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Biomedical subjects

F M Ferrante

Publications and source records attributed to F M Ferrante.

At least 19 recordsLinked to original sources
PubMed2000

Irreversible spinal cord injury as a complication of subarachnoid ethanol neurolysis.

Subarachnoid neurolysis using ethanol to destroy selectively the posterior roots of the spinal cord is a method for providing pain relief in patients with advanced cancer. Weakness of the extremities is a complication of the procedure that has been attributed to spread of the neurolytic agent to the anterior roots. The authors provide evidence of spinal cord injury as a cause of lower extremity weakness in a patient after subarachnoid ethanol neurolysis.

Alcohol-Induced Disorders, Nervous System↗
PubMed2000

Clinical guidelines for intraspinal infusion: report of an expert panel. PolyAnalgesic Consensus Conference 2000.

Consensus guidelines developed by an expert panel are helpful to clinicians when there is variation in practice and lack of a firm evidence base for an intervention, such as intraspinal therapy for pain. An internet-based survey of practitioners revealed remarkable variation in practice patterns surrounding intraspinal therapy. This prompted an interdisciplinary panel with extensive clinical experience in intraspinal infusion therapy to evaluate the results of the survey, the systematic reviews of the literature pertaining to this approach, and their own clinical experience with long-term spinal infusions. The panel proposed a scheme for the selection of drugs and doses for intraspinal therapy, and suggested guidelines for administration that would increase the likelihood of a successful outcome. These expert panel guidelines were designed to provide an initial structure for clinical decision making that is based on the best available evidence and the perspectives of experienced clinicians.

Analgesics↗
PubMed2000

Evidence-based review of the literature on intrathecal delivery of pain medication.

Evidence-based medicine depends on the existence of controlled clinical trials that establish the safety and efficacy of specific therapeutic techniques. Many interventions in clinical practice have achieved widespread acceptance despite little evidence to support them in the scientific literature; the critical appraisal of these interventions based on accumulating experience is a goal of medicine. To clarify the current state of knowledge concerning the use of various drugs for intraspinal infusion in pain management, an expert panel conducted a thorough review of the published literature. The exhaustive review included 5 different groups of compounds, with morphine and bupivacaine yielding the most citations in the literature. The need for additional large published controlled studies was highlighted by this review, especially for promising agents that have been shown to be safe and efficacious in recent clinical studies.

Analgesics↗
PubMed1999

Neuraxial infusion in the management of cancer pain.

Pain due to malignancy can be controlled through simple means in most patients. In certain refractory cases, however, the chronic delivery of analgesics to the epidural or subarachnoid space may be appropriate. This review will discuss criteria for patient selection for neuraxial drug delivery, the technologic systems available for neuraxial drug delivery, and criteria for selection of the appropriate technology in the individual patient.

Analgesics↗
PubMed1998

Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: a prospective study.

OBJECTIVES: To describe the extent of pain relief two weeks after an epidural steroid injection in patients with herniated disks and lumbar spinal stenosis, and to identify predictors of changes in pain ratings in each population. METHODS: The study design was a prospective evaluation of patients with lumbar spinal stenosis (LSS) and herniated disks (HDs) referred to a hospital-based pain clinic for an epidural steroid injection (ESI). A complete history, detailed physical examination, comprehensive pain questionnaire, and Brief Symptom Inventory were obtained for all patients. Pain was assessed at baseline and two weeks following a single ESI using a visual analog scale. RESULTS: Two hundred twelve patients (mean age 54 years) were enrolled, and 78 of these provided pain ratings before and two weeks after the injection. LSS patients improved less two weeks following the ESI than HD patients (P = 0.04). Just 38% of LSS patients reported improvement in pain score compared with 61% of HD patients. In analyses that combined LSS and HD patients, predictors of worse response included a report of health problems and a diagnosis of LSS. CONCLUSIONS: LSS patients have worse response to ESIs than HD patients. The poor response to ESI in patients with LSS underscores the need for randomized controlled trials of ESI in this population.

Adolescent↗
PubMed1996

Principles of opioid pharmacotherapy: practical implications of basic mechanisms.

Opioids form the cornerstone of the pharmacologic armamentarium for the treatment of pain. Despite their long history of use, much confusion and misperception still surrounds their use. This short review will focus on pharmacodynamic and physiologic considerations in the clinical use of oral and parenteral opioids.

Analgesics, Opioid↗
PubMed1996

The analgesic response to intravenous lidocaine in the treatment of neuropathic pain.

This study was performed in order to determine concentration-effect, and graded and quantal dose-response relationships for the clinical administration of intravenous (IV) lidocaine to patients with neuropathic pain. Thirteen patients were administered 500 mg of IV lidocaine at a rate of 8.35 mg/min over 60 min. Visual analog pain scores and venous blood samples were obtained concomitantly at 10 min intervals for 60 min. Blood samples were also obtained for determination of serum and serum water lidocaine concentrations at the onset of analgesia and at the time complete pain relief was attained. Lidocaine concentrations were determined by gas chromatography. Graded dose-response curves were prepared individually and for the group as a whole, and a quantal dose-response curve was prepared for the entire group. The dose-response relationship for IV lidocaine was characterized by large increases in pain relief for concomitant minimal increases in dosage. The difference between the ED50 (372.0 mg) and the ED90 (416.5 mg) was 44.5 mg of lidocaine (5.3 min of infusion). The concentration-effect relationship was also steep with pain scores abruptly decreasing over a range of 0.62 microgram/mL of lidocaine. Interestingly, the free concentration of lidocaine had no better correlation with the onset of analgesia or the attainment of complete analgesia than the serum concentration of lidocaine. This suggests that the mechanism of analgesia to IV lidocaine may not be based upon a conventional concentration-effect relationship. In conclusion, the results of this study suggest that the analgesic response to IV lidocaine is best characterized by a precipitous "break in pain" over a narrow dosage and concentration range.

Adult↗
PubMed1996

Postoperative pain management.

Distressing postoperative pain remains a prevalent problem. Poorly treated pain contributes to patient suffering and may prevent rapid recovery and rehabilitation. An understanding and application of the basic principles of pain management can provide adequate analgesia for the majority of postoperative patients. More advanced methods of pain control can allow excellent relief for virtually all patients but may require the presence of a dedicated pain management service. This article reviews the principles and practice of modern postoperative pain management.

Anesthetics, Local↗
PubMed1995

0.0625% bupivacaine with 0.0002% fentanyl via patient-controlled epidural analgesia for pain of labor and delivery.

OBJECTIVE: To compare the utility of 0.0625% bupivacaine with fentanyl administered via patient-controlled epidural analgesia (PCEA) to a traditional continuous epidural infusion for pain of labor and delivery. DESIGN AND SUBJECTS: Forty-one women in established labor were randomized to receive either (a) 0.0625% bupivacaine with 2 micrograms/ml fentanyl via PCEA (demand dose = 3 ml, lockout interval = 6 min, background infusion = 6 ml/h, no 1 or 4 h limits) or (b) 0.125% bupivacaine with 2 micrograms/ml fentanyl via continuous epidural infusion (CEI) at 12 ml/h. Supplemental 0.25% bupivacaine (3 ml every 5 min, p.r.n., x 3) was administered for treatment of breakthrough pain upon patient request. The study protocol was double-blind and placebo-controlled. OUTCOME MEASURES: Visual analogue pain scores, motor strength, pinprick level of sensory analgesia and bupivacaine use were assessed by an anesthesiologist unaware of the individual patient's randomization to a particular study group. RESULTS: The cephalad extent of pinprick sensory analgesia was significantly lower during both the first (p < 0.03) and second (p < 0.03) stages of labor in patients receiving PCEA. However, visual analogue pain scores, intensity of motor blockade, and need for physician-administered supplemental bupivacaine were comparable in both groups. Patients receiving PCEA used 40% less bupivacaine per hour while achieving analgesia comparable to patients receiving CEI. CONCLUSIONS: The results of this study show that 0.0625% bupivacaine with 2 micrograms/ml of fentanyl is an effective analgesic combination when used via PCEA.

Adult↗
PubMed1994

The role of continuous background infusions in patient-controlled epidural analgesia for labor and delivery.

The use of a background infusion with intravenous patient-controlled analgesia (IV-PCA) increases drug consumption without any additional contribution to analgesia. There are no data on the potential advantage of a background infusion administered with patient-controlled epidural analgesia (PCEA) for labor and delivery. Sixty women were randomized to one of four groups and received either: (a) demand dose PCEA (demand dose = 3 mL; lockout interval = 10 min); (b) continuous infusion plus demand dose PCEA (two separate infusion rates: 3 mL/h and 6 mL/h); or (c) a fixed-rate continuous epidural infusion (CEI) at 12 mL/h. All patients received 0.125% bupivacaine with 2 micrograms/mL of fentanyl. The study protocol was double-blind and placebo-controlled. Visual analog pain scores, motor strength, and bilateral pinprick analgesia were assessed every half hour by a blinded observer. Pain scores, cephalad extent of sensory analgesia, and motor block were no different among the study groups during the first and second stages of labor. Cumulative hourly bupivacaine use was similar among all PCEA study groups. However, use of PCEA (in whatever mode) provided a 35% dose-sparing effect in comparison to CEI. The PCEA groups receiving no background infusion or a 3-mL/h background infusion had a greater need for physician-administered supplemental bupivacaine during the first stage of labor. While not statistically significant, a trend toward increased need for supplementation was seen in these same patient groups over the entire course of labor and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection.

A retrospective analysis was done on 100 patients who had received cervical epidural steroid injections for neck pain and cervical radiculopathy to identify the predictors of outcome after such treatment. Potential predictors of outcome were assessed individually and then simultaneously with a multiple-regression model. Patients with radicular symptoms and signs had the best pain relief in contradistinction to those with axial (neck) pain. A clinical classification model predicting the outcome and an algorithm for the use of such injections in the treatment of cervical radiculopathy were developed.

Adult↗
PubMed1993

Regression of sensory anesthesia during continuous epidural infusions of bupivacaine and opioid for total knee replacement.

The epidural administration of morphine and fentanyl delay the regression of sensory anesthesia in postoperative patients receiving epidural bupivacaine. This study was performed to determine any differential effects of two lipid-soluble opioids upon regression of sensory anesthesia during coadministration with epidural bupivacaine. Forty-eight patients scheduled for total knee replacement underwent lumbar epidural catheterization and received 1.5% etidocaine with 1:200,000 epinephrine to establish sensory anesthesia to approximately T6 bilaterally. Patients were randomized by the investigational pharmacy to receive either: (a) bupivacaine without opioid (control) (n = 16), or (b) bupivacaine with 1 mg/mL of meperidine (n = 16), or (c) bupivacaine with 3 micrograms/mL of fentanyl (n = 16) in a double-blind fashion. Intraoperatively, 0.5% bupivacaine +/- opioid was administered by epidural infusion at a rate of 10 mL/h. Postoperatively, the bupivacaine concentration was decreased to 0.25% (+/- the same opioid), and the infusion rate was decreased to 4 mL/h. Pinprick sensory anesthesia and verbal numerical pain score were recorded each hour after surgery by a blinded investigator. For each patient, the study was considered terminated when the cephalad level of sensory anesthesia bilaterally decreased five dermatomal segments or the pain score reached "5" (moderate pain). Patients receiving epidural infusions of bupivacaine and meperidine had a significantly slower regression of sensory anesthesia and slower development of pain. There was no difference in the rate of regression of sensory anesthesia or the development of pain among patients receiving bupivacaine alone or bupivacaine with fentanyl.

Aged↗
PubMed1993

Psychosocial and pharmacologic predictors of satisfaction with intravenous patient-controlled analgesia.

Despite intravenous patient-controlled analgesia's (IV-PCA) increasing popularity, the psychological and pharmacological factors upon which patient satisfaction with IV-PCA are based are unknown. Sixty-eight women scheduled for abdominal hysterectomy completed a series of questionnaires measuring emotional distress, locus of control, perceived support, and optimism before their surgery. Postoperative ratings of pain intensity, emotional distress, anticipated recovery time, nightmares, and satisfaction with IV-PCA were taken 1 and 3 days after surgery. A nurse observer rated perceived anxiety, estimated recovery, and satisfaction with IV-PCA. Cumulative and hourly IV-PCA use and dose/demand ratio were obtained. Degree of dissatisfaction with IV-PCA was significantly correlated with pain intensity, nightmares, patient's perceptions of support, expectations of recovery, preoperative anxiety, and postoperative depression. Dose/demand ratio and hourly analgesic usage were significantly related to pre- and postoperative emotional distress factors. Perioperative management of anxiety, perceptions, and expectations may prove valuable in improving pain control and satisfaction with IV-PCA.

Adult↗
PubMed1991

Low back pain patients unresponsive to an epidural steroid injection: identifying predictive factors.

This study examined factors that help to identify low back pain patients who do not benefit from a lumbar epidural steroid injection (LESI). Two-hundred and forty-nine chronic low back pain patients assessed their pain intensity before, 1 day after, and 2 weeks after receiving a LESI. All patients completed a comprehensive pain questionnaire and a Brief Symptom Inventory (BSI) prior to treatment. Diagnosis and extent of pathology were independently assessed by two physicians. One-hundred and thirty-one patients (52.6%) were followed 1 year after treatment. Results showed that average pain intensity ratings decreased in 62.3% of patients 2 weeks after receiving a LESI. One year after treatment, 62.6% felt that LESI was helpful. Nine patients (7%) felt that the treatment was harmful. Four factors were identified that best predicted poor outcome 2 weeks after LESI: (a) greater number of previous treatments for pain; (b) more medications taken; (c) pain not necessarily increased by activities, and (d) pain increased by coughing. Factors that predicted no benefit 1 year after treatment included (a) pain does not interfere with activities; (b) unemployment due to pain; (c) normal straight-leg raise test prior to treatment; and (d) pain not decreased by medication.

Adolescent↗