ABSTRACT
BACKGROUND: Pain from multiple rib fractures may affect pulmonary function, morbidity, and length of stay in the intensive care units. This study describes some clinical characteristics of epidural buprenorphine, a lipophilic and partial opiate agonist with a higher micro receptor affinity than morphine, in combating the pain in multiple rib fractures. METHODS: The study was conducted prospectively over a 15-month period. A total of 27 patients admitted to the hospital with multiple rib fractures were studied. Buprenorphine at a concentration of 0.3 mg in 5-10 ml normal saline was administered epidurally, twice daily the first 24 h, thereafter once daily. Ventilatory function tests (including vital capacity, tidal volume, respiratory rate, and minute volume) and assessment of pain intensity using a simple, categorical, verbal rating scale were obtained before and after institution of analgesia. Any nausea, vomiting, hypotension, urinary retention, respiratory depression or pruritus were recorded. RESULTS: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd day after epidural analgesia when compared with the preanalgesia levels (P < 0.001). Changes in the verbal rating scale demonstrated that epidural buprenorphine was associated with marked improvement in pain at rest and pain during coughing and deep breathing. None of our patients developed hypotension (<10% of the baseline), urinary retention or respiratory depression. Nausea, vomiting, and mild pruritus were the only reported complications. CONCLUSIONS: Epidurally introduced narcotic, like buprenorphine in saline, has been found to be effective in our study to achieve adequate analgesia in treatment of patients with multiple rib fractures. In addition, this methodology of pain relief eliminates the costly delivery system and early discharge, and allows walking epidurals and follow-up on outpatient basis.
Subject(s)
Analgesia, Epidural , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Pain/drug therapy , Rib Fractures/drug therapy , Female , Humans , Male , Middle Aged , Pain/physiopathology , Pain Measurement , Prospective Studies , Pulmonary Ventilation/drug effects , Respiratory Function Tests , Tidal Volume/drug effects , Time Factors , Vital Capacity/drug effectsSubject(s)
Analgesics, Opioid/therapeutic use , Arthroscopy , Morphine/therapeutic use , Pain, Postoperative/drug therapy , Adult , Aged , Amides/administration & dosage , Amides/therapeutic use , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Anesthetics, Local/administration & dosage , Anesthetics, Local/therapeutic use , Drug Combinations , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Morphine/administration & dosage , Morphine/adverse effects , Ropivacaine , Shoulder/surgerySubject(s)
Amides , Anesthetics, Local , Cervical Plexus , Neck/surgery , Nerve Block , Aged , Bupivacaine , Endarterectomy , Female , Humans , Lidocaine , Male , Paresthesia/chemically induced , RopivacaineSubject(s)
Anesthetics, Local/pharmacology , Leukotrienes/metabolism , Phospholipids/metabolism , Prostaglandins/biosynthesis , Animals , Cattle , Chromatography, Thin Layer , Dibucaine/pharmacology , In Vitro Techniques , Lysophosphatidylcholines/biosynthesis , Microsomes/metabolism , Phosphatidylcholine-Sterol O-Acyltransferase/antagonists & inhibitors , Tetracaine/pharmacologySubject(s)
Amides/administration & dosage , Amides/therapeutic use , Anesthesia, Epidural , Anesthetics, Local/administration & dosage , Anesthetics, Local/therapeutic use , Multiple Trauma/complications , Pain/drug therapy , Rib Fractures/complications , Adult , Female , Humans , Male , Middle Aged , Multiple Trauma/physiopathology , Pain/etiology , Respiratory Function Tests , Rib Fractures/physiopathology , RopivacaineSubject(s)
Clonidine/pharmacology , Idazoxan/pharmacology , Muscle, Smooth, Vascular/drug effects , Yohimbine/pharmacology , Animals , Carotid Arteries/drug effects , Carotid Arteries/physiology , Dogs , Idazoxan/antagonists & inhibitors , In Vitro Techniques , Muscle, Smooth, Vascular/physiology , Receptors, Adrenergic, alpha/physiology , Vasoconstriction/drug effects , Vasoconstriction/physiology , Yohimbine/antagonists & inhibitorsSubject(s)
Carotid Artery, Common/metabolism , Lidocaine/pharmacokinetics , Absorption , Animals , DogsSubject(s)
Kidney/injuries , Adolescent , Child , Child, Preschool , Humans , Kidney/diagnostic imaging , Kidney/surgery , Laparotomy , New York City , Radiography , Retrospective Studies , Wounds, Gunshot/drug therapy , Wounds, Gunshot/epidemiology , Wounds, Gunshot/surgery , Wounds, Nonpenetrating/drug therapy , Wounds, Nonpenetrating/epidemiology , Wounds, Nonpenetrating/surgery , Wounds, Stab/drug therapy , Wounds, Stab/epidemiology , Wounds, Stab/surgeryABSTRACT
Complete thrombotic occlusion of the arterial blood flow in the upper extremity was produced after mixture of Isovue 370 (iopamidol) and papaverine hydrochloride during routine angiography. Bolus and then continuous infusion of urokinase failed to dissolve the thrombus. The patient required a surgical thrombectomy and recovered uneventfully. This case report demonstrates that caution should be exercised when Isovue 370 and papaverine are used in angiography.
