Rejected

Adjuvants to bupivacaine for single shot caudal block in children.

Methanol extract of (MECN) was evaluated for its anti-inflammatory and analgesic activities using rats and mice. Inflammatory activity of MECN was assessed by carrageenan-induced paw oedema while analgesic activity was evaluated by acetic acid -induced writhing and formalin paw lick test. Histological analyses of the paws were also carried out. There was evaluation of the mechanism(s) of action of MECN using naloxone, a blocker of opioid receptors; atropine, blocker of muscarinic receptors; and propranolol, blocker of beta adrenergic receptors. Findings from the study revealed that MECN has both anti-inflammatory and analgesic properties. These properties were found to be dose dependent with 200 mg/kg of MECN discovered to be the most potent dose. 200 mg/kg was able to cause statistically significant reduction in paw size (p < 0.001) when compared with the carrageenan group. Histological analysis revealed that rats treated with 200 mg/kg of MECN showed no inflammatory cells in the left paw compared to other groups treated with carrageenan. In the formalin test, the number of paw licking was significantly reduced by MECN at 50 mg/kg, 100 mg/kg and 200 mg/kg in both neurogenic and inflammatory pain responses (p < 0.001) even as 200 mg/kg showed the highest percentage inhibition of 98.17% while 100 mg/kg of aspirin showed percentage inhibition of 93.66%. In acetic acid-induced writhing test, 50 mg/kg, 100 mg/kg and 200 mg/kg of MECN produced significant inhibition of writhes when compared with control as highest inhibition is observed in mice that received 200 mg/kg which is similar to aspirin. Administration of propranolol and naloxone was unable to reverse the analgesic function of MECN. However, atropine administration blocked the analgesic function of MECN. This shows that MECN exhibits its analgesic property through cholinergic pathway and not opioid and adrenergic pathways. Phytochemical screening revealed that MECN contains flavonoids, steroids, saponins, tannins, anthraquinines, terpenoids, and alkanoids. These phytochemical contents may thus be responsible for its analgesic and anti-inflammatory properties.

To investigate whether temporomandibular disorders treatment can positively influence tinnitus complaints.

Joint position sense (JPS) is impaired in clinical musculoskeletal pain conditions, but when this impairment develops in the transition from initial to prolonged pain is not known.

The advent of neuroimaging methodologies, such as functional magnetic resonance imaging (fMRI), has significantly advanced our understanding of the neurophysiological processes supporting a wide spectrum of mind-body approaches to treat pain. A promising self-regulatory practice, mindfulness meditation, reliably alleviates experimentally induced and clinical pain. Yet, the neural mechanisms supporting mindfulness-based pain relief remain poorly characterized. The present review delineates evidence from a spectrum of fMRI studies showing that the neural mechanisms supporting mindfulness-induced pain attenuation differ across varying levels of meditative experience. After brief mindfulness-based mental training (ie, less than 10 hours of practice), mindfulness-based pain relief is associated with higher order (orbitofrontal cortex and rostral anterior cingulate cortex) regulation of low-level nociceptive neural targets (thalamus and primary somatosensory cortex), suggesting an engagement of unique, reappraisal mechanisms. By contrast, mindfulness-based pain relief after extensive training (greater than 1000 hours of practice) is associated with deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to reduce appraisals of arising sensory events. We also describe recent findings showing that higher levels of dispositional mindfulness, in meditation-naïve individuals, are associated with lower pain and greater deactivation of the posterior cingulate cortex, a neural mechanism implicated in self-referential processes. A brief fMRI primer is presented describing appropriate steps and considerations to conduct studies combining mindfulness, pain, and fMRI. We postulate that the identification of the active analgesic neural substrates involved in mindfulness can be used to inform the development and optimization of behavioral therapies to specifically target pain, an important consideration for the ongoing opioid and chronic pain epidemic.

The goal: to study the influence of various methods of analgesia on the state of postoperative anesthesia in patients after thoracotomy; compare the quantity of narcotic analgesics (morphine) used in different types of anesthesia and anesthesia related complications. In 85 patients after thoracotomy, anesthesia was performed by prolonged paravertebral analgesia (PVA) (19 patients), by prolonged epidural analgesia (EDA) (36 patients) with 0.2% solution of rapamycain and by an intravenous patient-controlled analgesia (PCA) with a morphine solution in the control group (30 patients). In all three groups, the nonsteroidal anti-inflammatory drug (NSAIDs) ketorolac tromethamine was used intramuscularly. The evaluation was performed within 3 days after surgery using the visual analog scale (VAS). In the PVA group, the pain level was 29.1 points four hours after surgery to 18.7 points at the end of the third day; in the EDA group – from 24.2 to 20.3 points, respectively; in the control group – from 48.8 to 38.0 points, respectively. The need for morphine administration within the first day after surgery was the highest in the control group and was 42.83±13.23 mg/day. In experimental groups, the need for morphine was 15.0±5.0 mg/day in the EDA group and 16.15±5.38 mg/day in the PVA group. The greatest number of complications was observed in the control group and was associated with the use of morphine. The method of anesthesia associated with the use of PVA was accompanied by the least amount of complications. In terms of the effectiveness of analgesia and the amount of narcotic analgesic used, it was comparable to EDA. Patients of this group least often developed chronic postoperative pain syndrome. PVA may be a priority for postoperative pain management in patients after thoracotomy.

Breastfeeding is an important issue in postpartum period and critical to the infant's health, but childbirth interventions such as childbirth analgesia may affect the onset and duration of the process. This study aimed to determine the status of breastfeeding in women receiving epidural analgesia.

Efforts to achieve balance between effective pain management and opioid-related adverse events (ORAEs) have led to multimodal analgesia regimens. This study compared opioids delivered via patient-controlled analgesia (PCA) plus liposomal bupivacaine, a long-acting local anesthetic with potential to be an effective component of such regimens, to opioids delivered through PCA alone or PCA plus subcutaneous bupivacaine infusion (ONQ), following laparotomy.

Activation of intracellular signaling pathways in circulating leukocytes represents an early step in systemic immune-inflammatory response occurring e.g. in acute pancreatitis (AP) and sepsis. Previously, we found aberrations in the phosphorylation of leukocyte signaling proteins in patients with sepsis or AP (measured <48 h from hospital admission) resembling each other and associating with AP severity. Of these patients, those with sepsis or severe AP complicated by persistent organ dysfunction (OD+,  = 17) and patients with moderately severe AP (OD-,  = 6) were followed up in this study by measuring the phosphorylations at two additional time points (2-4 and 5-8 days after the initial sample) using phosphospecific whole blood flow cytometry. Twenty-eighty healthy subjects served as controls (HC). Constitutive STAT3 phosphorylation (pSTAT3) declined in monocytes and neutrophils of OD-/OD + and in lymphocytes of OD + and remained higher in OD- than HC. Monocytes of OD-/OD + showed low pSTAT3 and pSTAT1 levels in response to IL-6 through follow-up. Monocyte pNF-κB levels in response to TNF, LPS and in OD+, to in OD-, and lymphocyte pNF-κB levels in response to TNF in OD- increased during follow-up but remained lower than in HC, and neutrophil pNF-κB levels in response to TNF declined in OD-. Phorbol myristate acetate + Ca ionophore-stimulated pERK1/2 decreased in neutrophils of OD-/OD+. To conclude, in patients with moderately severe or severe AP or sepsis, improvement and molecular events contributing to OD can be assessed at the level of blood leukocyte signaling.

This research aimed to evaluate the effect of gastroesophageal reflux disease (GERD) on pulmonary volumes, airflows, and airway resistance in the patients without respiratory symptoms and compare them with the healthy subjects.