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At least 991 records · Page 55Linked to original sources
PubMed1989

Discrimination of heterogenous mRNAs encoding strychnine-sensitive glycine receptors in Xenopus oocytes by antisense oligonucleotides.

Three synthetic oligodeoxynucleotides complementary to different parts of an RNA encoding a glycine receptor subunit were used to discriminate heterogenous mRNAs coding for glycine receptors in adult and neonatal rat spinal cord. Injection of the three antisense oligonucleotides into Xenopus oocytes specifically inhibited the expression of glycine receptors by adult spinal cord mRNA. In contrast, the antisense oligonucleotides were much less potent in inhibiting the expression of glycine receptors encoded by neonatal spinal cord mRNA. Northern blot analysis revealed that the oligonucleotides hybridized mostly to an adult cord transcript of approximately 10 kilobases in size. This band was also present in neonatal spinal cord mRNA but its density was about one-fourth of the adult cord message. There was no intense band in the low molecular weight position (approximately 2 kilobases), the existence of which was expected from electrophysiological studies with size-fractionated mRNA of neonatal spinal cord. Our results suggest that in the rat spinal cord there are at least three different types of mRNAs encoding functional strychnine-sensitive glycine receptors.

Aging↗
PubMed2002

Effect of single-dose subarachnoid spinal anesthesia on pain and recovery after unilateral percutaneous nephrolithotomy.

PURPOSE: We studied the impact of one dose of subarachnoid spinal analgesia on postoperative pain and recovery after percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between August 1999 and May 2000, 20 PCNL patients were randomized into two groups: Group A (N = 9), who received preoperative subarachnoid spinal analgesia with morphine sulfate, and Group B (N = 11), who received no subarachnoid spinal analgesia. Both groups were given general anesthesia, and the nephrostomy site was infiltrated with bupivacaine hydrochloride. Stone size was similar in the two groups, as were ASA classification, age, and body mass index. Pain analog scales (maximum score 10) were completed preoperatively and on the day of surgery (D0), after 1 day (D1), and after 2 days (D2). The amount of morphine sulfate equivalents (MS eq) needed, the activity level, and adverse effects were recorded. RESULTS: In Group A, the average pain score on D0, D1, and D2 was 2.7, 3.7, and 1.4, respectively; in Group B, the average pain score was 4, 4.5, and 2, respectively (P > 0.05). The average MS eq used in Groups A and B were 8.3 v 33.8 (P = 0.002) on D0; 17.7 v 28.7 (P > 0.05) on D1; and 11.1 v 10.1 (P > 0.05) on D2. On D0, in Group A, 56% of the patients were ambulating and 11% complained of nausea, while in Group B, 0 were ambulating and 46% complained of nausea. CONCLUSIONS: A single preoperative dose of subarachnoid spinal analgesia provides a statistically significant decrease in postoperative parenteral pain medication and earlier ambulation. It also appears to reduce the amount of postoperative pain and decrease nausea.

Adult↗
PubMed1990

Effect of epinephrine on intrathecal fentanyl analgesia in patients undergoing postpartum tubal ligation.

Eighty women receiving spinal anesthesia for postpartum tubal ligation were entered into a double-blind, randomized protocol studying the effects of epinephrine on intrathecal fentanyl-induced postoperative analgesia. All patients received 70 mg hyperbaric lidocaine with either 0.2 mg epinephrine (LE), 10 micrograms fentanyl (LF), epinephrine and fentanyl (LFE), or 0.4 ml saline (L). Onset and regression of anesthesia, degree of intraoperative comfort, incidence of pruritus, and extent of postoperative analgesia were evaluated. The simultaneous administration of epinephrine and fentanyl prolonged the duration of complete analgesia (137 +/- 47 min (LFE); 76 +/- 32 min (LE); 85 +/- 44 min (LF); 65 +/- 36 min (L)) and the duration of effective analgesia (562 +/- 504 min (LFE); 227 +/- 201 min (LE); 203 +/- 178 min (LF); 198 +/- 342 min (L)). Administration of epinephrine decreased the incidence of pruritus associated with intrathecal fentanyl (1/18 (LFE); 1/21 (LE); 8/19 (LF); 2/19 (L)).

Adult↗
PubMed1999

Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia?

BACKGROUND: The combined spinal-epidural technique provides rapid onset of labor analgesia and, anecdotally, is associated with labors of shorter duration. Epidural analgesia, by contrast, has been suggested to prolong labor modestly. It is unclear, however, whether more rapid cervical dilation in patients who receive combined spinal-epidural analgesia is a physiologic effect of the technique or an artifact of patient selection. The authors hypothesized that anesthetic technique may influence the rate of cervical dilation, and we compared the effects of combined spinalepidural with those of epidural analgesia on the rate of cervical dilation. METHODS: One hundred healthy nulliparous parturients in spontaneous labor with singleton, vertex, full-term fetuses were enrolled in a double-blinded manner when their cervical dilation was less than 5 cm. The patients were randomly assigned to receive analgesia via a standardized combined spinal-epidural (n = 50) or epidural (n = 50) technique. Data were collected on cervical dilation, pain, sensory level, and motor blockade. RESULTS: When regional analgesia was induced in comparable groups at a mean of 3 cm cervical dilation, the mean initial cervical dilation rates were significantly faster in the combined spinal-epidural group (mean values, 2.1 +/- 2.1 cm/h vs. 1 +/- 1 cm/h; P = 0.0008). Five parturients in the combined spinal-epidural group had a very rapid (> 5 cm/h) rate of mean initial cervical dilation, compared with none of the women in the epidural group. Overall mean cervical dilation rates in patients who achieved full cervical dilation were 2.3 +/- 2.6 cm/h and 1.3 +/- 0.71 cm/h (P = 0.0154) in the combined spinal-epidural and epidural groups, respectively. CONCLUSIONS: In healthy nulliparous parturients in early labor, combined spinal-epidural analgesia is associated with more rapid cervical dilation compared with epidural analgesia. Further study is needed to elicit the cause and overall effect of this difference.

Adult↗
PubMed2006

Severe toxic damage to the rabbit spinal cord after intrathecal administration of preservative-free S(+)-ketamine.

BACKGROUND: Ketamine and S(+)-ketamine have been advocated for neuraxial use in the management of postoperative pain and severe intractable pain syndromes unresponsive to opioid escalation. Although clinical experience has accumulated with S(+)-ketamine, safety data on toxicity in the central nervous system after neuraxial administration of S(+)-ketamine are conflicting. In this study, neurologic and toxicologic effects on the spinal cord from repeated daily intrathecal administration of commercially available, preservative-free S(+)-ketamine were evaluated against placebo in a randomized, blinded design. METHODS: Eighteen white New Zealand rabbits were assigned to two groups receiving either 0.5 ml intrathecal S(+)-ketamine, 0.5% solution (12 rabbits), or 0.5 ml saline (6 rabbits) once a day for 7 consecutive days. During general anesthesia, an intrathecal catheter was placed between the fifth and sixth spinous processes (lumbar). Neurologic (according to Tarlov criteria) and histopathologic assessments were performed after 7 days of treatment. RESULTS: Postmortem investigation of the spinal cord and nerve roots revealed histopathologic lesions suggestive of toxic damage in 11 rabbits, from the group of 12 animals receiving S(+)-ketamine. These results were significantly different compared with 5 control animals (no histologic changes observed). There was no significant difference in neurologic status between the two groups after 7 days of intrathecal treatment. CONCLUSIONS: The authors conclude that repeated intrathecal administration of preservative-free S(+)-ketamine in a clinically relevant concentration and dosage has, considering the extent and severity of the lesions, a toxic effect on the central nervous system of rabbits.

Anesthesia, Spinal↗
PubMed1989

The role of intrathecal opiates in the management of acute pain.

This article reviews the literature and describes clinical methods of providing analgesia for acute pain using epidural and intrathecal (spinal) opiates. The mechanism of action of these drugs, their basic pharmacology and spinal pharmacodynamics, and useful drugs and dosages are presented. The side effects of these drugs when administered by injection and possible ways to diminish their incidence and severity are discussed. A clinical protocol for the dosage and selection of these drugs is included.

Acute Disease↗
PubMed1988

Efficacy of 0.3 mg morphine intrathecally in preventing tourniquet pain during spinal anaesthesia with hyperbaric bupivacaine.

Tourniquet-induced pain is probably mediated by C-fibres. The ability of morphine to interrupt this nociceptive conduction was studied in a double-blind fashion by administering either morphine 0.3 mg or saline intrathecally along with hyperbaric bupivacaine 15 mg for spinal anaesthesia in 40 patients undergoing orthopaedic surgery on the lower extremity. The block characteristics were similar in both groups. During surgery, no patient in the morphine group complained of pain, whereas in the saline group one patient complained of pain caused by the tourniquet and two other patients experienced surgical pain. A 60-min experimental thigh tourniquet pressure provocation (53 kPa for 20 min; 0 kPa for 20 min; 53 kPa for 20 min) on the contralateral unoperated extremity was then performed following surgery, when the spread cephalad of the sensory block had decreased below the T10 dermatomal level. Eight patients in the morphine group experienced no pain in this test, compared with two patients in the saline group (P less than 0.05). The remaining 12 patients in the morphine group had pain responses similar to those patients not given morphine. Intrathecal morphine provides a level of prophylaxis against tourniquet pain. However, the dosage employed here was associated with urinary and emetic side-effects.

Adult↗
PubMed2006

Intrathecal 2-chloroprocaine for lower limb outpatient surgery: a prospective, randomized, double-blind, clinical evaluation.

We evaluated the dose-response relationship of 2-chloroprocaine for lower limb outpatient procedure in 45 ASA physical status I-II outpatients undergoing elective lower limb surgery under spinal anesthesia, with 30 mg (group Chlor-30, n = 15), 40 mg (group Chlor-40, n = 15), or 50 mg (group Chlor-50, n = 15) of 1% preservative free 2-chloroprocaine. Onset time was similar in the three groups. General anesthesia was never required to complete surgery. Intraoperative analgesic supplementation as a result of insufficient duration of spinal block was required in 5 patients of group Chlor-30 (35%) and 2 patients of group Chlor-40 (13%) (P = 0.014), with a median (range) time for supplementation request of 40 (30-60) min. Spinal block resolution and recovery of ambulation were faster in group Chlor-30 (60 [41-98] min and 85 [45-123] min) than in groups Chlor-40 (85 [46-141] min and 180 [72-281] min) and Chlor-50 (97 [60-169] min and 185 [90-355] min) (P = 0.001 and P = 0.003, respectively), with no differences in home discharge time (182 [120-267] min in group Chlor-30, 198 [123-271] min in group Chlor-40, and 203 [102-394] min in group Chlor-50; P = 0.155). No transient neurologic symptoms were reported at 24-h and 7-day follow-up. We conclude that although 40 and 50 mg of 2-chloroprocaine provide adequate spinal anesthesia for outpatient procedures lasting 45-60 min, 30 mg produces a spinal block of insufficient duration.

Ambulatory Surgical Procedures↗
PubMed1999

Prospective, randomized comparison of epidural and combined spinal epidural analgesia during labor.

The analgesic efficacy and incidence of maternal, fetal and neonatal side-effects of combined spinal epidural (CSE) and epidural (EPI) analgesia, using a mixture of bupivacaine 0.125%, epinephrine (1.25 micrograms.ml-1) and sufentanil (0.75 microgram.ml-1) for the relief of labor pain, were randomly and prospectively compared in 110 parturients. A 29 gauge Whitacre tip spinal needle was used to perforate the dura in CSE patients. Compared to EPI, CSE resulted in rapid (326 +/- 22 vs 766 +/- 79 sec, p < 0.05), excellent analgesia, using less bupivacaine (23.5 +/- 2.3 vs 33.9 +/- 2.9 mg, p < 0.05) and sufentanil (12.5 +/- 1.0 vs 16.5 +/- .7 micrograms, p < 0.05). A tendency to improved patient satisfaction in the CSE group was observed. The incidence of maternal or neonatal side effects was similar in both groups. No PDPH was observed. We conclude that CSE analgesia results in excellent pain relief during labor with immediate gratification as compared to epidural analgesia.

Adult↗
PubMed2000

Glial-derived neurotrophic factor upregulates expression of functional SNS and NaN sodium channels and their currents in axotomized dorsal root ganglion neurons.

Dorsal root ganglion (DRG) neurons produce multiple sodium currents, including several different TTX-sensitive (TTX-S) currents and TTX-resistant (TTX-R) currents, which are produced by distinct sodium channels. We previously demonstrated that, after sciatic nerve transection, the levels of SNS and NaN sodium channel alpha-subunit transcripts and protein in small (18-30 micrometer diameter) DRG neurons are reduced, as are the amplitudes and densities of the slowly inactivating and persistent TTX-R currents produced by these two channels. In this study, we asked whether glial-derived neurotrophic factor (GDNF), which has been shown to prevent some axotomy-induced changes such as the loss of somatostatin expression in DRG neurons, can ameliorate the axotomy-induced downregulation of SNS and NaN TTX-R sodium channels. We show here that exposure to GDNF can significantly increase both slowly inactivating and persistent TTX-R sodium currents, which are paralleled by increases in SNS and NaN mRNA and protein levels, in axotomized DRG neurons in vitro. We also show that intrathecally administered GDNF increases the amplitudes of the slowly inactivating and persistent TTX-R currents, and SNS and NaN protein levels, in peripherally axotomized DRG neurons in vivo. Finally, we demonstrate that GDNF upregulates the persistent TTX-R current in SNS-null mice, thus demonstrating that the upregulated persistent sodium current is not produced by SNS. Because TTX-R sodium channels have been shown to be important in nociception, the effects of GDNF on axotomized DRG neurons may have important implications for the regulation of nociceptive signaling by these cells.

Animals↗