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PubMed1987

Spinal opiates.

Explore the source record for details and available documents.

Acute Disease↗
PubMed1981

[Combined spinal-epidural anesthesia as a variant of conduction anesthesia during surgery].

A method of associated subarachnoid and peridural infusion of subblocking dose of local anesthetic and its solution of low concentration respectively is described. Results of such anesthesia in 210 patients are presented. The associated spino-peridural anesthesia is shown to have advantages as compared with traditional methods of a one-time radicular block.

Adolescent↗
PubMed1981

Time course for neurotoxic esterase inhibition in hens given multiple diisopropyl fluorophosphate injections.

Neurotoxic esterase has been useful for predicting delayed neurotoxicity after acute administration of organophosphorus esters. The present study determined how it could be used to predict neurotoxicity after 20 daily sc injections of 0.05 mg/kg diisopropyl fluorophosphate (DFP) in adult hens. Brain neurotoxic esterase activities were measured during the course of intoxication. No significant occurred after a single DFP injection but the level of inhibition gradually increased to a maximum of 54.3% after 20 injections. The time courses for inhibition of plasma cholinesterase, brain pseudocholinesterase and brain acetylcholinesterase were distinctly different from that for neurotoxic esterase and the former 3 enzymes reached a plateau of inhibition after 1 or 5 DFP injections. Walking behavior was regularly measured in treated hens and distinct motor impairment was first noted after 5 daily DFP injections. Brains, spinal cords and sciatic nerves were removed 24 hr after the last injection and examined microscopically. All hens exhibited central-peripheral distal axonopathy that was characteristic for organophosphate delayed neurotoxicity. Neurotoxicity developed in the absence of a high level of inhibition of neurotoxic esterase following multiple injections of DFP and the "critical" level neurotoxic esterase inhibition used to predict subchronic neurotoxicity may be lower than that used after single treatments.

Animals↗
PubMedDate not supplied

Uncommon applications for continuous spinal anesthesia.

The role that uncommon agents of antinociception, placed intrathecally, play in the control of nociceptive signal transmission in the spinal cord is described. Three specific agents are discussed in detail: baclofen, a gamma aminobutyric acid mimetic agent; clonidine, an alpha-2 agonist; and somatostatin, a neuroinhibitory peptide. In addition, the efficacy of using an implanted pump-catheter system for the long-term infusion of baclofen and octreotide, a somatostatin-like analog, is reviewed.

Anesthesia, Spinal↗
PubMed1997

Intrathecal opioids plus bupivacaine: an option to prolong analgesic efficacy when using the combined spinal-epidural technique--a case report.

Providing analgesia in the latent phase of labor can be challenging. Many obstetricians and nurse midwives believe that epidural analgesia initiated too early in the course of labor can prolong labor and result in fetal malpresentation, thus increasing the need for instrumentation. Many practitioners therefore use the combined spinal-epidural technique with intrathecal opioids during the early portion of first stage labor and initiate epidural analgesia only in the active phase of labor. However, the use of intrathecal opioids has been shown to be less than efficacious in meeting the analgesic needs in a large segment of the patient population, thus requiring initiation of epidural analgesia after only 1 to 2 hours. A case is reported in which the combined spinal-epidural technique was utilized in a primigravida patient. An intrathecal dose of 15 micrograms of sufentanil was given with a dilute concentration of bupivacaine at the initiation of analgesia. Analgesia was provided for approximately 5 hours before epidural analgesia was required. The patient delivered by spontaneous vaginal delivery without instrumentation or adverse sequelae to mother or infant.

Adult↗
PubMed2006

Protein phosphatase 2A regulates central sensitization in the spinal cord of rats following intradermal injection of capsaicin.

BACKGROUND: Intradermal injection of capsaicin into the hind paw of rats induces spinal cord central sensititzation, a process in which the responsiveness of central nociceptive neurons is amplified. In central sensitization, many signal transduction pathways composed of several cascades of intracellular enzymes are involved. As the phosphorylation state of neuronal proteins is strictly controlled and balanced by the opposing activities of protein kinases and phosphatases, the involvement of phosphatases in these events needs to be investigated. This study is designed to determine the influence of serine/threonine protein phosphatase type 2A (PP2A) on the central nociceptive amplification process, which is induced by intradermal injection of capsaicin in rats. RESULTS: In experiment 1, the expression of PP2A protein in rat spinal cord at different time points following capsaicin or vehicle injection was examined using the Western blot method. In experiment 2, an inhibitor of PP2A (okadaic acid, 20 nM or fostriecin, 30 nM) was injected into the subarachnoid space of the spinal cord, and the spontaneous exploratory activity of the rats before and after capsaicin injection was recorded with an automated photobeam activity system. The results showed that PP2A protein expression in the spinal cord was significantly upregulated following intradermal injection of capsaicin in rats. Capsaicin injection caused a significant decrease in exploratory activity of the rats. Thirty minutes after the injection, this decrease in activity had partly recovered. Infusion of a phosphatase inhibitor into the spinal cord intrathecal space enhanced the central sensitization induced by capsaicin by making the decrease in movement last longer. CONCLUSION: These findings indicate that PP2A plays an important role in the cellular mechanisms of spinal cord central sensitization induced by intradermal injection of capsaicin in rats, which may have implications in clinical pain therapy.

Animals↗
PubMed1996

Unilateral spinal anesthesia using low-flow injection through a 29-gauge Quincke needle.

Restriction of sympathetic denervation during spinal anesthesia may minimize hemodynamic alterations. Theoretically, the use of nonisobaric anesthetics may allow unilateral anesthesia and thus restrict sympathetic denervation to one side of the body. The present prospective study investigates the incidence of unilateral spinal anesthesia using hyperbaric bupivacaine 0.5% (1.4 mL, 1.6 mL, 1.8 mL, or 2.0 mL) injected via a 29-gauge Quincke needle with a pump-controlled injection flow of 1 mL/min. In 96 consecutive patients undergoing unilateral surgery of the lower extremities, spinal anesthesia was performed in the lateral decubitus position, which was maintained for 20 min postinjection. Increases in foot temperature of at least 0.5 degrees C were defined as sympathetic blockade. The incidence of unilateral block was not significantly influenced by the amount of bupivacaine. For all 96 patients, the incidence of unilateral sympathetic and complete motor block was 69% and 77%, respectively. Frequency of unilateral sensory block (assessed by pinprick and temperature discrimination) was significantly lower (28%). Strict unilateral spinal anesthesia was achieved in 24 cases (25%). Twenty minutes after injection of the local anesthetic, mean arterial blood pressure decreased significantly in patients with bilateral sympathetic blockade from 87 +/- 8 to 83 +/- 8 mm Hg (P < 0.01) but not in patients with unilateral sympathetic blockade (from 87 +/- 11 to 85 +/- 10 mm Hg). In conclusion, low-flow injection (1 mL/min) of hyperbaric bupivacaine 0.5% via a 29-gauge Quincke needle prevented bilateral sympathetic blockade in more than 69% of the patients. The data further suggest that loss of temperature discrimination alone is not a reliable estimation of sympathetic block.

Anesthesia, Spinal↗
PubMed2005

The evolving role of spinal agents in acute pain.

Local anesthetics and opioids were among the earliest pharmacologic agents used for intrathecal injection. Side-effect profiles have limited the use of additional agents and, after a century of clinical use, local anesthetics and opioids remain the most widely used intrathecal or epidural medications.

Anesthetics, Local↗