PubMed Health⌕ Search

Biomedical subjects

H Adriaensen

Publications and source records attributed to H Adriaensen.

At least 19 recordsLinked to original sources
PubMed2004

Systematic overview of the pharmacological management of postherpetic neuralgia. An evaluation of the clinical value of critically selected drug treatments based on efficacy and safety outcomes from randomized controlled studies.

OBJECTIVE: This study systematically reviews current evidence on drug treatments commonly used in postherpetic neuralgia. METHODS: Randomized controlled trials were critically selected using predefined search criteria. Efficacy was evaluated as percentage of improvement in pain intensity between baseline and endpoint, tolerability by number of study discontinuations because of adverse events and incidence of adverse events. RESULTS: Currently published trials enrolled different patient populations and small patient numbers. The great variability in doses, titration schemes, designs and washout periods together with other design flaws made comparison between different studies scientifically impossible. CONCLUSIONS: There is a real need for well-performed clinical trials with standardization in design and reporting. Development of adequate and validated questionnaires for evaluation and comparison of efficacy and safety of treatments is also needed. Based on the evaluation of individual studies, it is concluded that only gabapentin is studied in large (over 200 patients), placebo-controlled studies showing good efficacy and safety.

Analgesics↗
PubMed2004

Cerebral oximetry in patients undergoing carotid endarterectomy: preliminary results.

Carotid endarterectomy (CEA) is an appropriate treatment for carotid occlusive disease. The risk of stroke during CEA ranges from 1.1% to 7.5%. Shunting is usually advised when severe ischemia during cross-clamping of the internal carotid artery is suspected. Routine use of an intraluminal shunt may increase the perioperative stroke rate. Popular and well documented methods of neurologic monitoring for ischemia during general anesthesia are electroencephalography (EEG) and transcranial Doppler ultrasonography (TCD) of the middle cerebral artery. The purpose of this prospective study was to compare cerebral oximetry using near infrared spectrophotometry (NIRS) with EEG and TCD. Preliminary data on 14 patients scheduled for elective carotid endarterectomy were included and a literature search was performed to correlate the findings. No postoperative neurologic events occurred. During carotid clamping there was a significant decrease in regional oxygen saturation (rSO2) but there was only a weak correlation with the decrease in mean Doppler flow (R = 0.74; P = 0.02) and no correlation with EEG changes (R = 0.49; P = 0.18). A useful rSO2 cut-off value predictive for cerebral ischemia could not be defined.

Brain Ischemia↗
PubMed2003

Opioid tolerance and dependence: an inevitable consequence of chronic treatment?

Although opioids provide effective analgesia, largely unsubstantiated concerns about opioid-induced tolerance, physical dependence and addiction have limited their appropriate use. As a consequence, many patients receive inadequate treatment for both malignant and non-malignant pain. However, it has been shown that analgesic tolerance develops less frequently during chronic opioid administration in a clinical context than in animal experiments, and that instituting an appropriate dosing regimen can minimise withdrawal symptoms. Early studies had suggested that addiction might result from chronic opioid therapy, though more recent data indicate a low risk in patients with no history of drug abuse. New treatment regimens may also reduce the risk of tolerance, physical dependence and addiction. Long-acting preparations, such as transdermal fentanyl and possibly some forms of other slow release opioids, which maintain constant opioid concentrations in the plasma, minimise the occurrence of the 'between-dose' symptoms such as withdrawal and opioid-induced euphoria. This review discusses the development of tolerance, physical dependence and addiction during opioid therapy, and the influence of these factors on the choice of treatment.

Analgesics, Opioid↗
PubMed2002

Cost-effectiveness of analgesia after Caesarean section. A comparison of intrathecal morphine and epidural PCA.

BACKGROUND: Patient-controlled analgesia (PCA) techniques and intrathecal morphine are the most widely used treatments for post-Caesarean section pain. However these methods have not been compared with respect to analgesic quality and cost differences. METHODS: Fifty-three patients scheduled for elective or semi-urgent Caesarean section were randomized to receive for postoperative analgesia either epidural PCA with a mixture containing bupivacaine 0.06% and sufentanil 1 microg x ml(-1) or intrathecal morphine 0.15 mg together with the spinal anaesthetic and to be supplemented with paracetamol and tramadol. Analgesic efficacy, side-effects and costs were calculated during 48 h. RESULTS: VAS pain scores both at rest and during mobilization were lower in the PCA group, more particularly during the second postoperative day. Nausea and vomiting were more frequently registered in the morphine treated patients. PCA treated patients stayed longer in the recovery room but required fewer nurse interventions on the surgical ward. Manpower and drug costs were equal in both groups. The differences in total costs (Euro) amounted to euros 33 and were mainly caused by the more expensive equipment required for epidural PCA. Satisfaction and hospital discharge were similar for both treatments. CONCLUSIONS: It was concluded that epidural PCA induced better pain relief, caused less nausea/vomiting but was more expensive than intrathecal morphine.

Adult↗
PubMed2001

Evaluation of long-term efficacy and safety of transdermal fentanyl in the treatment of chronic noncancer pain.

The objective of this international, multicenter, open-label trial was to assess the efficacy and safety of up to 12 months of therapy with transdermal therapeutic system (TTS) fentanyl in patients (n = 532) with chronic noncancer pain. The trial was completed by 301 (57%) of the patients. The main outcome measures were pain control assessment, global treatment satisfaction, patient preference for TTS fentanyl, and quality of life. The mean dose of transdermal fentanyl (TDF) increased from 48 to 90 microg/h during a period of 12 months. During treatment, on average 67% of patients within the efficacy analysis group (n = 524) reported very good, good, or moderate pain control. Global satisfaction (very good or good) was also stable at 42%. The majority (86%) of patients reported a preference for TDF over their previous treatment (P < .001, binomial test). Short Form 36 quality-of-life scores improved from baseline for bodily pain. The most frequent treatment-related adverse events were nausea (31%), constipation (19%), and somnolence (18%). With regard to opioid-specific adverse events (respiratory depression [< 1%], adrenal insufficiency [< 1%], drug abuse/dependence [1%], and opioid withdrawal syndrome [3%]), these were extremely rare and, with the exception of opioid withdrawal syndrome, none was considered definitively related to the treatment. Long-term treatment with TDF provided a stable degree of pain control in the majority of patients with moderate to severe chronic noncancer pain. It was preferred by the majority of patients compared with their previous opioid medication. Overall, long-term treatment with TDF was generally well tolerated, particularly in view of the low incidence of potentially serious side effects such as drug abuse/dependence and respiratory depression. However, at present, it is important that patients receiving TDF should still be subject to careful assessment and monitoring.

Journal Article↗
PubMed2001

Piroxicam versus tenoxicam in spine surgery: a placebo controlled study.

In double-blind trial 60 patients undergoing spine surgery were randomized to receive either placebo, tenoxicam 40 mg intravenously (i.v.), tenoxicam 40 mg intramuscularly (i.m.) or piroxicam 40 mg i.m., immediately following the induction of general anesthesia. As compared to placebo, the 24 hour morphine consumption was reduced in all groups. This reduction was only statistically significant (p = 0.023) in the i.v. group (21.7 +/- 11.27 versus 36.53 +/- 20.33 mg). Rest and dynamic pain scores were significantly lower in both tenoxicam groups but more consistently in the i.v. group. With piroxicam only rest pain scores at 24 hours were lower. Less urinary retention was noticed in the i.v. tenoxicam group. This study shows that, following spine surgery, i.v. tenoxicam induces a morphine sparing effect (41%) while offering lower rest and dynamic pain scores and a lower incidence of urinary retention.

Adult↗
PubMed2000

The emotional stroop task and chronic pain: what is threatening for chronic pain sufferers?

Using a computer version of the emotional stroop task, it was investigated whether chronic pain patients display an involuntary attentional shift towards pain-related information (sensory, affective pain words and injury related words). Multiple regression analyses were used to investigate which pain and psychosocial variables (pain severity, pain-related fear, pain catastrophizing and negative affect) were predictive of attentional bias. Results indicated: (1) that there was an attentional bias towards the sensory pain words; and (2) that current pain intensity was predictive of the effect. No other attentional effects were found. The results are discussed in terms of possible reasons for the difficulty of demonstrating attentional bias in chronic pain patients.

Attention↗
PubMed2000

Endocrine consequences of long-term intrathecal administration of opioids.

Intrathecal administration of opioids is a very efficient tool in the long-term control of intractable nonmalignant pain. However, despite the well known role of opioids in endocrine regulation, few data are available about possible effects on hypothalamic-pituitary function during this treatment. Seventy-three patients (29 men and 44 women; mean age, 49.2 +/- 11.7 yr) receiving opioids intrathecally for nonmalignant pain were enrolled for extensive endocrine investigation. At the time of hormonal determination, the mean duration of opioid treatment was 26.6 +/- 16.3 months; the mean daily dose of morphine was 4.8 +/- 3.2 mg. The control group consisted of 20 patients (11 men and 9 women; mean age, 54.2 +/- 14.0 yr) with a comparable pain syndrome but not treated with opioids. Decreased libido or impotency was present in 23 of 24 men receiving opioids. The serum testosterone level was below 9 nmol/L in 25 of 29 men and was significantly lower than that in the control group (P < 0.001). The free androgen index was below normal in 18 of 29 men and was significantly lower than that in the control group (P < 0.001). The serum LH level was less than 2 U/L in 20 of 29 men and was significantly lower than that in the control group (P < 0.001). Serum FSH was comparable in both groups. Decreased libido was present in 22 of 32 women receiving opioids. All 21 premenopausal females developed either amenorrhea or an irregular menstrual cycle, with ovulation in only 1. Serum LH, estradiol, and progesterone levels were lower in the opioid group. In all 18 postmenopausal females significantly decreased serum LH (P < 0.001) and FSH (P = 0.012) levels were found. The 24-h urinary free cortisol excretion was below 20 microg/day in 14 of 71 opioid patients and was significantly lower than that in the control group (P = 0.003). The peak cortisol response to insulin-induced hypoglycemia was below 180 microg/L in 9 of 61 opioid patients and was significantly lower than that in the nonopioid group (P = 0.002). The insulin-like growth factor I SD score was below -2 SD in 12 of 73 opioid patients and was significantly lower than that in the control group (P = 0.002). The peak GH response to hypoglycemia was below 3 microg/L in 9 of 62 subjects and was significantly lower than that in the control group (P = 0.010). Thyroid function tests and PRL levels were considered normal. No metabolic disturbances were recorded, apart from significantly decreased high density lipoprotein cholesterol levels (P = 0.041) and elevated total/high density lipoprotein cholesterol ratio (P = 0.008) in the opioid group compared to the control group. Supplementation with gonadal steroids improved sexual function in most patients. In conclusion, of all patients receiving intrathecal opioids, the large majority of men and all women developed hypogonadotropic hypogonadism, about 15% developed central hypocorticism, and about 15% developed GH deficiency. These findings suggest that further investigations are required to determine the need for systematic endocrine work-up in these patients and the necessity for substitutive therapy.

Adult↗
PubMed1998

Behavioral assessment of facial pain in rats: face grooming patterns after painful and non-painful sensory disturbances in the territory of the rat's infraorbital nerve.

Noxious stimulation of the rat's face evokes intense face grooming with face wash strokes almost exclusively directed to the stimulated area (e.g. Clavelou et al., Neurosci. Lett., 14 (1989) 3263-3270). Similar asymmetric face grooming behavior has been observed after transection (Berridge and Fentress, J. Neurosci., 6 (1986) 325-330) and chronic constriction of the infraorbital nerve (Vos et al., J. Neurosci., 14 (1994) 2708-2723). In the present study, the relation between unilateral facial pain and asymmetric face grooming was experimentally studied in normal, intact rats: face grooming patterns evoked by non-painful sensory disturbances in the territory of the infraorbital nerve (i.c. unilateral vibrissae clipping, anesthetic infraorbital nerve blockade, application of mineral oil on vibrissae) were compared to those evoked by noxious facial stimulation (s.c. formalin injection in mystacial pad) and those observed in unstimulated control rats, using video-analysis. Only formalin-injected rats displayed significantly more face grooming activity directed to the affected infraorbital nerve territory than unstimulated control rats. Non-painful sensory disturbances (especially mineral oil application) induced an initial bout of directed face grooming; this response was transient and short-lasting. These observations suggest that directed face grooming can be used as a sign of unilateral facial pain in freely moving rodents; unilateral non-painful facial sensory disturbances do not lead to intense and persistent directed face grooming.

Animals↗
PubMed1997

Intravenous regional anesthesia. Evaluation of 4 different additives to prilocaine.

Intravenous regional anesthesia (IVRA) is an effective method of producing anesthesia of the extremities. Disadvantages are the rapid loss of anesthesia after the deflation of the tourniquet and the rapid development of postoperative pain. This study compared the effect of four different additives to prilocaine with saline on the development of a complete sensory block, on the return of sensory function after deflation of the tourniquet and on the development of postoperative pain after IVRA for minor orthopedic surgery of the arm. Seventy-five patients, ASA class 1 or 2, were randomly divided into 5 groups. All patients received 30 ml. of prilocaine 1%, together with 5 ml. of additive. In group 1, the additive was saline, in group 2 bupivacaine 0.25%, in group 3 clonidine 150 micrograms in saline, in group 4 sufentanil 25 micrograms in saline and in group 5 tenoxicam 20 mg. The development of a complete sensory block proved significantly faster in the patients receiving sufentanil (4.8 min.) as compared to plain prilocaine (7.5 min.). The return of the sensory function was comparable for all groups. Postoperative pain scores were significantly better in the clonidine and tenoxicam groups.

Adjuvants, Anesthesia↗
PubMed1997

Accidental overdosing with intraspinal morphine caused by misprogrammation of a Synchromed pump: a report of two cases.

Spinally administered opioids must be a last step in the therapeutical arsenal of chronic benigne pain. It is an invasive technique not free from adverse effects. Two chronic pain patients received an implantable Synchromed pump for treatment with spinal opiates after a trial period of resp. 3.5 and 5.5 months. Due to a misprogrammation (both on the same day) they received very high doses of spinal opiates. This caused relatively few side effects, which did not seem to require immediate treatment. A short time development of tolerance to life threatening side-effects has been proven by this accidental administration of high-dose intraspinal opiates. It is critical that care providers are knowledgeable and well-trained about implantable infusion systems. Programmation and refills must always be performed with care.

Aged↗
PubMed1995

Efficacy and safety of oral tramadol and pentazocine for postoperative pain following prolapsed intervertebral disc repair.

In this multicenter double-blind randomized study the analgesic efficacy and safety of 50 mg tramadol was compared against 50 mg pentazocine by mouth in the treatment of 160 patients with acute pain following prolapsed intervertebral disc repair. The day of surgery patients were treated with parenteral opioids. The study started the morning after surgery. A wash out period of four hours was allowed after parenteral analgesics. Pain assessment was made using a visual analogue scale (VAS) and a verbal rating scale (VRS) during a six hours observation period. Remedication with the same drug at the same dosage was allowed if pain relief was unsatisfactory. Overall analgesic activity and spontaneously reported side effects were also registered. Results showed both treatments provided equivalent effective analgesia for the six hours observation period. The global assessment of analgesia by patient and observer was not significantly different for both treatments, although less additional medication was required in the pentazocine group. Side effects were quite common in both groups, and occurred more frequently in the pentazocine group.

Administration, Oral↗
PubMed1994

Successful treatment of postherpetic neuralgia with oral ketamine.

OBJECTIVE: To demonstrate the possibilities of the use of oral ketamine in the treatment of postherpetic neuralgia. SETTING: A pain clinic in a university hospital. PATIENT: A patient with postherpetic neuralgia of the ophthalmic nerve. INTERVENTION: Subcutaneous and later oral ketamine after classical treatment had failed. RESULTS: A complete recovery was accomplished without any sign of side effects. CONCLUSIONS: Oral ketamine may provide an alternative in the treatment of postherpetic neuralgia. The possible mechanism of action by its N-methyl-D-aspartate (NMDA) blocking properties is discussed.

Administration, Oral↗
PubMed1993

Combined continuous spinal-epidural anaesthesia with a single interspace, double-catheter technique.

A double catheter, single interspace combined spinal-epidural anaesthetic was performed in 12 ASA grade 3 patients. The technique failed in one patient in whom the intrathecal catheter could not be inserted satisfactorily. In another patient, the epidural catheter was accidentally placed intrathecally. The maximum height of the block obtained with hyperbaric lignocaine or bupivacaine was below T10 in all patients and there were no adverse cardiovascular changes. As opposed to a classical combined spinal-epidural block, this technique is most suitable for very debilitated patients. The advantages are the ability to titrate the intrathecal dose of the local anaesthetic to achieve the desired dermatomal level and to test the correct position of the epidural catheter before injecting drugs intrathecally.

Aged↗
PubMed1993

Does epidural injection of physiological saline facilitate the advancement of catheters?

Seventy patients (ASA I, ASA II), scheduled for a surgical intervention under epidural or combined spinal-epidural anaesthesia, were randomly allocated to one of two groups. The epidural space was identified by loss of resistance using air, followed by injection in Group A (35 patients) of 10 ml of physiological saline directed cephallad and in Group B (35 patients) by no injection. Thereafter an anaesthetist, different to the one who placed the Tuohy in the epidural space, advanced a catheter up to 10 cm into the epidural space. At each cm of advance the resistance was judged. No significant difference in resistance was found between the groups. The authors conclude that the injection of 10 ml of physiological saline into the epidural space does not facilitate the advancement of an epidural catheter.

Adolescent↗
PubMed1992

Spinal sufentanil in rats: Part II: Effect of adding bupivacaine to epidural sufentanil.

Male Wistar rats were injected epidurally with various doses of sufentanil, bupivacaine or sufentanil combined with bupivacaine either 40 or 80 micrograms. Addition of 80 micrograms bupivacaine to sufentanil produced a 2.2- to 3-fold decrease of the lowest ED50 for a tail withdrawal reaction latency greater than 6 and greater than or equal to 10 s. The potentiation was already present at low doses. Whereas both 0.16 microgram sufentanil and 80 micrograms bupivacaine were inactive, the combination of the two drugs resulted in a deep analgesia in all animals. Because the addition of low doses of bupivacaine to sufentanil did not increase the ED50's for side-effects, higher specificity ratios were obtained as compared to sufentanil given alone. These results were discussed with regard to the potentiation of the analgesic properties of epidurally administered lipophilic opioids by local anaesthetics.

Analgesia, Epidural↗