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Injeção epidural de morfina ou cetamina em cães: avaliação do efeito analgésico pelo emprego de filamentos de von Frey

Valadão, C.A.A.; Mazzei, S.; Oleskovicz, N.
Fonte: Universidade Federal de Minas Gerais (UFMG), Escola de Veterinária Publicador: Universidade Federal de Minas Gerais (UFMG), Escola de Veterinária
Tipo: Artigo de Revista Científica Formato: 383-389
POR
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46.54%
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP); Utilizaram-se 14 cães mestiços, com idade inferior a cinco anos e peso médio de 12,5kg, com o objetivo de se avaliar os efeitos da injeção epidural de morfina ou cetamina sobre a dor pós-operatória. Os cães foram anestesiados com sevoflurano por meio de máscara facial, e em ato contínuo, receberam injeção epidural de morfina (0,1mg/kg; G1) ou cetamina (0,2mg/kg; G2) diluídas em 0,3ml/kg de solução salina. A incisão experimental de 1,5cm foi realizada no coxim plantar e suturada com fio de náilon. Interrompida a anestesia inalatória e decorridos 30 minutos iniciou-se a avaliação da dor peri-incisional, aplicando-se os filamentos de von Frey a 0,3cm equidistantes da incisão. O procedimento foi repetido a intervalos de 30 minutos até 120 minutos, e posteriormente às 3, 4, 5, 6 e 24 horas do período pós-incisional. Os animais de G1 não responderam à estimulação com os filamentos e apoiaram o membro incindido normalmente durante todo o período de avaliação. No G2 observou-se aumento progressivo da resposta à estimulação pelos filamentos de von Frey desde os 90 minutos até 24 horas. A morfina reduziu a dor pós-incisional por 24 horas, mostrando-se mais efetiva do que a cetamina para o controle da dor.; Pre-emptive analgesic effects of epidural ketamine or morphine were compared using the von Frey filaments (VF). Fourteen mixed breed male or female dogs...

Efeitos da administração epidural de dexmedetomidina sobre a concentração alveolar mínima do isofluorano em cães

Campagnol, Daniela
Fonte: Universidade Estadual Paulista (UNESP) Publicador: Universidade Estadual Paulista (UNESP)
Tipo: Dissertação de Mestrado Formato: 137 f.
POR
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP); Pós-graduação em Anestesiologia - FMB; A administracao intravenosa de dexmedetomidina reduz significativamente a concentracao alveolar minima (CAM) dos agentes halogenados. No entanto, esse beneficio e frequentemente acompanhado por efeitos colaterais tipicos dos agonistas 2, como hipertensao, bradicardia e reducao do debito cardiaco. Ha indicios de que a administracao epidural de doses reduzidas de dexmedetomidina pode potencializar e prolongar seu efeito analgesico. Hipotetizou-se que a administracao epidural de dexmedetomidina reduziria a CAM do isofluorano de forma dose e tempo-dependente, sem ocasionar depressao cardiovascular significativa. Objetivou-se tambem caracterizar as alteracoes do indice bispectral (BIS) induzidas pela estimulacao nociceptiva empregada na mensuracao da CAM, bem como o efeito da dexmedetomidina epidural sobre essas alteracoes. Seis caes higidos (18,8}4,0 kg) foram anestesiados com isofluorano em 4 ocasioes distintas, com intervalo de 7 dias. Em cada anestesia, os animais receberam aleatoriamente 1 de 4 tratamentos pela via epidural. No tratamento controle, administrou-se solucao salina...

Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep

DeRossi,Rafael; Pompermeyer,Cassio Tadeu Dias; Silva-Neto,Amadeu Batista; Barros,Andrea Lantieri Correa de; Jardim,Paulo Henrique de Affonseca; Frazílio,Fabrício Oliveira
Fonte: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia Publicador: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2012 EN
Relevância na Pesquisa
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PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1) ketamine (KE; 2.5 mg/kg), (2) magnesium sulphate (MG; 100 mg), and (3) KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively). Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline) and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD), that is, more than twice that obtained with KE (41 ± 7 min) or MG (29 ± 5 min) alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.

Comparison of the caudal and lumbar approaches to the epidural space

Price, C; Rogers, P; Prosser, A; Arden, N
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /11/2000 EN
Relevância na Pesquisa
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OBJECTIVES—To investigate the accuracy of placement of epidural injections using the lumbar and caudal approaches. To identify which factors, if any, predicted successful placement.
METHODS—200 consecutive patients referred to a pain clinic for an epidural injection of steroid were randomly allocated to one of two groups. Group L had a lumbar approach to the epidural space and group C a caudal approach to the epidural space. Both groups then had epidurography performed using Omnipaque and an image intensifier to determine the position of the needle.
RESULTS—Body mass index (BMI), grade of operator, and route of injection were predictors of a successful placement. 93% of lumbar and 64% of caudal epidural injections were correctly placed (p< 0.001). 97% of lumbar and 85% of caudal epidural injections clinically thought to be correctly placed were confirmed radiographically. For epidural injections where the clinical impression was "maybe", 91% of lumbar injections, but only 45% of caudal injections were correctly placed. Obesity was associated with a reduced chance of successful placement (odds ratio (OR) 0.34 (95% confidence interval (CI) 0.17 to 0.72) BMI >30 v BMI <30). A more senior grade of operator was associated with a reduced chance of successful placement (OR 0.16 (95% CI 0.03 to 0.89) consultant v other). However...

Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections

Goodman, Bradly S.; Posecion, Lyle W. F.; Mallempati, Srinivas; Bayazitoglu, Matt
Fonte: Humana Press Inc Publicador: Humana Press Inc
Tipo: Artigo de Revista Científica
Publicado em 15/08/2008 EN
Relevância na Pesquisa
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Lumbar interlaminar and transforaminal epidural injections are used in the treatment of lumbar radicular pain and other lumbar spinal pain syndromes. Complications from these procedures arise from needle placement and the administration of medication. Potential risks include infection, hematoma, intravascular injection of medication, direct nerve trauma, subdural injection of medication, air embolism, disc entry, urinary retention, radiation exposure, and hypersensitivity reactions. The objective of this article is to review the complications of lumbar interlaminar and transforaminal epidural injections and discuss the potential pitfalls related to these procedures. We performed a comprehensive literature review through a Medline search for relevant case reports, clinical trials, and review articles. Complications from lumbar epidural injections are extremely rare. Most if not all complications can be avoided by careful technique with accurate needle placement, sterile precautions, and a thorough understanding of the relevant anatomy and contrast patterns on fluoroscopic imaging.

Air Bubbles Mimic Disc Herniation in MRI after Cervical Epidural Block

Kim, Tae Sam; Shin, Sung Sik; Kim, Jung Ryul; Kim, Dal Yong
Fonte: The Korean Pain Society Publicador: The Korean Pain Society
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
36.76%
Magnetic resonance image (MRI) is the most sensitive imaging test of the spine in routine clinical practice. Unlike conventional x-ray examinations and computed tomography scans, high-quality magnetic resonance images can be assured only if patients are able to remain perfectly still. However, some patients find it uncomfortable to remain still because of pain. In that condition, interlaminar cervical epidural injections can reduce pain and allow the procedure. When using air with the "loss of resistance" technique in epidural injections to identify the epidural space, there is the possibility of injected excessive air epidurally to mimic a herniated disc. We describe a case report of epidural air artifact in a cervical MRI after cervical epidural injections.

An Alternative Approach to Needle Placement in Cervicothoracic Epidural Injections

Park, Seung Yong; Leem, Jung Gil; Jung, Sung Hwan; Kim, Young Ki; Koh, Won Uk
Fonte: The Korean Pain Society Publicador: The Korean Pain Society
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.78%
The use of fluoroscopy guidance together with the loss of resistance technique during epidural injections has been advocated lately; moreover, epidural injections in the absence of fluoroscopic guidance have a high rate of inaccurate needle-tip placement during the injections. However, the approach to the lower cervical and upper thoracic epidural space may be challenging due to its obscure lateral fluoroscopic views from overlying normal tissue structures. In this case, we report an alternative oblique C-arm fluoroscopy guided view approach to supplement the standard anterior-posterior and lateral fluoroscopic views to facilitate successful needle placement and precise anatomical localization of the epidural space.

Effective Dose of CT-Guided Epidural and Periradicular Injections of the Lumbar Spine: A Retrospective Study

Artner, Juraj; Lattig, Friederike; Reichel, Heiko; Cakir, Balkan
Fonte: Bentham Open Publicador: Bentham Open
Tipo: Artigo de Revista Científica
Publicado em 10/08/2012 EN
Relevância na Pesquisa
36.85%
Spinal injection procedures can be performed blindly or, more accurately, with fluoroscopic or computed tomography (CT) guidance. Radiographic guidance for selective nerve root blocks and epidural injections allows an accurate needle placement, reduces the procedure time and is more secure for the patient, especially in patients with marked degenerative changes and scoliosis, resulting in a narrowing of the interlaminar space. Limiting factors remain the availability of scanners and the radiation dose. Interventional CT scan protocols in axial CT-acquisition mode for epidural and periradicular injections help to limit the radiation dose without a significant decrease of image quality. The purpose of this retrospective study was to analyze the effective radiation dosage patients are exposed during CT-guided epidural lumbar and periradicular injections. A total amount of n=1870 datasets from 18 months were analyzed after multiplying the dose length product with conversion factor k for each lumbar segment. For lumbar epidural injections (n=1286), a mean effective dose of 1.34 mSv (CI 95%, 1.30-1.38), for periradicular injections (n=584) a mean effective dose of 1.38 mSv (CI 95%, 1.32-1.44) were calculated.

Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
Publicado em 24/08/2012 EN
Relevância na Pesquisa
46.82%
Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures)...

Lumbar epidural perineural injection: a new technique

Kraemer, J.; Ludwig, J.; Bickert, U.; Owczarek, V.; Traupe, M.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em /09/1997 EN
Relevância na Pesquisa
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Two controlled studies for a new epidural, perineural, singleshot, selective nerve root injection with a double-needle approach to the anterior epidural space of the lumbar spinal canal are presented. The results were analysed to determine the effectiveness of the new epidural perineural injection technique. The trial comprised two controlled studies on 182 patients. One study compared prospectively randomized results of patients with lumbar radicular syndromes who received epidural perineural injections (n = 47), conventional posterior epidural injections (n = 40) and, as a control group, paravertebral local anaesthetic (n = 46). A second, prospective, double-blind study compared the effect of epidural perineural injections with triamcinolone (n = 24) and pure saline (n = 25). Epidural perineural injections were more effective than conventional posterior epidural injections. Both epidural groups had better results than the paravertebral local injection group. Epidural perineural injections with steroids (10 mg triamcinolone) were more effective than saline alone. A systemic steroid effect was excluded by additional intramuscular steroid injections in the saline group. There were no severe complications or side effects in any of the three groups. The studies concluded that single-shot epidural perineural injection is effective in the treatment of lumbar radicular pain. It is a “one drop only” therapy to the source of pain.

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

Manchikanti, Laxmaiah; Singh, Vijay; Cash, Kimberly A.; Pampati, Vidyasagar; Datta, Sukdeb
Fonte: Ivyspring International Publisher Publicador: Ivyspring International Publisher
Tipo: Artigo de Revista Científica
Publicado em 08/09/2012 EN
Relevância na Pesquisa
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Study Design: A randomized, active control, double-blind trial. Objective: To evaluate the effectiveness of fluoroscopically directed caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to post lumbar surgery syndrome. Summary of Background Data: There is a paucity of evidence concerning caudal epidural injections for managing chronic persistent low back pain with or without lower extremity pain caused by post lumbar surgery syndrome.

Arachnoiditis Following Caudal Epidural Injections for the Lumbo-Sacral Radicular Pain

Nanjayan, Shashi Kumar; Swamy, Girish Nanjunda; Yallappa, Sachin; Bommireddy, Rajendra
Fonte: Korean Society of Spine Surgery Publicador: Korean Society of Spine Surgery
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
36.73%
Caudal epidural steroid injection is a very common intervention in treatment of low back pain and sciatica symptoms. Although extensively used, it is not devoid of complications. A few reports of chemical and infective arachnoiditis exist following lumbar epidural anaesthesia, but none following a caudal epidural steroid injection.We report a case of arachnoiditis following caudal epidural steroid injections for lumbar radiculopathy. The patient presented with contralateral sciatica, worsening low back pain and urinary retention few days following the injection, followed by worsening motor functions in L4/L5/S1 myotomes with resultant dense foot drop. Gadolinium-enhanced magnetic resonance imaging suggested infective arachnoiditis with diffuse enhancement and clumping of the nerve roots within the lumbar and sacral thecal sac. As the number of injections in the management of back pain and lumbo-sacral radicular pain is increasing annually, it is imperative to have a thorough understanding of this potentially dangerous complication and educate the patients appropriately.

Vertebral Artery Position in the Setting of Cervical Degenerative Disease: Implications for Selective Cervical Transforaminal Epidural Injections

Fitzgerald, Ryan T; Bartynski, Walter S; Collins, Heather R
Fonte: Centauro S.r.l. Publicador: Centauro S.r.l.
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.41%
Cervical transforaminal epidural injections (C-TfEI) are commonly performed in patients with cervical radiculopathy/pain. C-TfEIs are typically performed without incident but adverse events can occur. Using CT-fluoroscopy-guided C-TfEI, we commonly observe the vertebral artery in proximity to the target injection site. The purpose of this study was to assess the position of the vertebral artery relative to the typical C-TfEI injection point.

Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids

Manchikanti, Laxmaiah; Pampati, Vidyasagar; Benyamin, Ramsin M.; Boswell, Mark V.
Fonte: Ivyspring International Publisher Publicador: Ivyspring International Publisher
Tipo: Artigo de Revista Científica
Publicado em 20/01/2015 EN
Relevância na Pesquisa
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Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain.

Comparison of the Efficacy of Caudal, Interlaminar, and Transforaminal Epidural Injections in Managing Lumbar Disc Herniation: Is One Method Superior to the Other?

Manchikanti, Laxmaiah; Singh, Vijay; Pampati, Vidyasagar; Falco, Frank JE; Hirsch, Joshua A.
Fonte: The Korean Pain Society Publicador: The Korean Pain Society
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
56.88%
Background: Epidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches. Methods: This manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients). Results: Analysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial. Conclusions: The results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone...

Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis: A Systematic Review

Manchikanti, Laxmaiah; Kaye, Alan David; Manchikanti, Kavita; Boswell, Mark; Pampati, Vidyasagar; Hirsch, Joshua
Fonte: Kowsar Publicador: Kowsar
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
57.01%
Context: Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis. Evidence Acquisition: Recent randomized trials, systematic reviews and guidelines have reached varying conclusions about the efficacy of epidural injections in the management of central lumbar spinal stenosis. The aim of this systematic review was to determine the efficacy of all three anatomical epidural injection approaches (caudal, interlaminar, and transforaminal) in the treatment of lumbar central spinal stenosis. A systematic review was performed on randomized trials published from 1966 to July 2014 of all types of epidural injections used in the management of lumbar central spinal stenosis. Methodological quality assessment and grading of the evidence was performed. Results: The evidence in managing lumbar spinal stenosis is Level II for long-term improvement for caudal and lumbar interlaminar epidural injections. For transforaminal epidural injections, the evidence is Level III for short-term improvement only. The interlaminar approach appears to be superior to the caudal approach and the caudal approach appears to be superior to the transforaminal one. Conclusions: The available evidence suggests that epidural injections with local anesthetic alone or with local anesthetic with steroids offer short- and long-term relief of low back and lower extremity pain for patients with lumbar central spinal stenosis. However...

What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion

Manchikanti, Laxmaiah; Staats, Peter S.; Nampiaparampil, Devi E.; Hirsch, Joshua A.
Fonte: The Korean Pain Society Publicador: The Korean Pain Society
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.91%
Background: Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery. Methods: A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V. Results: Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar. Conclusions: The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments.

Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep

Rossi, Rafael de; Pompermeyer, Cassio Tadeu Dias; Silva Neto, Amadeu Batista; Barros, Andrea Lantieri Correa de; Jardim, Paulo Henrique de Affonseca; Frazílio, Fabrício Oliveira
Fonte: Acta Cirurgica Brasileira Publicador: Acta Cirurgica Brasileira
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.58%
OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1) quetamina (KE; 2,5 mg/kg), (2) sulfato de magnésio (MG; 100 mg) e (3) KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente). As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal) e depois da administração dos fármacos até o fim da analgesia. RESULTADOS: A duração da analgesia com o tratamento KEMG foi 115 ± 17 min (média ± DP), duas vezes superior ao obtido com o tratamento KE (41 ± 7 min) ou tratamento MG (29 ± 5 min) isolados. Os tratamentos KE e KEMG induziram bloqueio motor severo. As pressões arteriais e freqüência cardíaca não foram estatisticamente significantes nestes animais. CONCLUSÃO: A adição de sulfato de magnésio a analgesia epidural com quetamina é viável...

Randomized, double-blind, placebo-controlled, trial of transforaminal epidural etanercept for the treatment of symptomatic lumbar disc herniation

Freeman, B.; Ludbrook, G.; Hall, S.; Cousins, M.; Mitchell, B.; Jaros, M.; Wyand, M.; Gorman, J.
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
46.59%
STUDY DESIGN. Multicenter, randomized, double-blind, placebo-controlled trial. OBJECTIVE. To examine the safety and efficacy of three different doses of the tumor necrosis factor alpha (TNF-α) inhibitor etanercept versus placebo for the treatment of symptomatic lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA. TNF-α is considered to be a major cause of radicular leg pain associated with symptomatic LDH. Systemic administration of TNF-α inhibitors for sciatica has indicated a trend toward efficacy. METHODS. Forty-nine subjects aged between 18 and 70 years, with persistent lumbosacral radicular pain secondary to LDH, and an average leg pain intensity of 5/10 or more were randomized to 1 of 4 groups: 0.5-mg, 2.5-mg, 12.5-mg etanercept, or placebo. Subjects received 2 transforaminal epidural injections, 2 weeks apart, and were assessed for efficacy up to 26 weeks after the second injection. The primary outcome measure was the change in mean daily worst leg pain (WLP). Secondary outcomes included average leg pain, worst back pain, average back pain, in-clinic pain, Oswestry Disability Index, patient global impression of change, and tolerability. RESULTS: Forty-three of the 49 randomized patients completed the study. Patients receiving 0.5-mg etanercept showed a clinically and statistically significant (P< 0.1) reduction in mean daily WLP compared with the placebo cohort from 2 to 26 weeks for both the per protocol population (−5.13 vs. −1.95; P= 0.066) and the intention-to-treat population (−4.40 vs. −1.84; P= 0.058). Fifty percent of these subjects reported a 100% reduction in WLP 4 weeks post-treatment compared with 0% of subjects in the placebo cohort. Improvements in all secondary outcomes were also observed in the 0.5-mg etanercept cohort. The overall incidence of adverse events was similar in placebo and all etanercept cohorts. CONCLUSION. Two transforaminal injections of etanercept provided clinically significant reductions in mean daily WLP and worst back pain compared with placebo for subjects with symptomatic LDH. Epidural etanercept may offer patients with sciatica a safe and effective nonoperative treatment.; Freeman...

Effects of lumbosacral epidural ketamine and lidocaine in xylazine-sedated cats

DeRossi,R; Benites,A P; Ferreira,J Z; Neto,J M N; Hermeto,L C
Fonte: Journal of the South African Veterinary Association Publicador: Journal of the South African Veterinary Association
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2009 EN
Relevância na Pesquisa
46.54%
In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1) ketamine (2.5 mg/kg), (2) lidocaine (4.0 mg/kg), and (3) ketamine (2.5 mg/kg) plus lidocaine (4.0 mg/kg). Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, heart rate, arterial blood pressure, respiratory rate and arterial oxygen saturation were measured. Rectal temperature was compared before and after sedation as well as after epidural administration of the drugs. Epidural administration of the ketamine/lidocaine combination induced prolonged analgesia extending from the coccygeal to the T13-L1 dermatomes, leading to severe ataxia. Cardiovascular effects were significant in all treatments: heart rate decreased,but there was a minimal reduction in arterial pressure. It was concluded that addinga dose of ketamine to epidural lidocaine in cats is feasible and effective.