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Biomedical subjects

J Chrubasik

Publications and source records attributed to J Chrubasik.

At least 37 records · Page 2Linked to original sources
PubMed1993

Non-opioid peptides for analgesia.

Amongst the spinal peptide candidates believed to be involved in the mediation of analgesia, only somatostatin fulfills the criterium of a real analgesia substance. Spinal somatostatin specifically blocks the transmission of painful stimuli. Spinal calcitonin may lower the opioid dose requirement in patients with bone metastases but it fails to relieve acute pain. The usefulness of ACTH and CRF for treatment of pain remains to be established. The role of CCK-8, vasopressin and neurotensin is unclear. The contradictory findings on antinociception using simple rodent withdrawal reflex tests (e.g. the tail flick test), or more complex behavioral tests in which supraspinal sensory processing is involved, (e.g. the hot plate test), indicate that these tests are inappropriate when neuropeptides are employed. Furthermore, due to their inability to predict analgesia in humans, they do not fulfill the guidelines proposed by the IASP that animal test procedures have to be for the benefit of humans.

Analgesia↗
PubMed1992

Intravenous tramadol for post-operative pain--comparison of intermittent dose regimens with and without maintenance infusion.

Thirty-five ASA Grade I-II females received tramadol 150 mg intravenously followed randomly and double-blind by an infusion of either tramadol 15 mg h-1 (Group I) or saline (Group II) and tramadol 100 mg bolus on demand for the treatment of post-operative pain. Patients in Group I required 60% less tramadol on demand (P less than 0.01) and had better pain relief after operation (P less than 0.05) than those in the group given saline. Total tramadol consumption, however, was about 30% higher in Group I (P less than 0.05) and was associated with an increased incidence of minor side-effects. In both groups median serum tramadol concentrations peaked at 15 and 60 min and decreased after the second peak steadily (P less than 0.001). Tramadol failed to relieve pain within 2 h after the beginning of treatment in 6% (Group I) and 20% (Group II) of the patients. It is suggested that use of an i.v. maintenance tramadol infusion in addition to on-demand i.v. tramadol boluses is a safe and recommended mode of post-operative intravenous pain therapy.

Adult↗
PubMed1990

Plasma concentrations of methadone during postoperative patient-controlled extradural analgesia.

Plasma concentrations of methadone were measured by gas chromatography in 16 patients receiving extradural methadone by continuous infusion for relief of postoperative pain. Venous blood samples were taken after a loading dose of extradural methadone 2 mg and during infusion of 0.46 mg h-1 plus patient-controlled increments of 0.2-1 mg. Mean (SD) plasma concentration of methadone was 9.8 (2.1) ng ml-1 at 15 min; this did not change significantly during the first 2 h, after which it increased gradually to 32.2 (4.6) ng ml-1 (P less than 0.001) at the end of 24 h. The mean quantity of extradural methadone required to produce effective analgesia was 10.3 (1.8) mg during the first 12 h after operation and 6 (1.0) mg for the subsequent 12 h. The mean amount of methadone for effective analgesia on the second day was 7.6 (1.1) mg. No adverse effects were detected during the 2-3 days of methadone therapy. Plasma concentration of methadone increased significantly during patient-controlled infusion of extradural methadone in the first 24 h after operation, suggesting rapid vascular uptake. Systemic activity of the drug contributes to the analgesic effect of extradural methadone.

Adult↗
PubMed1989

Spread of analgesia and ventilatory response to carbon dioxide following epidural somatostatin.

The effects of somatostatin, injected into the epidural space, on analgesia and control of ventilation were studied in 25 patients aged 41 +/- 9 yrs (mean +/- SD). The patients were allocated to three groups to receive: Group I--1 mg of somatostatin in 2 ml saline (n = 13); Group II--1 mg of somatostatin in 10 ml saline (n = 6); and Group III--somatostatin in a loading dose of 250 micrograms followed by an infusion of 125 micrograms h-1 (n = 6). Segmental cutaneous analgesia, assessed by pinprick, without loss of thermal sensibility or motor blockade was found in all patients. Onset times and durations of analgesia were 15 +/- 2 min and 69 +/- 19 min (mean +/- SD) in Group I and 14 +/- 2 min and 68 +/- 11 min in Group II. The extent of dermatome analgesia at 30 min and 60 min after somatostatin injection, respectively, was: T6 +/- 2 to T12 +/- 1, T4 +/- 2 to L1 +/- 2 in Group I, and T7 +/- 3 to L1 +/- 3, T3 +/- 1 to T12 +/- 2 in Group II. Continuous analgesia with onset of 16 +/- 2 min and extending from T7 +/- 1 to T12 +/- 1 was observed in Group III. No side-effects were observed. The control of ventilation studies in eight patients in Group I by the Read's rebreathing method did not show any significant change.

Adult↗
PubMed1988

Absorption and bioavailability of nebulized morphine.

During anaesthesia seven patients received a bolus of morphine 10 mg injected into the nebulization reservoir placed between the tracheal tube and the anaesthetic circle (IH). Five days after operation the same seven patients received morphine 10 mg i.m. On both occasions, venous blood samples were taken before and every 15 min after administration over 4.5 h for measurement of free morphine immunoreactivity by radioimmunoassay. There was marked individual variation in the serum morphine concentrations produced following each route of administration. The maximum serum morphine concentration following inhaled morphine was approx. six times lower than that after morphine i.m. and the time of occurrence differed significantly (P less than 0.001). The individual relative bioavailabilities of inhaled morphine varied from 9% to 35%, with a mean of 17%.

Absorption↗
PubMed1987

Continuous intraventricular morphine- or peptide-infusion for intractable cancer pain.

The continuous intraventricular administration of small daily doses of morphine by means of an implantable pump is an effective method of obtaining considerable pain reduction for patients suffering from otherwise untractable carcinoma pain. We consider this method of treatment to be an excellent alternative to the epidural and intrathecal application. Particularly in cases with obstruction of the spinal canal or in cases suffering from untractable pain in the face, neck or upper thoracic area. During the period of treatment, none of the patients involved in the study developed tolerance to morphine or specific opiate side effects. The programmable pump allows precise dosage which is adjusted to the requirements of the individual patient. The high cost of a pump is a justifyable investment in patients in good general condition with a life expectancy longer than 3 months. In most cases the patient may be cared for at home, making further hospitalization unnecessary.

Adult↗
PubMed1987

Continuous-plus-on-demand epidural infusion of buprenorphine versus morphine in postoperative treatment of pain. Postoperative epidural infusion of buprenorphine.

In a randomized, double-blind study, buprenorphine was compared with morphine in the treatment of pain after major abdominal operations by means of continuous-plus-on-demand epidural infusion for constant analgesia. The patients received bolus epidural injections of 0.15 mg buprenorphine or 2 mg morphine-HCl prior to an on-demand epidural infusion of 0.03% buprenorphine or 0.25% morphine HCl at a basal rate of 0.06 ml/h. Over 50 h, mean buprenorphine consumption was 0.85 +/- 0.08 mg, and mean morphine consumption was 6.4 +/- 0.5 mg. Under the treatment, no discomfort or side-effects necessitating treatment occurred. We conclude that buprenorphine is a useful substitute for morphine in the treatment of pain after major abdominal operations by continuous-plus-on-demand epidural infusion, and that the relative analgesic potency ratio of epidural buprenorphine is 8.

Adolescent↗
PubMed1987

Application of a new method for measurement of plasma methadone levels to the use of epidural methadone for relief of postoperative pain.

A method is described for measurement of plasma methadone concentrations using a gas chromatic technique that is rapid and specific and enables the detection of concentrations of less than 1 ng/ml in plasma samples of only 1 ml. The method, when used to determine the plasma methadone levels in patients given continuous epidural infusions of methadone plus on-demand supplementation for relief of postoperative pain, showed plasma methadone plateaus of around 10 ng/ml (starting at 15 min and lasting over 2 hr) and 20 ng/ml (starting at 3 hr and lasting over the period of treatment) (P less than 0.001) after an initial 2-mg methadone epidural bolus and with continuous epidural methadone. Mean plasma methadone levels of around 10 ng/ml were associated with pain relief. Analgesia could be safely maintained for 24 hr.

Adult↗
PubMed1986

Permeability of epidural somatostatin and morphine into the intrathecal space of dogs.

In an in vivo saline perfusate of the intrathecal space of 6 dogs, the concentration of somatostatin was determined by radioimmunoassay before and over 2 h after epidural administration of 3 mg somatostatin. The total recovered amount of somatostatin was negligible, about 0.02%. However, within 50 min after the bolus epidural injection of somatostatin, the concentration per ml perfusate increased from 0.1 +/- 0.02 ng/ml to 138 +/- 102 ng/ml (P less than 0.001) and declined to 4 +/- 1.7 ng/ml after 120 min. This increase of the somatostatin concentration by 3 orders of magnitude might explain why epidurally administered somatostatin is effective in treatment of acute and chronic pain. In a control investigation with epidural morphine in another 6 dogs to prove the feasibility of the method, the total recovered amount of morphine in the intrathecal perfusate over 2 h was about 12%.

Animals↗