Local Anesthetics Potentiate Spinal Morphine Antinociception

Akerman, B; Arweström, Ewa; Post, Claes

doi:10.1213/00000539-198810000-00007

Cited by 96 publications

(77 citation statements)

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“…~,2 Animal studies have also demonstrated antinociceptive synergism between intrathecal opioids and local anaesthetics during visceral and somatic nociception. [3][4][5][6][7] Fentanyl (a lipophilic opioid) has a rapid onset and a shorter duration of action following intrathecal adminislaation but its duration of action may be dosedependent) , 9 Hunt et al reported that the addition of fentanyl -->6.25 ttg to hyperbaric bupivacaine reduced the intraoperative opioid requirement in patients undergoing Caesarean delivery under spinal block, z Belzarena further demonstrated that low-dose fentanyl, 0.25 ttg" kg -I it, with bupivacaine 0.5% provided excellent surgical anaesthesia with few side effects. An increased dose of fentanyl, 0.5-0.75 ~g" kg -l it, was associated with increased incidence of adverse effects in patients undergoing Caesarean delivery.…”

Section: Intrathecal Fentanyl Prolongs Sensory Bupivacaine Spinal Blockmentioning

confidence: 99%

Intrathecal fentanyl prolongs sensory bupivacaine spinal block

et al. 1995

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Section: Intrathecal Fentanyl Prolongs Sensory Bupivacaine Spinal Blockmentioning

confidence: 99%

Intrathecal fentanyl prolongs sensory bupivacaine spinal block

et al. 1995

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“…The findings being in accordance with similar studies. 11,12,13,14 Parturients in both our groups showed a significant fall in MAP by 4-6 minutes, this fall was less than 20% of the baseline and was comparable in both the groups. Hypotension was defined as a decrease in mean arterial blood pressure by ≥ 20% and treated with mephenteramine 3mg boluses.…”

Section: Methodsmentioning

confidence: 50%

“…It improves the quality of sensory blockade intra-operatively without increasing sympathetic or motor blockage, it also enhances the quality and duration of post-operative analgesia to a significant extent and has been found to be safe and effective both in terms of neonatal and maternal outcome not only in normal parturients but also in severely preeclamptic patients for labour analgesia and elective caesarean section. 11,12,13 OBJECTIVES TO ASSESS:…”

Section: Introductionmentioning

confidence: 99%

A COMPARATIVE STUDY BETWEEN 0.5% HYPERBARIC BUPIVACAINE AND 0.5% HYPERBARIC BUPIVACAINE WITH 25 mcg FENTANYL IN SPINAL ANAESTHESIA IN OBSTETRIC PATIENTS UNDERGOING ELECTIVE LSCS

Abhinav¹,

Harshavardhan²

2015

jemds

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“…Preclinical studies have typically shown minimal effects upon acute nociception at sub-motor impairing doses of conventional sodium channel blockers given intrathecally. However, they are reported to reliably result in a remarkable analgesic synergy with intrathecal agents such as opiates or alpha 2 agonists with minimal attendant effects upon motor function in animal models [111][112][113][114] and in humans [115][116][117]. There is a clinical literature that suggests that neuraxial local anesthetics may display a tachyphylaxis with chronic exposure that may respond to different local anesthetics [118].…”

Section: Spinal Antagonistsmentioning

confidence: 99%

Current and Future Issues in the development of spinal agents for the management of pain

Yaksh¹,

Fisher²,

Hockman³

et al. 2016

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Targeting analgesic drugs for spinal delivery reflects the fact that while the conscious experience of pain is mediated supraspinally, input initiated by high intensity stimuli, tissue injury and/or nerve injury is encoded at the level of the spinal dorsal horn and this output informs the brain as to the peripheral environment. This encoding process is subject to strong upregulation resulting in hyperesthetic states and downregulation reducing the ongoing processing of nociceptive stimuli reversing the hyperesthesia and pain processing. The present review addresses the biology of spinal nociceptive processing as relevant to the effects of intrathecally-delivered drugs in altering pain processing following acute stimulation, tissue inflammation/injury and nerve injury. The review covers i) the major classes of spinal agents currently employed as intrathecal analgesics (opioid agonists, alpha 2 agonists; sodium channel blockers; calcium channel blockers; NMDA blockers; GABA A/B agonists; COX inhibitors; ii) ongoing developments in the pharmacology of spinal therapeutics focusing on less studied agents/targets (cholinesterase inhibition; Adenosine agonists; iii) novel intrathecal targeting methodologies including gene-based approaches (viral vectors, plasmids, interfering RNAs); antisense, and toxins (botulinum toxins; resniferatoxin, substance P Saporin); and iv) issues relevant to intrathecal drug delivery (neuraxial drug distribution), infusate delivery profile, drug dosing, formulation and principals involved in the preclinical evaluation of intrathecal drug safety.Keywords: Adenovirus transfection, dorsal horn, neurotoxins, pain pathways, spinal drug delivery, spinal analgesics, toxicity. RATIONALETargeting analgesic drugs for direct spinal delivery reflects the fact that while the conscious experience of pain is mediated supraspinally, input initiated by high intensity stimuli, tissue injury and/or nerve injury is encoded at the level of the spinal dorsal horn. Thus, high intensity (e.g., nociceptive) stimulation activates populations of small primary afferents, generating an intensity-dependent increase in activity of second order dorsal horn projection neurons. This excitation is transmitted through spinofugal projection pathways to higher centers, such as the somatosensory thalamus -somatosensory cortex, and to the medial thalamus -limbic cortices that are respectively believed to underlie the sensory-discriminative and affectivemotivational components of the pain experience [1-3]. The dorsal horn encoding process reflects a remarkable plasticity wherein the input-output function of the spinal dorsal horn is subject to pronounced regulation by local neuronal and nonneuronal circuits as well as supraspinal (bulbospinal) input. Thus, following tissue or nerve injury there is an enhanced neuronal response to moderate or low intensity stimuli, e.g., *Address correspondence to this author at the University of California, San Diego, Anesthesia Research Lab 0818, 9500 Gilman Dr. LaJolla, CA 92093, USA; ...

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Local Anesthetics Potentiate Spinal Morphine Antinociception

Cited by 96 publications

References 0 publications

Intrathecal fentanyl prolongs sensory bupivacaine spinal block

Intrathecal fentanyl prolongs sensory bupivacaine spinal block

A COMPARATIVE STUDY BETWEEN 0.5% HYPERBARIC BUPIVACAINE AND 0.5% HYPERBARIC BUPIVACAINE WITH 25 mcg FENTANYL IN SPINAL ANAESTHESIA IN OBSTETRIC PATIENTS UNDERGOING ELECTIVE LSCS

Current and Future Issues in the development of spinal agents for the management of pain

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