Articles: analgesia.
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The ATP-gated K(+) channel openers diazoxide, levcromakalim and morphine induce cell hyperpolarization by opening the K(+) channels and enhancing K(+) efflux. This hyperpolarization decreases intracellular Ca(2+) levels, lessening neurotransmitter release thus leading to antinociception. ⋯ Antisense to all three opioid receptors attenuated the effect of diazoxide, suggesting that diazoxide is inducing the release of endogenous opioids activating the mu(MOR-1)-, delta(DOR-1)-, and kappa(KOR-1)-opioid receptors. Antisense to the mu-opioid receptor clone and delta-opioid receptor clone attenuated levcromakalim-induced antinociception, indicating that endogenous opioids acting at the mu- and delta-opioid receptors are potential candidates for the mediation of the antinociceptive effects of levcromakalim.
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Clinical Trial Controlled Clinical Trial
Intrathecal neostigmine and sufentanil for early labor analgesia.
Recent efforts to improve the combined spinal epidural (CSE) technique have focused on adding opioids to other classes of analgesics. In this study, the authors used intrathecal neostigmine in combination with intrathecal sufentanil to investigate the usefulness of neostigmine for reducing side effects and prolonging the duration of sufentanil. ⋯ The 10-microg intrathecal neostigmine dose alone produced no analgesia or side effects, but reduced the ED50 of intrathecal sufentanil by approximately 25%. Additionally, doses approximately double these ED50s each produced a similar duration of analgesia and side effects, indicating intrathecal neostigmine shifts the dose-response curve for intrathecal sufentanil to the left.
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Southern medical journal · Nov 1999
Epidural analgesia provided during labor by obstetricians: outcome analysis.
Epidural analgesic has been given during labor by attending obstetricians at Minden Medical Center since 1976. This outcome analysis was done to determine the frequency, effectiveness, and complications of epidural analgesia from January 1, 1993 through December 31, 1995. ⋯ Obstetricians at this hospital provided epidural analgesia for a high percentage (91.8%) of patients in labor. Adequate pain relief was obtained in 94.8% of the patients who received epidural analgesia. No serious complications occurred.
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We relate the experience of 506 consecutive deliveries under epidural analgesia in the same hospital, by the same obstetrician (JSS). 336 patients delivered without epidural analgesia during the same period. In the epidural group (n = 506), 93 patients had a normal spontaneous vaginal delivery, 357 had a low forceps, 22 had a mid-forceps, 4 had an assisted breech extraction, and 30 delivered by cesarean section. There were 24 cases (out of 506) of significant hypotension; all of them responded to an intravenous bolus of ephedrine. ⋯ Eleven newborns in the epidural group had one-minute Apgar scores between 4 and 6, but they all had excellent Apgar scores at five minutes. None had a one-minute Apgar score below 4. We conclude that epidural analgesia is a safe and highly effective method of pain relief during labor.