine (Diphenhydramine) and orphenadrine and has both spinal and supraspinal mechanisms of action. The aim of the study is to evaluate the efficacy and safety of Nefopam as part of multimodal analgesia in the postoperative period in dogs. For the study were selected 20 dogs aged 1 to 10 years who underwent radical surgery requiring multicomponent anesthesia. The animals were divided into 2 groups of 10 dogs each. Surgical interventions were performed under conditions of general combined anesthesia according to standard protocols of the clinic using neuroleptics, anesthetics, non-narcotic painkillers. In the postoperative period, a non-opioid centrally acting analgesic, Nefopam, was introduced into the scheme of multimodal analgesia in the animals of the experimental group, and Analgin was administered to the dogs of the control group. The level of pain of the visual analog scale for assessing pain according to VAS. To assess the health status of experimental animals before surgery and on the 3rd and 7th days after it, blood was taken for biochemical and clinical studies. The use of Nefopam in the complex of multimodal analgesia used in the clinic is therapeutically justified and effective. It is this kind of analgesia that makes it possible to fully and safely anesthetize patients after extensive and traumatic operations with minimal consumption of non-opioid and opioid analgesics.

Outpatient Hysteroscopic Polypectomy—A Retrospective Study Comparing Rigid and Semirigid Office Hysteroscopes

Endometrial polyps are one of the most common pathological conditions in gynecology. Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. The purpose of this multicenter, retrospective study was to compare patients' pain perception during an operative hysteroscopic endometrial polypectomy in an outpatient setting with two different hysteroscopes (rigid and semirigid) and to identify some clinical and intraoperative characteristics that are related to worsening pain during the procedure. We included women that underwent, at the same time as an diagnostic hysteroscopy, the complete removal of an endometrial polyp (using the see-and-treat strategy) without any kind of analgesia. A total of 166 patients were enrolled, of which 102 patients underwent a polypectomy with a semirigid hysteroscope and 64 patients underwent the procedure with a rigid hysteroscope. No differences were found during the diagnostic step; on the contrary, after the operative procedure, a statistically significant greater degree of pain was reported when the semirigid hysteroscope was used. Cervical stenosis and menopausal status were risk factors for pain both in the diagnostic step and in the operative one. Our results confirm that operative hysteroscopic endometrial polypectomy in an outpatient setting is an effective, safe, and well-tolerated procedure and indicate that it might be better tolerated if a rigid rather than semirigid instrument is used.

Practice of dilatation after surgical correction in anorectal malformations

In order to prevent stricture of the neoanus after surgical correction, regular dilatation is recommended. There is a lack of knowledge about the performance of anal dilatation and the occurrence of pain. The aim of our investigation was to describe the practice of dilatation and to identify possible risk factors for painful procedures. Congenital Uro-Rectal Malformations Network is a German interdisciplinary multicenter research network. With standard questionnaires, physicians interviewed 243 patients and/or their parents at home, additional 103 patients born since 2009 were assessed through their treating physicians. In total, 88 % of the patients received dilatations. Treatment lasted for 7 months in median (range 1-156 months), until the age of 13 months (range 1-171 months). In 69 % painful dilatation was reported; without a significant differences in age or gender. In 32 % bleeding was reported. In 30 % at least one dilatation was performed under general anesthesia. In 11 % some kind of analgesia was used. Type of fistula, dilatations lasting longer than 10 months and Hegar size above 15 were relevant factors for experience of pain. There were about 16 % postoperative strictures of the neoanus, without reported differences in dilatation procedures; but there was a relation to type of malformation. Considering the high number of painful treatments, predictors for painful dilatations should be further clarified through standardized documentation and prospective evaluation in order to improve follow-up.

Pressão arterial e freqüência cardíaca avaliadas pela MAPA em primigestas durante o trabalho de parto e puerpério imediato

OBJETIVO: analisar os valores da pressão arterial e da freqüência cardíaca durante o trabalho de parto e puerpério imediato de primigestas normais. MÉTODOS: foram incluídas no estudo 60 parturientes, às quais foi aplicada a monitorização ambulatorial da pressão arterial (MAPA) com uso do aparelho modelo SpaceLabs 90207, durante o trabalho de parto e nas primeiras 12 horas após o mesmo. A pressão arterial e a freqüência cardíaca foram registradas a cada 15 minutos durante o trabalho de parto e na primeira hora após o parto, e a cada 30 minutos até a 12ª hora após o parto. Esses parâmetros foram avaliados em três momentos do trabalho de parto (com dilatação cervical até 7 cm, entre 8 cm e dilatação total e durante o período expulsivo) e em dois momentos do puerpério (na primeira e décima segunda hora). Primeiramente os resultados foram analisados sem levar em consideração o tipo de procedimento anestésico, e depois, dividindo-os em grupos conforme o tipo de procedimento realizado: anestesia local, analgesia peridural lombar e anestesia subaracnóidea. Para comparação dentro de cada grupo foram realizados análise de variância (ANOVA) e teste t de Student pareado e, entre os grupos, o teste t não-pareado. Foi considerado o limite de significância estatística de 5%. RESULTADOS: quando os resultados foram avaliados sem levar em consideração o procedimento anestésico, os valores médios da pressão arterial sistólica, registrados durante o trabalho de parto, foram significativamente mais elevados que no puerpério. Durante o trabalho de parto esses valores foram significativamente mais elevados nos períodos de dilatação final e expulsivo que no período de dilatação inicial e, na 12ª hora, inferiores ao da primeira hora após o parto. Os valores médios da pressão arterial diastólica registrados durante o trabalho de parto foram significativamente mais altos que no puerpério. Estes valores não apresentaram alteração durante os diferentes períodos do trabalho de parto ou durante as primeiras doze horas do puerpério. A freqüência cardíaca aumentou progressivamente durante o trabalho de parto, diminuindo nas primeiras 12 horas após o parto. Quando a pressão arterial e a freqüência cardíaca foram avaliadas conforme o tipo de procedimento anestésico empregado, ambas mostraram-se com mesmo comportamento na anestesia local e peridural, embora naquelas submetidas à anestesia subaracnóidea, tanto a pressão arterial sistólica como a diastólica não apresentaram alteração durante o trabalho de parto. CONCLUSÕES: o trabalho de parto determinou aumento da pressão arterial sistólica e da freqüência cardíaca. Durante o trabalho de parto os valores das pressões arteriais sistólica e diastólica foram mais altos que nas primeiras 12 horas do puerpério, havendo queda significativa entre a primeira e a décima segunda hora do mesmo. Diferentes procedimentos anestésicos não interferiram nos valores das pressões arteriais sistólica e diastólica ou da freqüência cardíaca, durante o trabalho de parto e nas primeiras doze horas após o parto.

Does postoperative locally applied second shot analgesia improve the patients' pain perception after tension free hernia repair? A doubleblinded study

The aim of this study was to evaluate a possible advantage concerning the perceived level of pain following tension free hernia repair, by applying local anesthesia postoperatively. A prospective randomised double blind study was performed on patients undergoing tension free hernia repair according to the techniques of Lichtenstein. Two groups, each consisting of 30 patients, underwent tension free hernia repair under local anesthesia, during which a drainage tube was placed beneath the aponeurotic layer of the external oblique muscle. On the first postoperative day the patients received either local anesthesia (LA) or isotonic saline, through the drainage tube, which was then removed. For a period of six days, from the operation day onwards, the perceived level of pain was measured using a Visual Analogue Scale (VAS). All patients were mobilised early, the latest being 4 hours after the operation. Comparing the perceived pain levels (VAS) between the two groups of patients there was no significant or relevant advantages of applying local anesthesia. If performing the tension free hernia repair under local anesthesia conditions, the application of local anesthesia 24 hours later does not significantly reduce the perceived level of pain. This kind of analgesia is, therefore, not recommended for postoperative analgesia after tension free hernia repair.

Differentiation between acupuncture and non-acupuncture points by association with analgesia inhibitory system.

Acupuncture and non-acupuncture points were differentiated by their connection to different pathways in the central nervous system. We have found that the pathway connected to the acupuncture point is different from the pathway connected to the non-acupuncture point. In addition, pathway connected to the non-acupuncture point is inhibited within the lateral periaqueductal gray when the analgesia inhibitory system (AIS) is activated. We have explored these pathways by means of selective lesioning of discrete brain regions, selective stimulation of brain regions, as well as by recording evoked potentials arising from stimulation of acupuncture and non-acupuncture points. It was found that the lateral centromedian nucleus of the thalamus and the posterior hypothalamus are parts of the AIS. The acupuncture (tibialis muscle) and non-acupuncture (abdominal muscle) points are both connected to the AIS. Analgesia caused by stimulation of the acupuncture point is naloxone reversible, while that caused by stimulation of the non-acupuncture point after lesion of AIS is dexamethasone reversible. Stress-induced analgesia caused by low frequency electrical shock is naloxone as well as dexamethasone reversible. All three kinds of analgesia were abolished by hypophysectomy. The features and the degree of analgesia caused by intraperitoneal 0.5 mg/kg morphine were similar to analgesia caused by acupuncture point stimulation. D-phenylalanine acts like a lesion of AIS in analgesia caused by stimulation of acupuncture and non-acupuncture points, and enhances naloxone reversible analgesia. The descending pain inhibitory system plays a role as the common pathway to produce these three kinds of analgesia. This pathway is found in the arcuate nucleus (dopaminergic), ventromedian nucleus of the hypothalamus, raphe nucleus (serotonergic), reticular gigantocellular nucleus (noradrenergic) and reticular paragigantocellular nucleus.

The study of the central grey matter in mechanisms of different kinds of analgesia: Effects of lesions

The effect of the central grey matter (CG) on pain sensitivity has been investigated in rats. It has been demonstrated that baseline pain thresholds, tested by the hot plate method (HPM) after surgical operation, were significantly greater in CG-lesioned rats than in controls. Baseline tail flick latencies did not differ from those in the control group of animals. In the CG-lesioned rats, the latencies of pain responses, measured by the hot plate and tail flick tests after stress and auricular electroacupuncture, were significantly shorter than in the control group. The analgesia in the CG-lesioned rats after auricular electrostimulation was less than that after stress. Obtained data suggest: (1) significance of the CG in the regulation of baseline pain sensitivity, tested by different methods, is variable. CG mechanisms do not play a leading role in producing the tail flick response, whereas hind paw licking is mediated through CG-dependent mechanisms. (2) Antinociceptive effect of stress and acupuncture is mediated by the CG. (3) The role of the CG in analgesic mechanisms is greater in acupuncture than in stress. (4) Apart from the CG, other antinociceptive systems are involved in the mechanisms of stress-induced analgesia.

The effect of paracervical block on cervical dilatation and uterine activity.

Abstract. This investigation was carried out to determine whether paracervical block (PCB) has any effect on the duration of the first stage of labour, relating the speed of cervical dilatation to uterine activity. Uterine activity was measured by internal tocometry and calculated in Montevideo units (MU).Fourty patients were selected and allocated in random manner to a PCB or a control group, the patients in the latter receiving other kinds of analgesia. Oxytocin was given when required, to assure a steady and fairly high degree of uterine activity. Four patients were excluded.The mean duration of the first stage of labour, from cervical dilatation 2 to 10 cm, was 161 minutes in the PCB group, 237 minutes in the control group.Uterine activity, calculated as total MU needed for each cm of cervical dilatation, was reduced after PCB, the differences being statistically significant for increments from 3 to 8 cm cervical dilatation inclusive.PCB caused a transient reduction in frequency of contractions, and a relative fall in amniotic pressure between contractions.It is concluded that PCB facilitates cervical dilatation by inhibiting muscular contraction in the lower uterine segment.