Biomedical subjects
F Magora
Publications and source records attributed to F Magora.
Historical data on the neuraxial administration of opioids.
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[Intravenous lignocaine for chronic pain: an 18-month experience].
Intravenous injection of lignocaine relieves pain in animals with experimentally induced pain, and in man, mainly those with neuropathic pain. 106 patients were treated with intravenous lignocaine during a period of 18 months (212 treatment sessions). Blood pressure, heart rate and pain scores were continuously monitored after an intravenous bolus of lignocaine, 1 mg/kg, followed by continuous infusion of lignocaine, 5 mg/kg during 1 hour. There was significant pain relief after each session in most patients, lasting from a few hours to 4 weeks. There were no significant side effects. We present 2 of our patients. Due to its simplicity, efficacy and safety, intravenous lignocaine injection is recommended for those with neuropathic pain unrelieved by other therapeutic modalities.
[The importance of acute pain units].
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Use of alfentanil for in vitro fertilization oocyte retrieval.
STUDY OBJECTIVES: To determine alfentanil levels with a specific radioimmunoassay in serum and ovarian follicular fluid. DESIGN: Observational study. SETTING: University hospital. PATIENTS: 14 ASA status I women undergoing oocyte retrieval for in vitro fertilization. INTERVENTIONS: General anesthesia was induced with alfentanil 15 micrograms/kg and midazolam 2 mg and maintained with alfentanil 0.5 mg, 60% nitrous oxide (N2O) in oxygen (O2) and midazolam up to a total of 4 mg. Oocyte retrieval was performed using a transvaginal ultrasound guided technique, 34 to 36 hours after human chorionic gonadotrophin administration. MEASUREMENTS AND MAIN RESULTS: Mean procedure time for oocyte retrieval was 18 +/- 2.4 (SEM) minutes. All patients were fully awake within 5 minutes and all patients except one were able to move from the operating table to the stretcher with minimal help. Mean total protein concentration in the follicular fluid was 3.8 +/- 0.4 mg%. Maximal serum alfentanil concentrations (Cmax) were attained 5 minutes after start of the procedure (tmax) and were 92 +/- 20 ng/ml. In contrast, alfentanil concentrations in the follicular fluid increased constantly throughout the procedure up to 8.9 +/- 0.8 ng/ml at 15 minutes. Clinical pregnancy rate was 3 of 14 patients. CONCLUSION: It is evident that during the oocyte retrieval procedure, the alfentanil concentrations in the follicular fluid are about ten-fold smaller than the serum alfentanil concentrations at the same time points. Similar pharmacokinetics have been shown when propofol was used as anesthetic. The low accumulation of alfentanil in the follicular fluid increases the attractiveness of alfentanil for anesthesia during oocyte retrieval for in vitro fertilization.
Assessment of pain threshold and pain tolerance in women in labour and in the early post-partum period by pressure algometry.
The changes in the pressure pain threshold (PPThr) and pressure pain tolerance (PPTol) in 41 parturients have been studied during the active phase of labour and in the early post-partum period. The sensitivity to pressure stimuli was examined with an electronic pressure algometer placed on the sternum during the interval between painful contractions, after extradural analgesia and 24 h after childbirth. Prior to extradural analgesia, mean (+/- SD), PPThr and PPTol were 4.9 +/- 1.6 kg 0.25 cm-2 and 6.9 +/- 1.8 kg 0.25 cm-2, respectively. Similar values were recorded 1 h after induction of the extradural block when the pain of labour was abolished. At 24 h post-delivery, a significant decrease in both PPThr and PPTol was noted (P < 0.001). The lack of influence of extradural analgesia on pressure algometry values, and the elevated sensitivity to pain in the early post-partum period, may be related to the influence of pregnancy and labour on the appreciation of pain.
Comparison between intranasal and intravenous midazolam sedation (with or without patient control) in a dental phobia clinic.
Two new modes of sedation; patient-controlled sedation (PCS) and intranasal sedation (INS) were compared with the traditional bolus intravenous sedation (BIVS) while delivering dental care to apprehensive patients in a specialized dental fear clinic. Effective sedation was evaluated in a randomized, prospective study in 42 ASA 1 and 2 patients, in a factorial design. Eighteen patients were sedated with .5% midazolam INS. Ten patients received intravenous PCS via a patient-controlled analgesia pump containing midazolam, and 14 patients received intermittent intravenous boluses of 1 mg midazolam given as needed (BIVS). Appropriate local anesthetic nerve blocks with 2% lidocaine with 1:100,000 epinephrine, and supplementary inhalation of nitrous oxide and oxygen via a nasal mask, were also given to all patients in the study. The dosage requirement with PCS was higher than that found with INS or BIVS. However, PCS produced some anxiety reduction when compared with INS and BIVS. It also reduced interfering movements during treatment more effectively than the other sedation modes. No complications were detected in any of the patients and they were able to leave the clinic within 1 hour after completion of treatment.
Bupivacaine wound infiltration in thyroid surgery reduces postoperative pain and opioid demand.
Control of postoperative pain is an important element in preventing the modification of the excitability of the dorsal horn neurons. We studied the efficacy of bupivacaine 0.5% wound infiltration for postoperative pain management following thyroid surgery. Forty consecutive ASA I-II patients, scheduled for thyroidectomy, were assigned randomly to two groups. Group I (n = 20) consisted of patients receiving bupivacaine 0.5% (10 ml) wound infiltration at the end of surgery and group II (n = 20 included patients without infiltration. The patients did not know whether the wound had been anaesthetized or not. All patients received balanced inhalational anaesthesia, including fentanyl (a total dose of up to 4 micrograms.kg-1). Postoperative pain medication included morphine IV or IM, as needed. Twenty-four hours after surgery the worst pain was recorded using a visual analogue scoring system, from 0 to 10. Twenty-four hour postoperative morphine requirement was recorded. Groups did not differ in demographic data. Pain scores significantly different in the two groups. In group I, the mean pain score was 3.7 +/- 1.6 compared with 6.9 +/- 1.7 in group II (P < 0.05). Only six patients (30%) in group I received opioids and only one of these (5%) had a pain score above 5. In comparison, 18 patients (90%) in group II received morphine during the first postoperative day. The local injection of bupivacaine corresponds to a block of the superficial branches of the cervical plexus. This study demonstrated a simple, efficient and safe way to reduce pain perception following a thyroidectomy.
[The use of nonsteroidal anti-inflammatory drugs for premedication].
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Electronic pressure algometry of deep pain in healthy volunteers.
Deep pressure pain threshold (PPT) and pressure pain tolerance (PPtol) were measured by pressure algometry at the mastoid processes, external malleoli, and sternum in 24 healthy volunteers. The algometer consisted of a force displacement transducer with a 0.25 cm2 pressure tip linked to a recorder. The rate of force application was approximately 1kg/sec/0.25cm2. High intersubject variation was noted at all sites for both PPT and PPtol. Mean PPT and PPtol values at the sternum were 5.2kg +/- 2.1 and 8.1kg +/- 2.4, respectively, and significantly higher than at the other sites. PTT did not differ significantly between the sexes or between dominant and nondominant sides. PPtol, on the other hand, was lower in the women, but significantly so only at the malleoli. On repeat examination, comparison between the mean values at each site showed no statistical differences in any instance. Pressure algometry, as used in this study in healthy subjects, proved a reliable technique for the estimation of deep PPT and PPtol values. It may possibly serve for screening the response to experimental pain in various groups of pain patients.
Dose-response effect of intrathecal alfentanil on canine lower urinary tract dynamics.
The effect of intrathecal (IT) administration of three different doses (1, 2.5, and 5 micrograms/kg) of alfentanil on lower urinary tract dynamics was examined by urodynamic studies, cystometrograms (CMG), and urethral pressure profiles (UPP) in seven anesthetized dogs. Simultaneous serum drug concentrations were determined by specific radioimmunoassay for time-response analysis. A significant dose-dependent relaxation of urethral musculature expressed by a reduction in UPP values of 41.5% and 38.4% (P < 0.03) was noted 30 min after 5 and 2.5 micrograms/kg IT alfentanil, respectively, whereas the decrease of 13.4-22% in mean CMG values was not significant. All changes in UPP and CMG returned to baseline values by 60 min. The pharmacokinetics of alfentanil from the cerebrospinal fluid to the systemic circulation were linear, i.e., dose-independent with maximal serum concentrations of 0.6, 1.4, and 3.5 ng/mL 10 min after the three respective IT doses. The low serum alfentanil concentrations and the lack of time correlation between the peak values and the changes in urinary tract activity, point to a spinally mediated mechanism. The short-lived effect of IT alfentanil on lower urinary tract dynamics and the relaxation of the bladder neck allow for unobstructed micturition pathways and may avoid urinary retention.
[Patient-controlled i.v. morphine for acute postoperative pain].
The use of patient-controlled i.v. analgesia for postoperative pain relief in 60 cases is described. 0.1% morphine was given by Bard or Graseby microprocessor. After a loading dose of 2-6 mg, the pump delivered a bolus of 0.8-1.5 mg of morphine every 8-12 min. The dosages necessary to provide good analgesia varied from 30-85 mg (mean 48). Good pain scores of 0-2 (on a scale of 5) were obtained in 92%. The method was also found satisfactory by the families and health care providers, and is highly recommended for control of postoperative pain.
[Recent aspects of post-operative pain control].
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Continuous epidural methadone treatment for cancer pain.
Seventy cancer patients suffering from visceral or somatic pain received continuous epidural methadone (EM) analgesia. Initially, 4 mg of 0.1% methadone was given three times daily. If this dose proved ineffective, it was gradually increased to 8 mg four times daily. With this regimen good pain control was obtained in 56 patients (80%). Patients continued the EM therapy for periods up to 140 days, with an average duration of 27 days. Morphine was substituted for methadone in 14 patients (20%). Four of these patients responded well and continued treatment for an average of 18 days. No serious side effects have been observed with EM. With a proper selection of patients and following strict therapy guidelines, epidural methadone is efficacious in treating cancer pain.
[Fentanyl vs alfentanil anesthesia for in vitro fertilization].
In a prospective double-blind study, 36 women undergoing ultrasonically guided oocyte retrieval for in vitro fertilization (IVF) were examined. Anesthesia in 19 was based on alfentanil, up to 0.025 mg/kg and in 17, fentanyl, 0.0025 mg/kg. There were no significant differences between groups with regard to age, weight, duration of procedure and pregnancy rate. There were no complications aside from nausea and vomiting. Amnesia for the puncture and analgesia were always perfect. Induction was significantly shorter for alfentanil, 1.3 +/- 0.7 min, than for fentanyl, 3.4 +/- 2.2 (p less than 0.01). All who received fentanyl were drowsy at the end of the procedure, while those in the alfentanil group were fully awake and able to move from operating table to stretcher with minimal help. We therefore recommend alfentanil as the base for anesthesia for IVF.
[Epidural injection during treatment with aspirin and other non-steroidal anti-inflammatory drugs--a protocol].
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[Problems raised by the administration of a peridural block in patients receiving anticoagulant therapy].
More and more patients likely to get an epidural block are treated with anticoagulant or antiplatelet drugs. An epidural hematoma may be consecutive to an injury of the epidural venous plexus. The mechanisms of action of the different drugs are reviewed. The bleeding time is not an infallible indication of aspirin or other non steroidal antiinflammatory drugs platelet defect. The protocol used in our institution for the administration of an epidural block in this group of patients is discussed.
[The use of 0.5% bupivacaine by infiltration for analgesia during thyroidectomies].
We studied the postoperative analgesia in 25 patients scheduled for a thyroidectomy or a parathyroidectomy. In 15 patients we used wound infiltration of bupivacaine 0.5%. In both groups we compared the pain score and the analgesic drugs administered after the surgery, within the first 24 hours. We found that wound infiltration is a very efficient way to prevent and to treat the postoperative pain.