Control Of Visceral Pain Research Articles

Comparative Study between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Block in Post-Operative Pain Management after Cesarean Section

Abstract Background Cesarean section rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Aim of the Work The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans- muscular QLB compared with TAP block during cesarean section surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into two groups (n = 25; each); group QLB and group TAP. Group QLB: Patients (n = 25) of this group received bilateral ultrasound-guided QLB after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg. Group TAP: Patients (n = 25) of this group received bilateral ultrasound-guided TAP block after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg. Results The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique over the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent in QLB beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after cesarean section in comparison to transversus abdominis plane block and even more time covering to rescue opioid.

A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries

Abstract Background Operations rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Aim of the Work This work aims to compare the efficacy of Transversus Abdominis Plane (TAP) Block versus Quadratus Lumborum 2 (QL 2) Block on postoperative period regarding pain control, total opioid given in the first 24-hour post-operative, VAS score and first time to ask for analgesia in patients undergoing lower abdominal surgeries. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this Randomized controlled trial study was conducted in Ain Shams University Hospitals. Forty patients scheduled for elective lower abdominal surgeries were included in this study. The patients' age was ranged from 21 to 65 years and with the American Society of Anesthesiologists (ASA) Class-I and II. At the end of the surgery, patients were randomized using a random number table and the use of a closed envelopes technique to receive either quadratus lumborum block (Group QLB), or TAP (transversus abdominis plane) block (Group TAP), each group constitutes of 20 patients. Results In this study, the effect of quadratus lumborum block and transversus abdominis plane block result of decreased incidence and severity of postoperative pain (VAS) resulting in decrease in incidence and degree of sedation and opioid total requirement. The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique affected the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after lower abdominal surgeries in comparison to transversus abdominis plane block and even more time covering to rescue opioid.

Gentians, natural remedies for future of visceral pain control; an ethnopharmacological review with an in silico approach.

Different gentian preparations are used as traditional remedies for internal pain control in: Persian traditional medicine (PTM), Chinese traditional medicine (CTM) and Ancient Greek medicine (AGM) from the time of the Roman Empire. Objective: To present a survey of the ethnopharmacological applications of gentians recorded as being used in Eastern and Western traditional medical systems (PTM, CTM and AGM) and their pharmacological effects, chemical composition as well as an in silico investigation of the possible active component/s for the alleviation of internal pain via molecular docking studies. Major traditional medicine literature (PTM, CTM and AGM, 50 AD- 1770) and ethnobotanical studies for the application of gentians were reviewed. Nine European species representing 5 of the 13 sections currently attributed to Gentiana were selected. Chemical compounds and pharmacological activity data of these species were gathered from different databases including Google Scholar, PubChem, PubMed and Web of Science (between 1972 and 2020). The possible active constituents of gentians on visceral pain receptors were investigated, in silico. In all investigated literature, traditional uses of gentian were indicated to have anti-nociceptive effects on visceral pain and possess diuretic action. According to our computational study, acylated flavonoid glycosides, viz. trans-feruloyl-2"-isovitexin (33), trans-feruloyl-2"-isovitexin-4'-O-β-D-glucoside (34), iso-orientin-4'-O-glucoside (38), trans-caffeoyl-2"-iso-orientin-4'-O-β-D-glucoside (39), iso-orientin-2"-O-β-D-glucoside (40) and isoscoparin (41), might be responsible for visceral pain reduction by interacting with the purinergic receptor (P2X3) and vanilloid receptor 1 (TrpV1). This finding shows a good correlation with different traditional gentian uses in Persian, Chinese and European ethnomedicine for visceral pain control.

Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Post-Operative Pain Management after Cesarean Section

Abstract Background Cesarean section rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Objectives The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans-muscular QLB compared with TAP block after cesarean section surgeryperiod regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into three groups (n = 20; each); group QLB and group TAP. Group QLB: Patients (n = 20) of this group received bilateral ultrasound-guided QLB after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%, Group TAP: Patients (n = 20) of this group received bilateral ultrasound-guided TAP block after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%. Results The current study also measured and compared postoperative VAS score and firs time to rescue analgesia and the total amount of opioid (pethidine) given in the first 24 hours with the standard deviation for each of the two groups studied we found that TAP patients had the highest values compared to the QLB group. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after cesarean section without associated hemodynamic instability in comparison to transversus abdominis plane block and even more time covering to rescue opioid.

Neuromodulation for Refractory Angina, Heart Failure and Peripheral Vascular Disease

Use of spinal cord stimulation (SCS) has expanded beyond pain control. There are increasing indications in which SCS is being used. The understanding of central and peripheral neural pathways and their controlling influences on peripheral organs is better understood now. The concept of stimulating the spinal cord and modulating central pathways with SCS is already established. Different studies have shown the benefit with SCS on visceral pain control, improving quality of live in severe peripheral vascular disease and even assist in controlling the vago-sympathetic balance. We will discuss the art of implantation. Patient selection and stimulation with respect to current clinical data.

Эффекты стимуляции инфралимбической коры на реакции нейронов каудальной вентролатеральной ретикулярной формации, вызванные ноцицептивным раздражением толстой кишки крысы

The infralimbic cortex of the cerebral hemispheres is characterized by an extensive system of afferent and efferent connections with cortical, subcortical, bainstem structures and the spinal cord, which ensure its participation in the higher mechanisms of regulation of the functions of the visceral sphere. At the same time, the involvement of the infralimbic cortex in the mechanisms of cortical modulation of visceral nociception, both acute and chronic, seems to be poorly understood. In this work, using an experimental model of abdominal pain on two groups of urethane anesthetized rats (normal rats and rats with experimental colitis), we studied the effects of electrical stimulation of the infralimbic cortex on the neuronal (responses of neurons of the caudal ventrolateral reticular formation) and systemic (changes in arterial blood pressure) reactions induced by nociceptive distension of the colorectal region of colon. It has been found that in rats of both groups nociceptive colorectal distension was accompanied by both excitatory and inhibitory reactions of neurons of the ventrolateral reticular formation, as well as depressor changes in blood pressure. Electrical stimulation of the infralimbic cortex increased excitatory and decreased inhibitory neuronal responses to visceral painful stimulation and also enhanced nociceptive depressor responses in both normal rats and rats with colitis. This effect was more pronounced in the group of healthy animals. In general, the influence of the infralimbic cortex on nociceptive neurons of the ventrolateral reticular formation and vascular responses to visceral pain can be considered as facilitating visceral nociception. Quantitative differences in the effects of cortical stimulation in normal rats and rats with colitis are possibly related to differences in the brain processing of acute visceral pain and pain complicated by chronic inflammation. One of the possible mechanisms of cortical influence on visceral nociception may be modulation of the current activity of nociceptive neurons of the caudal ventrolateral reticular formation, directly or indirectly involved in the descending control of visceral pain.

Reevaluating Withholding Intraoperative Opioids: A Lesson Learned from Visceral Pain Control in Laparoscopic Colectomy with TAP Block

Reevaluating Withholding Intraoperative Opioids: A Lesson Learned from Visceral Pain Control in Laparoscopic Colectomy with TAP Block

Synergic Effect of Trimebutine Combined with Mosapride on Gastrointestinal Dysfunction and Visceral Pain Induced in Stress Models

The present study was undertaken to determine whether combined treatment with prokinetic trimebutine and mosapride has a synergic effect on gastrointestinal motility and visceral pain associated with gastrointestinal dysfunction. To develop effective gastroprokinetic agents with greater potencies than trimebutine or mosapride for the treatment of gastrointestinal tract disease, a mixture of trimebutine and mosapride was designed and prepared. In the present study, treatment with trimebutine alone showed a dose-dependent effect on propelling movements of normal small and large intestine in mice, whereas mosapride effected only small intestine motility. Co-administration of trimebutine with mosapride, a well-established prokinetic drug, produced a synergistic infl uence on normal small intestine motility, but demonstrated an unclear effect on large intestine motility, with a slight tendency to reduce the propelling time. In a stress model, the small and large intestine motilities were signifi cantly decreased. The reduction of intestine motility was restored to a normal level and the restoring effect was more pronounced in the combined treatment with trimebutine plus mosapride than treatment with trimebutine or mosapride alone. Furthermore, treatment with trimebutine plus mosapride signifi cantly decreased acute visceral pain which was not controlled by trimebutine or mosapride alone. These data suggest that combination therapy with trimebutine plus mosapride has a synergic effect on small and large intestine motility and visceral pain control in gastrointestinal disorders.

NK-1-receptor-mediated lesion of spinal post-synaptic dorsal column neurons might improve intractable visceral pain of cancer origin

The cancer-related visceral pain has traditionally been frustrating to treat by either medical or surgical means. Recent investigations from bench and bedside have suggested that a critical visceral nociceptive pathway originates from post-synaptic dorsal column (PSDC) neurons located in the central area of the spinal-cord. Interruption of the PSDC pathway using different surgical approaches effectively relieves intractable visceral pain in cancer patients. However, the indications of surgical lesion of DC are very limited in clinical setting because of the surgical risks and complications. Thus, a means of high-specific pharmacological lesion of DC pathway is necessary. Some evidence has shown that spinal PSDC neurons start to express neurokinin-1 (NK-1) receptors after visceral stimulation, suggesting new targets for the development of pharmacological strategies for the control of visceral pain. Here, we present our hypothesis that the targeted cytoxin composed of substance P coupled to the cytotoxic ribosome inactivating protein, saporin, might selectively destroy spinal PSDC neurons expressing NK-1 receptors, which will lead to pharmacological interruption of PSDC pathway and will greatly improve intractable visceral pain of cancer origin. Based on the data from related research, we believe that the current therapy we propose might be one of the optimal pharmacological approaches to replace the neurosurgical interruption of DC pathway and could be used for cancer-related visceral pain in wider clinical indications.

Visceral Antinociceptive Effects of Spinal Clonidine Combined with Morphine, [D-Pen sup 2, D-Pen sup 5] Enkephalin, or U50,488H

Visceral pain is an important component of many clinical pain states. The perispinal administration of drug combinations rather than a single agent may reduce side effects while maximizing analgesic effectiveness. The purpose of this study was to examine the nature of interactions between an alpha 2-adrenergic agonist (clonidine) and a mu-opioid agonist (morphine), a delta-opioid agonist ([D-Pen2, D-Pen5] enkephalin [DPDPE]), or a kappa-opioid agonist (U50,488H). Colorectal distension was used to elicit a nociceptive visceromotor response (contraction of abdominal musculature) in rats. The ability of intrathecally administered clonidine alone or in combination with morphine, DPDPE, or U50,488H to alter thresholds for the production of the visceromotor response was examined. Clonidine produced dose-dependent reduction in threshold. U50,488H, at the doses tested, showed no synergistic interaction with clonidine. Spinal combinations of alpha 2-adrenergic and mu- or delta- but not kappa-opioid agonists may be beneficial in the control of visceral pain.