分娩镇痛的临床观察

目的 探讨布比卡因硬膜外自控镇痛和罗湃卡因蛛风膜下腔－硬膜外自控镇痛用于分娩的效果及对产程、母婴的影响。方法 ９０例初产妇分为３组,布比卡因硬膜外自控镇痛组（Ａ组,ｎ＝３０）、罗哌卡因蛛网膜下腔－硬膜外自控镇痛组（Ｂ组,ｎ＝３０）和对照组（Ｃ组,ｎ＝３０,未行分娩镇痛）,观察各组镇痛效果、产程时间、分娩方式血清皮质醇及新生儿Ａｐｇａｒ评分情况。结果 Ａ,Ｂ组镇痛效果满意,以Ｂ组为佳两组 产程未血清     

Etodolac in the management of pain: A clinical review of a multipurpose analgesic

Etodolac is a non-steroidal anti-inflammatory drug with analgesic properties. Its primary anti-inflammatory mechanism of action is through a selective effect on cyclo-oxygenase-2 (COX-2). It is rapidly absorbed after oral administration, and maximum plasma concentration (C_max) is reached in 1-2 h, with an elimination half-life (t1/2 ) of 6-8 h. Etodolac has been widely applied in the treatment of inflammatory arthritides such as rheumatoid arthritis, ankylosing spondylitis and gout and in osteoarthritis and has been shown to be efficacious and well tolerated. However, etodolac has other applications which rely primarily on its efficacy as an analgesic. In particular, etodolac has been evaluated in the treatment of a variety of different pain states. Etodolac has been observed to be efficacious in the treatment of acute pain following dental extraction, orthopaedic and urological surgery, and episiotomy, as well as in the treatment of pain due to acute sports injuries, primary dysmenorrhoea, tendonitis, bursitis, periarthritis, radiculalgia and low back pain. These studies indicate that etodolac is a multipurpose analgesic with many clinical applications in addition to its use in the treatment of inflammatory and degenerative forms of arthritis.     

Oligogenic determination of morphine analgesic magnitude: A genetic analysis of selectively bred mouse lines

Two ongoing selective breeding projects have produced mice that display divergent analgesic responses to morphine. These two projects have selected for similar phenotypes: high and low levorphanol analgesia (HAR/LAR lines; Portland, OR) and high and low swim stress-induced analgesia (HA/LA lines; Jastrzebiec, Poland). Evidence suggests genetic commonalities between mice of the two projects. Using a Mendelian breeding protocol, we have recently found that one or two genetic loci predominantly determine the high morphine analgesia exhibited by HA mice. In the present study we demonstrate that the differential morphine analgesia (5 mg/kg. i.p.) displayed by HAR and LAR mice is similarly oligogenic, predominantly determined by two unlinked loci. A complementation analysis, in which the analgesic responses to morphine of the recessive homozygotes of each project (HAR and HA) were compared to those of their hybrid offspring (HAR x HA), revealed that different genetic loci have been fixed in each project. An intriguing bimodal distribution was observed in the HAR x HA population: Some HAR x HA hybrids displayed greater morphine analgesia than either HAR or HA mice, whereas others displayed minimal analgesia. LAR x LA hybrids displayed less analgesia than either LAR or LA mice. The analgesic responses of HAR x LA and LAR x HA mice were comparable to those of their low-line parents. These findings indicate not only that different loci were responsible for producing high morphine responders in each selection project but that these distinct loci can interact synergistically to produce superhigh and superlow responders.     

食管癌术后一次性硬膜外注射和肌肉注射镇痛法的比较

目的：确定硬膜外一次性镇痛法对食管癌病人术后的镇痛效果和减少并发症的意义。方法：９３ 例病人随机分成实验组（ Ｔ 组,５１ 例） 和对照组（ Ｃ 组,４２ 例） , Ｔ 组于手术结束缝合皮肤切口时经硬膜外导管于 Ｔ６ － ７ 水平注射吗啡１ ｍｇ 加１ ％ 普鲁卡因１０ ｍｌ, Ｃ 组用阿片类药物肌肉注射镇痛。结果： Ｔ 组病人术后疼痛明显减轻,各种并发症显著下降。结论：硬膜外一次性镇痛效果确切,操作方便,副作用少,对降低术后心肺并发症很有意义,尤其对年龄大、心肺功能差的病人较适合。     

麻黄素并吗啡硬膜外注射的术后镇痛效果

①目的　探讨麻黄素并吗啡硬膜外注射的术后镇痛效果。②方法　对１２６ 例泌尿外科开放手术后的病人进行间断硬膜外腔注射吗啡（２ｍ ｇ）、麻黄素（２０ｍ ｇ）,观察其镇痛效果,并与４０ 例单用吗啡（ ２ｍ ｇ）者进行对照。③结果　吗啡、麻黄素的镇痛作用强而持久,一次用药有效时间为（２８．４±３．５）ｈ,较对照组的（１８．１±２．６）ｈ 明显延长（ｔ＝ １７．１,Ｐ＜ ０．０１）。未见出现血压波动者。④结论　吗啡加麻黄素硬膜外腔注射是安全、长效的术后镇痛方法,特别适用于术后留置导尿或尿流改道的泌尿外科开放手术。     

Postoperative nausea and vomiting in children using patient-controlled analgesia: the effect of prophylactic intravenous dixyrazine

BACKGROUND: Although patient-controlled analgesia (PCA) with morphine provides a high degree of satisfactory postoperative analgesia in children, it is often associated with a high incidence of postoperative nausea and vomiting (PONV). Our aim in this study was to evaluate the prophylactic effect of dixyrazine, a phenothiazine with proven anti-emetic properties. METHODS: The incidence of nausea and vomiting was studied in 60 children using PCA after major surgery. The patients were randomised to receive either dixyrazine 0.25 mg kg-1 or placebo on the induction of anaesthesia in a double-blind, placebo-controlled design. The anaesthetic technique was standardised. The PCA pump was programmed to deliver bolus doses of morphine of 20 micrograms kg-1 with a continuous background infusion of 8-10 micrograms kg-1 h-1. Nausea, vomiting, sedation and pain scores were noted every 3 h for a period of 24 h. RESULTS: The morphine consumption of morphine was the same in both groups. During the stay in the recovery room the incidence of vomiting was 3% in the dixyrazine group compared to 30% in the placebo group (P < 0.05). On the ward, 57% versus 83% of the children vomited (P < 0.05). Rescue antiemetics were significantly lower, 30%, in the dixyrazine group compared to 60% in the placebo group (P < 0.05). Higher sedation scores were recorded for the dixyrazine group in the recovery room. No other adverse effects were found. CONCLUSION: A significant number of children using PCA with morphine after major surgery experience PONV. Although prophylactic dixyrazine reduces the incidence and severity of vomiting, the incidence still remains high.     

Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty

BACKGROUND: After total knee arthroplasty, patients regularly suffer from severe pain. It is unclear whether epidural or systemic pain therapy is superior in terms of postoperative pain relief, patients' comfort and side effects. A new therapeutic approach, intraarticular opioids, has been suggested with the detection of opioid receptors in inflamed tissue. This method has proven suitable for clinical use in small operations (e.g. knee arthroscopy). In this study, we compared epidural analgesia and intraarticular application of morphine plus "on-demand" intravenous analgesia to "on-demand" intravenous analgesia alone. METHODS: Thirty-seven patients, scheduled for total knee arthroplasty, were randomly assigned to three treatment groups: in group 1 (EPI) patients received bolus doses of morphine via an epidural catheter; in group 2 (IA) an intraarticular bolus of 1 mg of morphine was applied at the end of the operation with subsequent use of a patient-controlled analgesia (PCA) pump; group 3 (Control), in which only PCA was provided, served as control for both analgesic procedures. Main outcome measures included visual analogue pain scales, total morphine consumption, and stress hormones. RESULTS: No statistically significant differences in visual analogue pain scales could be detected between the three groups. Application of intraarticular morphine did not reduce the amount of analgesics required for postoperative analgesia as compared to intravenous analgesia alone. Application of epidural morphine significantly suppressed beta-endorphine release, but did not significantly influence other stress hormones as compared to the control group. CONCLUSION: Epidural and intravenous analgesia after total knee arthroplasty are equivalent methods of pain relief. In major orthopaedic procedures, application of intraarticular morphine does not reduce analgesic requirements.     

Postoperative Pain Therapy After Lumbar Disc Surgery

Summary  Object. This study was undertaken to determine whether a special postoperative pain administration of tramadol and diclofenac provides any benefits in patients who underwent microsurgical lumbar discectomy.  Methods. The study consisted of 60 patients undergoing microsurgical lumbar discectomy. Patients were randomly divided into two groups based on the postoperative pain management: 1) Group A (n=30): no standardized pain therapy; these patients received on demand different analgesics and at variable dosages which were selected by the neurosurgeons; 2) Group B (n=30): standardized pain therapy with specific dosages of tramadol and diclofenac in regular time intervals during the first 48 hours after surgery. After surgery follow-up data from a special standardized questionnaire were obtained for all 60 patients during the first 48–72 postoperative hours. The patients were asked for course and intensity of pain as well as about some specific circumstances of clinical therapy after surgery.  The postoperative pain intensity of patients treated with the special combination of tramadol and diclofenac was significantly diminished (24 hours after surgery: p=0.0002, 48 h: p=0.0047, 72 h: p=0.0034) in relation to the group without standardized pain therapy. Similarly, the frequency of breakthrough pain was significantly reduced (24 h: p=0.0001, 48 h: p=0.003, 72 h: p=0.004).  Conclusions. The results suggest that the application of tramadol and diclofenac during the first 48 hours after lumbar microdiscectomy results in a reduction in postoperative pain without complications. We suggest that the use of this combination can be a beneficial adjunct to lumbar disc surgery.     

Post-operative pain and inflammatory reaction reduced by injection of a corticosteroid

Summary In a controlled crossover study, identical surgical procedures, the prophylactic removal of bilateral non-erupted 3rd molar teeth, were performed on two separate occasions in 24 healthy patients. Prior to each procedure, either betamethasone 9 mg (Celeston Chronodose^®) or placebo was administered intramuscularly, in a randomized fashion. Objective and subjective assessments were recorded for paired comparison of the post-operative course, including swelling, pain, trismus, local temperature, bleeding, wound-healing and preference for treatment. In 23 patients, less swelling occurred when betamethasone was given pre-operatively. The mean reduction on the 3rd and 6th post-operative days was 55% (p<0.001) and 69% (p<0.001), respectively. Pain assessments (visual analogue scale) were significantly lower after the corticosteroid injection; mean response: 1st evening 17 vs 56 mm, 2nd evening 5 vs 37 mm, and 3rd evening 2 vs 13 mm. No significant correlation between the steroid-induced reduction in swelling and pain could be made. This may indicate that dissociation may exist between pain and other inflammatory events like swelling. No clinically apparent infection or other disturbance of wound-healing was noted after corticosteroid administration. This treatment course was preferred by 23 of the 24 patients.     

Clonidine antinociceptive activity: Effects of drugs influencing central monoaminergic and cholinergic mechanisms in the rat

Summary Clonidine is able to increase the threshold for vocalisation during stimulation and the threshold for vocalisation after withdrawal of stimulus (vocalisation afterdischarge). These effects of clonidine were investigated after treatment of rats with drugs influencing central monoaminergic and cholinergic mechanisms.Chlorpromazine, atropine and p-chlorophenyl-alanine increased the activity of clonidine at both thresholds while phenoxybenzamine and reserpine pretreatment increased the activity at the threshold for vocalisation only.Yohimbine decreased clonidine activity at both thresholds while 5-HTP and -methyl-p-tyrosine decreased the effects at the threshold for vocalisation afterdischarge. Naloxone did not change the activity of clonidine at either pain response studied.It is concluded from the present findings that influence from several neuronal systems modulate the antinociceptive action of clonidine.The inhibition of the medullary nociceptive response after clonidine might be connected to a decreased activity of noradrenergic neurons. Endogenous noradrenaline seems to be of minor importance in mediating this effect. It is moreover shown that decreased cholinergic receptor activity enhances clonidine antinociceptive action on both medullary and diencephalic-rhinencephalic pain responses. The possible involvement of serotonin in these functional responses after clonidine is also discussed.Data from this investigation was presented at the International Narcotic Research Club Conference, Airlie, Va. 1975.