PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Injections, Spinal”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed1989

Arginine8-vasopressin reduces spinal cord blood flow after spinal subarachnoid injection in rats.

Arginine8-vasopressin (AVP) causes hindlimb paralysis, loss of nociceptive responsiveness and increased arterial pressure after spinal subarachnoid injection in rats. In these experiments, the effects of paralytic intrathecal doses of AVP on rat brain and spinal cord blood flow, vascular resistance and cardiac output were measured using radiolabeled microspheres. Ten minutes after injection, AVP (10-100 pmol) elevated mean arterial pressures significantly, increased vascular resistances in thoracic and lumbosacral spinal cord and reduced blood flow to the lumbosacral spinal cord without altering cardiac output, total peripheral resistance and blood flow to brain and other spinal cord regions. Lumbosacral blood flows remained significantly reduced 30 min after injection of 100 pmol of AVP, and recovered to pretreatment base-line levels by 60 min postinjection. Lactic acid concentrations were elevated significantly in spinal cerebrospinal fluid samples removed 5 to 15 min after AVP injection (100 pmol). The selective AVP V1 receptor antagonist [1-(beta-mercapto-beta,beta-cyclopentamethylene propionic acid), 2-(O-methyl)tyrosine] arg8-vasopressin, which previously blocked the effects of AVP on hindlimb motor and nociceptive function, in these experiments also blocked the AVP-induced increases in arterial pressure and reductions in lumbosacral perfusion. Intravenous infusion of the vasodilators papaverine and nifedipine failed to block AVP-induced hindlimb paralysis. Nifedipine, however, did accelerate subsequent recovery of hindlimb motor function, although it did not alter the lumbosacral blood flow reductions measured at 10 and 30 min after AVP injection. These findings indicate that AVP has significant vascular effects in the rat spinal cord that are associated with ischemia and neurological dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

The diagnostic accuracy of spinal nerve injection studies. Their role in the evaluation of recurrent sciatica.

The spinal nerve injection study (SNIS) is a diagnostic test for the evaluation of sciatica. SNIS consists of selective infiltration of nerve root with local Xylocaine anesthesia. The most common indication is in the postlaminectomy patient with persistent or recurrent sciatica and peridural scarring causing myelograms or CT scans to be difficult to interpret. Of 105 patients with SNIS, 55 subsequently had surgical exploration of the suspected lesion. In patients with a diagnostic or highly suggestive SNIS, an accurate diagnosis was made in 43 (93%); myelograms in the same group had an accuracy of 24%. At follow-up evaluations ranging from 12 to 60 months (average, 20 months), 40 (73%) of the patients were improved by further surgical treatment.

Adult↗
PubMed1998

[Does intrathecal clonidine prolong the effect of spinal anesthesia with hyperbaric mepivacaine? A randomized double-blind study].

BACKGROUND: Clonidine, an alpha 2-receptor agonist, has been reported to prolong the blocking actions of local anaesthetics. The aim of this study was to investigate the effects of spinally injected clonidine on the duration of spinal anaesthesia by mepivacaine and on the postoperative demand for analgesics. METHODS: Forty-five patients who had transurethral urological surgery under spinal anaesthesia were randomized to 3 groups (n = 15 each) and studied in a double-blind fashion. Group I received 80 mg mepivacaine 4% only, while in group II mepivacaine was combined with 75 micrograms clonidine intraspinally and in group III with 150 micrograms clonidine. Onset time, spread of anaesthesia, duration of sensory and motor blockade, regression of anaesthesia and postoperative demand for analgesics were recorded. In addition heart rate and mean arterial pressure were measured at regular intervals. RESULTS: Clonidine had no effect on the onset time and spread or intensity of spinal anaesthesia. The higher dose of clonidine significantly prolonged the duration of sensory blockade by 50 min and the duration of motor block by 40 min, while 75 micrograms had no significant effect. Heart rate and mean arterial pressure were significantly reduced in both clonidine groups when compared to plain mepivacaine. There was no significant reduction in postoperative analgesic demand. CONCLUSION: While clonidine prolonged sensory analgesia, there was also an undesirable prolongation of motor block postoperatively. In addition, there was a significant and long lasting reduction in heart rate and mean arterial pressure in both clonidine groups. Unfavourably, postoperative demand of analgesics was not reduced by spinal injection of clonidine. Thus, the routine addition of clonidine for spinal anaesthesia with local anaesthetics is not recommended.

Adrenergic alpha-Agonists↗
PubMed1999

Comparison of low-dose epidural with combined spinal-epidural analgesia for labour.

We have performed a randomized comparison of two low-dose epidural regimens for analgesia in labour, differing only in the manner in which initial analgesia was established. In the epidural (EPI) group, 484 women received a loading dose of 20 ml of 0.1% bupivacaine with fentanyl 2 micrograms ml-1. In the combined spinal-epidural (CSE) group, 524 women received a spinal injection of plain bupivacaine 2.5 mg with fentanyl 25 micrograms. In both groups, these initial doses were followed by 0.1% bupivacaine with fentanyl 2 micrograms ml-1 infused at a rate of 12 ml h-1, with 20-ml top-ups for breakthrough pain. The groups were compared for midwife assessment of analgesic efficacy, delivery mode, patient assessments of first stage analgesia, second stage analgesia, overall analgesia, motor block and complications. Midwives, who were not blinded to the treatment groups, assessed 61.6% of CSE as providing 'excellent' analgesia compared with 56.4% of epidurals (P = 0.02). Patients assessed overall analgesia as 'excellent' in 74.8% of CSE compared with 71.7% of epidurals (P = 0.14). Other comparisons between groups revealed no differences. These findings may have been affected by an uneven distribution of multiparous women between the groups (25% in the EPI group and 34.2% in the CSE group; P = 0.002). However, subgroup analysis of primiparous and multiparous women did not alter the results.

Adolescent↗
PubMed2003

Intrathecal ketorolac enhances antinociception from clonidine.

UNLABELLED: Although both alpha2-adrenergic agonists and cyclooxygenase inhibitors produce analgesia, their exact sites of action and interaction remain unclear. A previous report demonstrated a surprising inhibition of antinociception in rats from intrathecal clonidine by co-administered ketorolac. There are no other reports of interaction between these two classes of analgesics. We therefore reexamined this interaction, determining the effect of intrathecal clonidine and ketorolac alone and in combination in normal rats. Clonidine, but not ketorolac, produced antinociception to noxious hind paw thermal stimulation. The addition of ketorolac significantly enhanced the effect of clonidine, indicating a synergistic interaction for analgesia. Although the reasons for the discrepancy between this and the previous report are unclear, these results are consistent with previous studies that indicate an antinociceptive action of intrathecal alpha2-adrenergic agonists in the normal condition, a lack of such effect for cyclooxygenase inhibitors, and positive reinforcing effects of these two systems when co-stimulated. IMPLICATIONS: Spinal injection of the alpha2-adrenergic agonist clonidine and the cyclooxygenase inhibitor ketorolac results in a synergistic interaction for antinociception in normal animals, suggesting that the combination of these drugs will enhance rather than detract from the analgesia of either alone.

Adrenergic alpha-Agonists↗
PubMed2004

Audit of conservative management of chronic low back pain in a secondary care setting--part I: facet joint and sacroiliac joint interventions.

The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16-40% and 13-19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.

Acupuncture Therapy↗
PubMed2001

CT fluoroscopy--guided interventional procedures: techniques and radiation dose to radiologists.

PURPOSE: To determine the radiation dose to radiologists who perform computed tomographic (CT) fluoroscopic interventional procedures by using a quick-check method and a low-milliampere technique. MATERIALS AND METHODS: Two hundred twenty CT fluoroscopy--guided interventional procedures were performed in 189 patients. Procedures included 57 spinal injections, 17 spinal biopsies, 24 chest biopsies, 20 abdominal aspirations, 44 abdominal biopsies, and 58 abdominal drainages. Procedure details were prospectively recorded and included site, depth, target diameter, milliampere value, kilovolt peak, fluoroscopic time, and CT technique (continuous CT fluoroscopy, quick-check method, or a combination of these techniques). An individual collar and finger radiation detector were worn by each radiologist during each procedure to determine the dose per procedure. RESULTS: The quick-check technique was performed in 191 (87%) of 220 procedures. Four procedures were performed with continuous CT fluoroscopy, and a combination technique was used for 25 (11%) procedures. The overall mean CT fluoroscopic time was 17.9 seconds (range, 1.2--101.5 seconds). The mean milliampere value was 13.2 mA (range, 10--50 mA). The overall mean radiologist radiation dose per procedure was 2.5 mrem (0.025 mSv) (whole body). Individual procedure doses ranged from 0.66 to 4.75 mrem (0.007--0.048 mSv). The finger radiation dose was negligible. CONCLUSION: By using a low-milliampere technique and the quick-check method, CT fluoroscopic time and radiation exposure can be minimized.

Adult↗
PubMed2005

Involvement of nitric oxide in clonidine-induced spinal analgesia.

BACKGROUND: The chronic pain relieving effects following spinal administration of clonidine are probably connected to alpha2-adrenoreceptor-induced augmented synthesis of nitric oxide (NO) in the spinal cord. In contrast, when acute pain is considered, the possible role of NO is still speculative. The aim of the present study was to explore the role of NO in acute pain relief following intraspinal administration of clonidine. METHODS: We used the mouse tail-flick model of acute pain. Spinal injections of the following agents and their combinations were administered: clonidine, L-arginine (NO precursor), the NO production inhibitor nitro-L-arginine-methyl ester (L-NAME), the NO antagonist methylene blue (MB) and nitroglycerine (NO releasing agent). RESULTS: A 95% analgesic response was achieved with 2.0 microg clonidine. L-Arginine produced analgesia, and L-arginine administration followed by clonidine resulted in a pronounced synergistic analgesic effect. This synergistic effect was attenuated by L-NAME. Pre-treatment with MB decreased and nitroglycerine administration did not affect the clonidine-induced analgesia. CONCLUSIONS: NO may be involved in the mediation of the acute pain relieving effects of intraspinally administered clonidine. Further research is warranted to establish the potential benefits and possibility for incorporation of NO promoting agents in therapeutic regional pain regimens.

Acute Disease↗
PubMed2000

Potential for patient harm from intrathecal administration of preserved solutions.

Intrathecal drug administration is an important component of the management of malignancy and symptom control. This route of administration reduces systemic adverse effects, but can increase the risk of local adverse effects such as arachnoiditis. It is accepted practice that any spinal injection should not contain any preservatives (such as benzyl alcohol and parabens-containing compounds). The intrathecal administration of solutions preserved with benzyl alcohol has been shown in case studies to increase the risk of adverse neurological events. Available data do not support the safety of intrathecal injection of products preserved with parabens; rather, they demonstrate a need for further investigation. Steps should be taken to ensure that preservative-free products are used. Staff involved with the preparation and administration of intrathecal preparations need to be educated about the risks associated with preservatives in this setting.

Antineoplastic Agents↗
PubMed1991

[Pharmacology and mechanism of action of opiates administered by the subarachnoid route].

The sites of action of spinally administered opiates are specific receptors (mu kappa delta) located in the spinal dorsal horn. Pharmacokinetics of spinally administered opiates are determined by their lipophilic property. Morphine has a weak octanol-water partition coefficient and remains in the CSF during a long period following the cephalic movements of lumbar CSF to the supraspinal structures. More lipophilic opiates are rapidly eliminated from the CSF. Nevertheless, significant pethidine concentrations are documented in the ventricular CSF, due to vascular absorption of the drug. Pharmacokinetics features of different opiates determine the duration of analgesia and the risk of respiratory depression after spinal injection.

Analgesics, Opioid↗
PubMed1977

Administration of human interferon to rabies virus-infected monkeys after exposure.

The treatment of rabies-infected cynomolgus monkeys (Macaca fascicularis) with human interferon after exposure was studied. The monkeys were infected with rabies street virus by the intramuscular route; larger than or equal to 24 hr after infection, human interferon was administered intramuscularly or by lumbar spinal injection into the cerebrospinal fluid. Whereas 90% of the infected untreated monkeys died, 40%-80% of animals treated with interferon survived. No or only low levels of neutralizing antibody to rabies virus were found in the sera of monkeys that survived after a single intramuscular injection of human interferon. Distinctly higher antibody titers, however, were detected in the sera of surviving monkeys that had been given six consecutive intralumbar doses of interferon beginning three days after infections. Therefore, we conclude that in these monkeys rabies virus propagated until it spread into the central nervous system, where further viral replication was inhibited by the human interferon administered by the intralumbar route.

Animals↗
PubMed1998

Reduced anti-allodynic effect of the adenosine A1-receptor agonist R-phenylisopropyladenosine on repeated intrathecal administration and lack of cross-tolerance with morphine in a rat model of central pain.

UNLABELLED: We examined the development of tolerance to the antiallodynic effect of chronic intrathecal (IT) administration of the adenosine analog R-phenylisopropyladenosine (R-PIA) in a rat model of central pain after ischemic spinal cord injury. After 10 days of IT R-PIA treatment, the effect of IT morphine was also assessed to examine whether cross-tolerance between R-PIA and morphine was present. IT R-PIA completely alleviated allodynia-like behaviors to mechanical and cold stimuli in spinally injured rats. The anti-allodynic effect of R-PIA was maintained for 6-7 days with twice-daily administration and was reduced thereafter, particularly with respect to cold allodynia. IT morphine alleviated mechanical and cold allodynia in rats rendered tolerant to R-PIA to a degree comparable to that in R-PIA-naive (control) rats, which indicates that the anti-allodynic property of R-PIA is independent of the mechanisms by which morphine acts. The possibility of using agonists of adenosine receptors in treating refractory pain in patients with spinal cord injury is discussed. IMPLICATIONS: There is often no satisfactory treatment for chronic pain after spinal cord injury. Our study suggests such pain can be treated with a spinal injection of R-phenylisopropyladenosine in rats. Reduced effect to R-phenylisopropyladenosine was noted with repeated administrations. However, there was no cross-tolerance to morphine.

Adenosine↗
PubMedDate not supplied

Effects of epidural injection on spinal block during combined spinal and epidural anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: Epidural injection has been known to enhance spinal anesthesia in combined spinal and epidural (CSE) anesthesia. Saline and local anesthetics have been reported to have a volume effect, elevating sensory level when supplementing a volume into the epidural space. We evaluated the effects of epidural injection when using the CSE technique for cesarean delivery. METHODS: Sixty-six parturients were allocated randomly into group C (control, n = 21), S (saline, n = 21), or B (bupivacaine, n = 24): epidural injections of 10 mL saline and 0.25% bupivacaine were given in groups S and B, respectively, 10 minutes after they received 8 mg of 0.5% hyperbaric bupivacaine intrathecally, and no injection was given in group C. The sensory level at 10 minutes, the maximal level and the time to reach it, and degree of motor block and muscle relaxation were compared. We also investigated intraoperative side effects and postoperative findings in the postanesthesia care unit. RESULTS: Epidural injection raised the sensory level significantly in groups S and B, but the maximal height of sensory block and degree of muscle relaxation did not differ among the groups. Fewer patients complained of intraoperative pain in group B than in the other groups (P <.001). CONCLUSIONS: We could not achieve satisfactory surgical analgesia with 8 mg of hyperbaric bupivacaine injected into the subarachnoid space using the needle-through-needle technique in cesarean deliveries. An epidural saline injection elevated the sensory level, which did not improve the spinal block, whereas an epidural injection of 10 mL of 0.25% bupivacaine enhanced the spinal block and sustained the block postoperatively.

Adult↗
PubMed1997

Image-Guided Spinal Steroid Injections.

This paper has been written to stimulate the radiologist to consider the various aspects of spinal steroid injections as therapeutic procedures. Special emphasis is placed on needle guidance, asepsis, and possible problems involved. It constitutes a highly practical and variously illustrated and informative guide for the choice of steroids and various spinal joint approaches. It details the following target areas: lumbar facet joints, cervical facet joints, costovertebral joints, C1-C2 joint, intervertebral discs, epidural space, and interspinous bursa. Safety is the key element of the above-mentioned techniques. The radiologist must pay special attention to the omnipresent risk of iatrogenic infection.

Journal Article↗
PubMed1999

Exogenous and endogenous adenosine enhance the spinal antiallodynic effects of morphine in a rat model of neuropathic pain.

Adenosine analogs produce antinociception in normal animals and reduce allodynia and hyperalgesia following inflammation and nerve injury following spinal injection, yet none have been tested for clinical safety. While adenosine itself is in clinical trials for spinal administration, there is little data on the spinal effects of adenosine in animal models. In this study, we determined that the spinal administration of adenosine produced a dose-dependent reduction in tactile allodynia in rats following spinal nerve ligation without producing motor blockade. Although the maximal effect of adenosine was less than 50% reversal of allodynia, its duration of action was >24 h after a single spinal injection. In contrast, injection of a synthetic adenosine analog which produced an anti-allodynic action to a similar degree of effect resulted in a pronounced motor blockade. Spinal opioid action has been suggested to result in part from spinal adenosine release. We hypothesized that the reduced efficacy of spinal morphine in nerve injury-induced allodynia and hyperalgesia might reflect a disruption in this spinal opioid-adenosine mechanism. Spinal morphine itself produced a minimal reduction in allodynia in rats following spinal nerve ligation and this was enhanced in an additive manner by spinal adenosine. The maximal effect of this combination resulted in less than 60% reversal of allodynia. In contrast, spinal injection of adenosine deaminase or reuptake inhibitors greatly enhanced the effect of spinal morphine, resulting in over 80% reversal of allodynia. These results support the clinical testing of spinal adenosine alone and with morphine in the treatment of neuropathic pain, and further testing of the proposed opioid-adenosine link in normal and hyperesthetic conditions.

Adenosine↗
PubMedDate not supplied

Urine retention due to intra-spinal cord injection of colchicine in rats: improved recovery of bladder function by monosialoganglioside GM1 and nerve growth factor administration.

Intra-spinal cord injection of a low dose of colchicine (2 micrograms/rat) at the lumbar level affects the micturition reflex leading to voiding suppression, bladder hypertrophy and overflow incontinence which lasts about four weeks. The administration of nerve growth factor and monosialoganglioside GM1 normalizes urine output within 3 days and improves recovery of the bladder contraction tested by a cystometric analysis.

Animals↗
PubMedDate not supplied

Depressor and bradycardic effects induced by spinal subarachnoid injection of D-Ala2-D-Leu5-enkephalin in rats.

The effects of D-Ala2-D-Leu5-enkephalin (DADLE), a specific delta receptor agonist, on spinal control of cardiovascular function, were investigated by its intrathecal (i.th) injection into the spinal subarachnoid space at the T-9 level. In chloralose-anesthetized rats, DADLE (17.5, 35 and 70 nmol, i.th) caused dose-dependent hypotension and bradycardia. The mean maximal hypotension by 70 nmol of DADLE was -45 +/- 7 mmHg, with a bradycardia of -79 +/- 15 beats/min. These inhibitory cardiovascular effects were antagonized by the opiate antagonist naloxone (50 nmol, i.th.) given prior to DADLE. Intrathecal injection of DADLE also decreased splanchnic sympathetic nerve discharge (-46 +/- 5%). DADLE (70 nmol) given i.v. did not cause significant changes in mean arterial pressure (MAP) and heart rate (HR). Neither bilateral vagotomy nor pretreatment with atropine (0.2 mg/kg, i.v.) prevented the BP and HR effects of intrathecal injection of DADLE at a dose of 35 nmol. DADLE at this dose failed to produce significant alteration in the frequency of respiration and blood PaO2, PaCO2 and blood pH. In conscious rats, 140 nmol of DADLE (i.th.) did not produce any consistent changes in MAP and HR. These data suggest that intrathecal injection of DADLE inhibits central sympathetic activity, possibly at a spinal locus.

Animals↗