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PubMed1997

Differential sensory block after spinal bupivacaine in volunteers.

We performed this study to determine whether differential sensory block to touch, pinprick, and cold after spinal bupivacaine could be used to predict the dermatomal level of block to transcutaneous electrical stimulation (TES) equivalent to surgical stimulation, onset of tourniquet pain, or magnitude of hemodynamic depression. Eight subjects per group were randomized to receive 3.75, 7.5, or 11.25 mg of 0.75% bupivacaine with 8.25% dextrose in a double-blind fashion. Sensory block was assessed with touch, pinprick, cold, TES at T-12, L-2, S-1, and thigh tourniquet pain. Differential extent of sensory block to touch, pinprick, and cold occurred at the time of offset of tolerance to TES (P < 0.03) and at the time of tourniquet pain (P < 0.05). However, the extent of differential sensory block to touch, pinprick, and cold varied up to 10 dermatomes (2 SD) cephalad to block to TES and up to 7 dermatomes (2 SD) cephalad to the thigh tourniquet at the time of intolerable tourniquet pain. Sensory block to cold did not correlate with hemodynamic depression. Differential sensory block occurs after bupivacaine spinal anesthesia, but is a poor predictor for surgical anesthesia, tourniquet pain, and hemodynamic depression.

Adult↗
PubMed1999

Dose-response relationship of intrathecal morphine for postcesarean analgesia.

BACKGROUND: This series investigated the quality of analgesia and the incidence and severity of side effects of intrathecal morphine for post-cesarean analgesia administered over a dose range of 0.0-0.5 mg. METHODS: ONE hundred eight term parturients undergoing cesarean delivery at term and given spinal anesthesia were randomized to receive a single dose of intrathecal morphine (0.0, 0.025, 0.05, 0.075, 0.1, 0.2, 0.3, 0.4, or 0.5 mg). A patient-controlled analgesia (PCA) device provided free access to additional analgesics. PCA morphine use, incidence and severity of side effects, and need for treatment interventions were recorded for 24 h. Data were analyzed with analysis of variance and linear regression analysis for trends among groups. RESULTS: Patient-controlled analgesia use differed significantly between groups; PCA use was higher in the control group than in groups receiving 0.075, 0.1, 0.3, 0.4, or 0.5 mg. Twenty-four-hour PCA morphine use was 45.7 mg lower (95% CI, 4.8-86.6 mg lower) in the 0.075-mg group than the control group. There was no difference in PCA morphine use between the 0.075- and 0.5-mg groups (95% CI, 36.8 mg lower to 45.0 mg higher); despite a fivefold increase in intrathecal morphine dose, PCA morphine use remained constant. There was no difference between control and treatment groups or among treatment groups with respect to nausea and vomiting. Pruritus and the need for treatment interventions increased in direct proportion to the dose of intrathecal morphine (linear regression, P = 0.001 and P = 0.0002, respectively). CONCLUSIONS: These data indicate there is little justification for use of more than 0.1 mg for post-cesarean analgesia. For optimal analgesia, augmentation [corrected] of intrathecal morphine with systemic opioids may be necessary.

Analgesics, Opioid↗
PubMed1989

Spinal buprenorphine for postoperative analgesia after caesarean section.

Two doses of intrathecal buprenorphine for postoperative analgesia have been compared. Forty-five women undergoing elective caesarean section under spinal anaesthesia were randomly divided into three groups. Group A (controls, n = 15) received hyperbaric bupivacaine; Groups B and C received the same but with the addition of 0.03 mg or 0.045 mg buprenorphine, respectively. Patients receiving buprenorphine had a longer pain-free interval than the controls (P less than 0.01). Within the buprenorphine groups, patients receiving the higher dose had a longer effect (420 min s.d. 24) than those receiving the lower dose (173 min s.d. 31) (P less than 0.01) without any increase in side-effects.

Adult↗
PubMed2003

Differential activation of extracellular signal-regulated protein kinase in primary afferent neurons regulates brain-derived neurotrophic factor expression after peripheral inflammation and nerve injury.

To investigate the intracellular signal transduction pathways involved in regulating the gene expression of brain-derived neurotrophic factor (BDNF) in primary afferent neurons, we examined the activation of extracellular signal-regulated protein kinase (ERK) in dorsal root ganglion (DRG) neurons after peripheral inflammation and sciatic nerve transection. Peripheral inflammation induced an increase in the phosphorylation of ERK, mainly in tyrosine kinase A-containing small-to-medium-diameter DRG neurons. The treatment of the mitogen-activated protein kinase (MAPK) kinase 1/2 inhibitor U0126 reversed the pain hypersensitivity and the increase in phosphorylated-ERK (p-ERK) and BDNF in DRG neurons induced by complete Freund's adjuvant. On the other hand, axotomy induced the activation of ERK mainly in medium-and large-sized DRG neurons and in satellite glial cells. U0126 suppressed the axotomy-induced autotomy behavior and reversed the increase in p-ERK and BDNF. The intrathecal application of nerve growth factor (NGF) induced an increase in the number of p-ERK-and BDNF-labeled cells, mainly small neurons, and the application of anti-NGF induced an increase in p-ERK and BDNF in some medium-to-large-diameter DRG neurons. The activation of MAPK in the primary afferents may occur in different populations of DRG neurons after peripheral inflammation and axotomy, respectively, through alterations in the target-derived NGF. These changes, including the changes in BDNF expression, might be involved in the pathophysiological changes in primary afferent neurons.

Activating Transcription Factor 3↗
PubMed2004

[Combined spinal and epidural anesthesia for cesarean section: a retrospective study with 0.5% hyperbaric bupivacaine].

BACKGROUND: We investigated retrospectively the relationship between the intrathecal dose of 0.5% hyperbaric bupivacaine and the use of 2% mepivacaine through an epidural catheter. METHODS: Forty-nine patients undergoing cesarean section with combined spinal and epidural anesthesia (CSEA) were analyzed. They were divided into two groups; with (CSEA group) and without additional epidural injection group (spinal group). RESULTS: In the CSEA group (24 patients received 1.2 +/- 0.4 ml of 0.5% hyperbaric bupivacaine), 5-10 ml of 2% mepivacaine were required to achieve the adequate surgical anesthesia. In the spinal group (25 patients received 1.6 +/- 0.3 ml of 0.5% hyperbaric bupivacaine), cesarean section was performed without additional mepivacaine before delivery. The analgesic level and the amount of fluid infusion were similar in the two groups. However, 20% of patients in the spinal group showed hypotension (systolic blood pressure below 80 mmHg), although no patients in the CSEA group developed hypotension. The amount of ephedrine used before delivery was significantly larger in the spinal group (8.9 +/- 7.7 mg) than in the CSEA group (3.9 +/- 4.3 mg). CONCLUSIONS: Spinal anesthesia induced by 1.2 ml of 0.5% hyperbaric bupivacaine with sequential epidural block induced by 5-10 ml of 2% mepivacaine caused no hypotension during cesarean section.

Adult↗
PubMed1978

Bupivacaine in spinal anaesthesia.

A study of 400 consecutive cases of bupivacaine spinal anaesthesia is presented. The anaesthesia was for surgery on the lower abdomen or on the lower limbs. The patients' ages ranged from 19--91 years with the majority (60%) being over 60 years old. The patients were graded according to the A.S.A. (American Society of Anaesthesiologists physical status grade and 43% of the patients were graded as III or more. The duration of surgery lasted up to 3 hours yet analgesia always outlasted the surgery. The quality of analgesia achieved was assessed and in 94% of patients this was either good or perfect. No serious complications was observed but a common sequela was hypotension which was easily controlled by etilefrine (Effortil). There were a few cases of post-spinal headache but this was never severe or long lasting.

Abdomen↗
PubMed1997

[Atypical use of continuous spinal anesthesia sets].

Continuous spinal anesthesia technique with portex sets was used for treatment of neuroinfection. The patients was 43 years old woman with meningitis caused by Cryptococcus sp. suffered from chronic kidney failure, after transplantation and graft removal because of it's rejection. Effectiveness of therapy confirmed high value of CSA not only for pain treatment, but for central nervous system diseases as well.

Adult↗
PubMedDate not supplied

Experimental allergic encephalomyelitis raises betaine levels in the spinal cord of strain 13 guinea-pigs.

Chronic relapsing experimental allergic encephalomyelitis, an animal model of multiple sclerosis, was induced in Strain 13 guinea-pigs by subcutaneous injection of spinal cord homogenate and Freund's incomplete adjuvant supplemented with Mycobacterium tuberculosis. High resolution 1H NMR spectra of CNS tissue extracts indicated that the levels of choline metabolites, particularly betaine, were elevated in the spinal cord tissue, the principal site of lesion formation in this guinea-pig strain. The spectra also show that N-acetylated compounds are slightly depleted in the disease. The results are discussed in relation to the biochemical interpretation of NMR spectra obtained in vivo from patients with multiple sclerosis.

Acetylation↗