Izabel C. P. R. Lima

The effects of intrathecal neostigmine on somatic and visceral pain: improvement by association with a peripheral anticholinergic.

This study was designed to qualitatively evaluate the analgesic actions of intrathecal neostigmine alone and with intravenous (IV) N-butyl-scopolamine on somatic and visceral pain. Twenty-seven patients scheduled for both tubal ligation and vaginoplasty were divided into three groups. Patients received a standard anesthetic with thiopental, atracurium, and N2 O/O2/enflurane. N-butyl-scopolamine, 20 mg, or saline was administered as a 2-mL IV bolus 20 min before the end of the surgical procedure. The control group (CG) received spinal and IV saline; the neostigmine group (NG), spinal neostigmine and IV saline; and the neostigmine-N-butyl-scopolamine group (NSG), spinal neostigmine and IV N-butyl-scopolamine. Postoperatively, patients assessed their pain on a 10-cm visual analog scale (VAS). The CG had both visceral and somatic pain at the first 30-min assessment, and all patients requested morphine. Patients from the NG had only visceral pain from the first assessment; however, they had lower VAS scores (P = 0.026) and requested less morphine (P = 0.037). Patients from the NSG were pain free during all assessment times (P < 0.0001). Neostigmine was more effective for somatic pain than visceral pain. N-butyl scopolamine administration acted peripherally as an effective complement for treatment of visceral pain, reflecting an association between central cholinergic effects and peripheral anticholinergic effects in the treatment of visceral postoperative pain. (Anesth Analg 1996;82:617-20)

The antinociceptive effect of local or systemic parecoxib combined with lidocaine/clonidine intravenous regional analgesia for complex regional pain syndrome type I in the arm.

We evaluated the efficacy of local or systemic parecoxib combined with lidocaine/clonidine IV regional analgesia in complex regional pain syndrome (CRPS) type 1 in a dominant upper limb. Thirty patients with CRPS type 1 were divided into three groups. The control group (CG) received both IV saline in the healthy limb and IV loco-regional 1 mg/kg of lidocaine + 30 &mgr;g of clonidine, diluted to a 10-mL volume with saline. The systemic parecoxib group (SPG) received a regional block similar to that administered to the CG but with systemic 20 mg of parecoxib, whereas the IV regional anesthesia with parecoxib group (IVRAPG) received an extra IV 5 mg of loco-regional parecoxib compared with the CG. The block was performed once a week for 3 consecutive weeks. Analgesia was evaluated by the 10-cm visual analog scale (VAS) and rescue analgesic consumption. The IVRAPG showed less daily ketoprofen (milligrams) consumption in the second and third weeks compared with the other groups (P < 0.05). The IVRAPG also showed less ketoprofen consumption when comparing the first and second week with the third week (P < 0.05). The VAS score comparison among groups revealed that groups were similar during the first and second week observation, although the IVRAPG showed smaller VAS scores in the third week compared with both CG and SPG (P < 0.05). We conclude the IV 5 mg of parecoxib was an effective antiinflammatory drug combined with clonidine/lidocaine loco-regional block in CRPS type 1.

Tramadol and beta-cyclodextrin piroxicam: Effective multimodal balanced analgesia for the intra-and postoperative period†‡

Background and Objectives. This study was conducted to evaluate the analgesic efficacy of tramadol, an analgesic with both opioid and nonopioid actions (norepinephrine and serotonin pathways), with beta‐cyclodextrin piroxicam, a nonsteroidal antiinflammatory drug, in the perioperative setting. Methods. The study population consisted of 48 patients scheduled for minor abdominal procedures, who were assigned to one of four groups of 12 patients each. The premedication was either a placebo tablet or a 192.1‐mg beta‐cyclodextrin piroxicam tablet, administered orally 30‐40 minutes before anesthesia induction. After intravenous administration of tramadol 1.5 mg/kg, anesthesia was induced with an intravenous loading dose of propofol. Anesthesia was maintained an intravenous infusion of propofol at 6‐12 mg/kg/h plus either saline or tramadol at 1.2 mg/kg/h, atracurium, and a 2:1 nitrous oxide‐oxygen mixture. The control group received a placebo tablet and an infusion of saline with propofol for anesthesia maintenance; the tramadol group received a placebo tablet and a continuous tramadol‐propofol infusion; the betacyclodextrin piroxicam (BCP) group received a BCP tablet and a continuous saline‐propofol infusion; and the beta‐cyclodextrin piroxicam‐tramadol (BCPT) group received beta‐cyclodextrin piroxicam and a continuous tramadol‐propofol infusion. Results. The relative propofol consumption by the four groups was control = BCP (P > .05) >tramadol (P < .001) > B‐CPT (P < .0002). The time for analgesic rescue decreased in the order BCPT > BCP (P < .0002) = tramadol > control (P < .001). The degree of sedation and the visual analog scores 10‐cm scale at the time patients requested rescue analgesics were similar among the groups (P > .05). Conclusions. The combination of tramadol and beta‐cyclodextrin piroxicam provided better perioperative analgesia than tramadol alone.

418 THE CLINICAL AND LABORATORIAL EVALUATION OF TRANSDERMAL KETAMINE, FENTANYL, CLONIDINE OR THEIR COMBINATION IN CHRONIC LOW BACK PAIN

Background and Objectives: Clinical experience suggests a role for botulinum toxin type A (TXB-A) in headache. However, there is no report regarding conversion factor between Botox and Prosigne. The objective was to evaluate the safety and efficacy of the two available preparations of TXB-A. Methods: 40 patients with chronic daily headache were randomized into 4 groups and double-blinded evaluated. Patients received either im 25UI Botox (Botox group); 25UI Prosigne (25-Pro group); 33.3UI Prosigne (33-Pro group) or saline (Control group). Pain and adverse effects were evaluated: 1) prior to TXB-A; 2) 28 days after the TXB-A or saline; and 3) 56 days after the TXB-A or saline application. Results: The conversion factor between Botox and Prosigne was 1:1.3. Both 25UI Botox and 33.3UI Prosigne resulted in approximately seven headache-free days compared to baseline at 28and 56-day evaluation. Patients experienced a 50% or more decrease in the frequency of headache days, in addition to significant reductions in headache intensity, with only transient adverse effects. Conclusions: The conversion factor between Botox and Prosigne was 1:1.3. The dose of 25UI Botox was similar to 33.3UI Prosigne regarding efficacy and adverse effects in chronic daily headache.

404 EFFICACY OF FENTANYL TRANSDERMAL DELIVERY SYSTEM FOR ACUTE POSTOPERATIVE PAIN AFTER POSTERIOR LAMINECTOMY

remifentanil hydrochloride (0.10mg/kg/min, Ultiva, GlaxoSmithKline) over 45 minutes. QST measures, including heat, cold and mechanical pain thresholds were assessed before and during remifentanil infusion. In addition, visual analogue scale (VAS) ratings were measured continuously for two minutes for cold and heat pain stimulation applied with a thermode (Pathway, Medoc, Israel) and during a cold water bath. Results show analgesic efficacy of remifentanil on several QST parameters. The VAS ratings for the continuous heat and cold pain stimulation show a reduction in pain during remifentanil infusion. These data show that pain threshold parameters of the QST protocol as well as subjective VAS ratings both measure analgesic efficacy and can be utilized for early clinical development of analgesic compounds.

417 RANDOMIZED, DOUBLE‐BLIND, CONTROLLED TRIAL OF BOTULINUM TOXIN TYPE‐A (PROSIGNE‐CHINESE OR BOTOX) AS COADJUVANT FOR CHRONIC DAILY HEADACHE

Background and Objectives: Clinical experience suggests a role for botulinum toxin type A (TXB-A) in headache. However, there is no report regarding conversion factor between Botox and Prosigne. The objective was to evaluate the safety and efficacy of the two available preparations of TXB-A. Methods: 40 patients with chronic daily headache were randomized into 4 groups and double-blinded evaluated. Patients received either im 25UI Botox (Botox group); 25UI Prosigne (25-Pro group); 33.3UI Prosigne (33-Pro group) or saline (Control group). Pain and adverse effects were evaluated: 1) prior to TXB-A; 2) 28 days after the TXB-A or saline; and 3) 56 days after the TXB-A or saline application. Results: The conversion factor between Botox and Prosigne was 1:1.3. Both 25UI Botox and 33.3UI Prosigne resulted in approximately seven headache-free days compared to baseline at 28and 56-day evaluation. Patients experienced a 50% or more decrease in the frequency of headache days, in addition to significant reductions in headache intensity, with only transient adverse effects. Conclusions: The conversion factor between Botox and Prosigne was 1:1.3. The dose of 25UI Botox was similar to 33.3UI Prosigne regarding efficacy and adverse effects in chronic daily headache.