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Cai H, Zhou Q, Bao G, Kong X, Gong LY. Transcutaneous electrical nerve stimulation of acupuncture points enhances therapeutic effects of oral lactulose solution on opioid-induced constipation. J Int Med Res 2019; 47:6337-6348. [PMID: 31774002 PMCID: PMC7045659 DOI: 10.1177/0300060519874539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the therapeutic effects of transcutaneous electrical nerve stimulation (TENS) on opioid-induced constipation (OIC) and patient quality of life. Methods A total of 251 patients were randomly allocated to a treatment group, who received TENS and oral lactulose solution (n = 124), and a control group, who received only oral lactulose solution (n = 127). Constipation and quality of life after treatment were measured by comparing semiquantitative scores based on subjective symptoms. Results The defecation difficulty, incomplete defecation feeling, and overall defecation satisfaction scores of the treatment group were significantly different from those of the control group ( P = 0.018). Bowel Function Index and quality of life scores of the treatment group were significantly greater than those of the control group. The effective rates of control and treatment groups were 85.8% and 91.9%, respectively. Conclusion TENS of relevant acupuncture points significantly relieved the clinical symptoms of constipation of patients with OIC and improved their quality of life.
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Affiliation(s)
- Hu Cai
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qinfei Zhou
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Guanai Bao
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiangming Kong
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Li-Yan Gong
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
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Dhar D, Poree LR, Yaksh TL. Evolution of the Spinal Delivery of Opiate Analgesics. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gatson BJ, Garcia‐Pereira FL, James M, Carrera‐Justiz S, Lewis DD. Use of a perfusion index to confirm the presence of sciatic nerve blockade in dogs. Vet Anaesth Analg 2016; 43:662-669. [DOI: 10.1111/vaa.12378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022]
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Bansal A, Gupta S, Sood D, Kathuria S, Tewari A. Bier's block using lignocaine and butorphanol. J Anaesthesiol Clin Pharmacol 2011; 27:465-9. [PMID: 22096277 PMCID: PMC3214549 DOI: 10.4103/0970-9185.86580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Opioids are most commonly used as adjuncts in intravenous regional anesthesia (IVRA) to improve the quality of intraoperative and postoperative analgesia. There is paucity of literature on the use of butorphanol in IVRA. AIMS The aim of this study was to evaluate the likely benefits of addition of butorphanol to lignocaine in Bier's block in terms of onset and duration of sensory block and also for analgesic requirement in postoperative period. SETTINGS AND DESIGN A randomized double blind study was conducted at Tertiary Care Educational Institute. PATIENTS AND METHODS A total of 40 adult ASA I or II patients scheduled to undergo upper limb surgery were randomized in two groups (n=20). Group I received 3 mg/kg of lignocaine alone and group II received 1 mg butorphanol in addition to 3 mg/kg lignocaine. Sensory block onset time and time to recovery from sensory block after tourniquet deflation were noted using the pin prick method. Duration of postoperative analgesia was noted using a visual analogue scale. All the patients were compared for the time to first rescue analgesic consumption and total analgesic consumption in first 24 hours postoperatively. STATISTICAL ANALYSIS USED The statistical analysis was done using unpaired Student's t-test. RESULTS Our study showed significant prolongation of postoperative analgesia in group II as noted by the time to first analgesic requirement. Total analgesic consumption in first 24 hours postoperatively was less in group II. Sensory block onset time and time to recovery from sensory block after tourniquet deflation, did not show any significant difference between the two groups. CONCLUSIONS Addition of butorphanol to lignocaine in IVRA significantly prolongs the duration of postoperative analgesia and 24 hours analgesic consumption is less in patients receiving butorphanol along with lignocaine in IVRA. However, there is no effect on sensory block onset time and time to recovery from sensory block.
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Affiliation(s)
- Abhishek Bansal
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, India
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Kimberger O, Kurz A. Thermoregulatory management for mild therapeutic hypothermia. Best Pract Res Clin Anaesthesiol 2009; 22:729-44. [PMID: 19137813 DOI: 10.1016/j.bpa.2007.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In recent years the use of mild therapeutic hypothermia as a means of neuroprotection has become an important concept for treatment after cerebral ischemic hypoxic injury. Mild therapeutic hypothermia has been shown to improve outcome after out-of-hospital cardiac arrest, and many studies suggest a beneficial effect of mild therapeutic hypothermia on patient outcome after traumatic brain injury, cerebrovascular damage and neonatal asphyxia. This review article explores the numerous possibilities and methods for the induction of mild therapeutic hypothermia, reviews thermoregulatory management during maintenance and discusses associated risks and complications.
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Affiliation(s)
- Oliver Kimberger
- Department of Anaesthesiology, General Intensive Core and Pain Medicine, Medical University of Vienna, Austria.
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Derossi R, Medeiros U, de Almeida RG, Righetto FR, Frazílio FO. Meperidine prolongs lidocaine caudal epidural anaesthesia in the horse. Vet J 2007; 178:294-7. [PMID: 17892957 DOI: 10.1016/j.tvjl.2007.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/24/2007] [Accepted: 08/02/2007] [Indexed: 11/20/2022]
Abstract
The aim of the study was to evaluate and compare the effects of caudal epidural administration of meperidine (MP), lidocaine (LD), and a combination of the two (MPLD) in six mature saddle horses. Horses were randomly assigned to receive three treatments (MP 0.3 mg/kg; LD 0.2 mg/kg; and MPLD: MP 0.3 mg/kg and LD 0.2 mg/kg), with at least 1 week between treatments. Drugs were injected into the epidural space between the first and second coccygeal areas in conscious standing horses. Analgesia, ataxia, sedation, cardiovascular and respiratory effects, and rectal temperature were recorded at different intervals before (baseline) and after administration. Epidural administration of MPLD resulted in a longer duration of analgesia of the tail, perineum, and upper hind limb regions than did administration of MP or LD alone.
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Affiliation(s)
- Rafael Derossi
- Department of Veterinary Medicine, Surgery and Anaesthesiology, Faculty of Veterinary Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
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Haeseler G, Foadi N, Ahrens J, Dengler R, Hecker H, Leuwer M. Tramadol, fentanyl and sufentanil but not morphine block voltage-operated sodium channels. Pain 2006; 126:234-44. [PMID: 16949748 DOI: 10.1016/j.pain.2006.07.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Revised: 05/30/2006] [Accepted: 07/06/2006] [Indexed: 11/16/2022]
Abstract
Lidocaine-like sodium channel blocking drugs provide pain relief either by interrupting impulse conduction in neurons when applied locally in high concentrations or, when given systemically, by suppressing high-frequency ectopic discharges due to preferential drug binding to inactivated channel states. Lidocaine-like actions of opioids have frequently been demonstrated clinically. However, drug binding to resting and inactivated channel conformations has been studied systematically only in the case of meperidine. The aim of this in vitro study was to investigate the effects of four currently used opioids on heterologously expressed neuronal (NaV(1.2)) voltage-gated sodium channels. Block of sodium currents was studied at hyperpolarized holding potentials and at depolarized potentials inducing either fast- or slow-inactivation. Sufentanil, fentanyl and tramadol but not morphine reversibly suppressed sodium inward currents at high concentrations (half-maximum blocking concentrations (IC50) 49+/-4, 141+/-6 and 103+/-8 microM) when depolarizations were started from hyperpolarized holding potentials. Short depolarizations inducing fast-inactivation and long prepulses inducing slow-inactivation significantly (*p < or = 0.001) increased the blocking potency for these opioids. 15% slow inactivated channels reduced the respective IC50 values to 5+/-3, 12+/-2 and 21+/-2 microM. These results show that: (1) Sufentanil, fentanyl and tramadol block voltage-gated sodium channels with half-maximum inhibitory concentrations similar to the IC50 reported for meperidine. (2) Slow inactivation--a physiological mechanism to suppress ectopic activity in response to slow shifts in membrane potential--increases binding affinity for sufentanil, fentanyl and tramadol. (3) Morphine has no such effects.
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Paris A, Ohlendorf C, Marquardt M, Bein B, Sonner JM, Scholz J, Tonner PH. The Effect of Meperidine on Thermoregulation in Mice: Involvement of ??2-Adrenoceptors. Anesth Analg 2005; 100:102-106. [PMID: 15616061 DOI: 10.1213/01.ane.0000139355.86522.d1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Meperidine has potent antishivering properties. The underlying mechanisms are not fully elucidated, but recent investigations suggest that alpha2-adrenoceptors are likely to be involved. We performed the current study to investigate the effects of meperidine on nonshivering thermogenesis in a model of thermoregulation in mice. After injection (0.1 mL/kg intraperitoneally) of saline, meperidine (20 mg/kg), the specific alpha2-adrenoceptor antagonist atipamezole (2 mg/kg), plus saline or atipamezole plus meperidine, respectively, mice were positioned in a Plexiglas chamber. Rectal temperature and mixed expired carbon dioxide were measured after provoking thermoregulatory effects by whole body cooling. Maximum response intensity of nonshivering thermogenesis and the thermoregulatory threshold for nonshivering thermogenesis, which was defined as the temperature at which a sustained increase in expiratory carbon dioxide can be measured, were investigated. Meperidine significantly decreased the threshold of nonshivering thermogenesis (36.6 degrees C +/- 0.7 degrees C) versus saline (37.9 degrees C +/- 0.6 degrees C) and versus atipamezole plus saline (37.8 degrees C +/- 0.4 degrees C; P <0.01). This effect was abolished after administration of meperidine combined with atipamezole (37.7 degrees C +/- 0.6 degrees C; P <0.05). Meperidine did not decrease the maximum intensity of nonshivering thermogenesis. The results suggest a major role of alpha2-adrenoceptors in the inhibition of thermoregulation by meperidine in mice.
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Affiliation(s)
- Andrea Paris
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; *Department of Anesthesia, University of California, San Francisco, California
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Khaw KS, Ngan Kee WD, Critchley LA. Epidural meperidine does not cause hemodynamic changes in the term parturient. Can J Anaesth 2000; 47:155-9. [PMID: 10674510 DOI: 10.1007/bf03018852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Meperidine has local anesthetic properties and, therefore, when given epidurally it has the potential to cause hemodynamic changes. Our objective was to study the hemodynamic effects of an analgesic dose of epidural meperidine (50 mg) in 34 ASA 1-2 term parturients scheduled for elective Cesarean section under epidural anesthesia. METHODS A lumbar epidural catheter was inserted and patients lay in the supine left wedge position. Intravenous fluid preload was withheld, and hemodynamic measurements comprising of mean arterial pressure, cardiac output and heart rate were made using automatic oscillotonometry (Dinamap 1486SX) and transthoracic electrical bioimpedance (Bomed NCCOM3). Following baseline measurements, the hemodynamic effects of sequential epidural injection of first, 10 ml saline, and 20 min thereafter, 50 mg meperidine diluted to 10 ml with saline, were recorded. Sensory blockade was assessed following each injection using loss of temperature discrimination to ice. Paired Student t tests were used to compare changes in hemodynamic variables. RESULTS Epidural meperidine produced a small increase from the saline values in the mean (SD) cardiac output of 5.81 +/-1.44 to 6.04+/-1.54 L x min(-1) (P<0.05), and mean arterial pressure of 77.1+/-8.8 to 79.3+/-9.9 mm Hg (P<0.05). Sensory changes, the upper level of which ranged from L1 to T1, were detected in 94% of patients given epidural meperidine. Epidural saline injection had no such hemodynamic effects, but produced a detectable sensory level in two patients. CONCLUSION Epidural meperidine, 50 mg, caused minimal hemodynamic changes in term parturients.
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Affiliation(s)
- K S Khaw
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Peoples Republic of China.
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Fernandez-Galinski SM, Monells J, Espadaler JM, Pol O, Puig MM. Effects of subarachnoid lidocaine, meperidine and fentanyl on somatosensory and motor evoked responses in awake humans. Acta Anaesthesiol Scand 1996; 40:39-46. [PMID: 8904258 DOI: 10.1111/j.1399-6576.1996.tb04386.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although the effects of local anaesthetics (LA) on motor and sensory transmission in the spinal cord have been described, the effects of opioids are controversial. Our aim was to evaluate the action of clinically relevant doses of subarachnoid (SA) meperidine (MP) and fentanyl (FN), on somatosensory (SSEP) and cortical motor evoked responses (CMER) in awake subjects. Thirty ASA I-II patients scheduled for infra umbilical surgery received SA (N = 10/group): 1 mg/kg lidocaine (LD), 1 mg/kg MP or 25 mu g FN. SSEP elicited by stimulation of the posterior tibial nerve at the ankle, and cortical motor evoked response at rest (r-CMER) and during facilitation (f-CMER) were obtained prior and 30 min after treatment. Conduction at the proximal segment of the motor nerve (F-wave) was evaluated by stimulation of the posterior tibial nerve at the popliteal fossa. Motor/sensory block and side effects were clinically assessed. LD completely abolished SSEP and CMER. At the same dose, MP abolished SSEP in 40% of the patients, while r-CMER and f-CMER were absent in 70% and 30%, respectively; in addition, the F-wave was absent in 50% of the patients. Fentanyl induced small changes in the latencies of SSEP and F-wave; however, a 28% decrease in the amplitude of the f-CMER (P<0.05) was observed. Pruritus was present in 60% of patients in the FN group (P<0.006). Our results show that while LD and MP block sensory and motor conduction at the spinal roots, FN seems to decrease the excitability of the spinal interneurons in the corticospinal tract.
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