A randomized, within-patient, cross-over, placebo-controlled trial on the efficacy and tolerability of the tricyclic antidepressants chlorimipramine and nortriptyline in central pain.

Antidepressant drugs are increasingly used in the management of chronic pain. They are mainly prescribed for cancer-related pain and central pain, e.g. phantom or stump pain, post-herpetic neuropathy. However, no controlled clinical trials have validated their in either pathology. Thus, physicians still do not know whether antidepressants are really effective and which might be best. It is still debated whether the effect of antidepressants in the management of chronic pain is limited to the amelioration of frequently concomitant depression or extends to pain itself. To verify both the analgesic effect of tricyclic antidepressants, and the possible relationship between their antidepressant effect and the relief of central pain, we carried out a randomized, within-patient (cross-over) placebo-controlled study in patients suffering from central pain. The results clearly indicate the better analgesic effect of tricyclic antidepressants over placebo (p less than 0.0001). Within the antidepressants tested, chlorimipramine, a blocker of serotonin reuptake, is significantly more effective (p less than 0.0001) than notriptyline, a blocker of noradrenaline reuptake. Finally, the antinociceptive effect is independent of the effects of the two drugs on the symptoms of depression.

Evaluation of the analgesic activity and tolerability of aceclofenac in the treatment of post-episiotomy pain.

The activity and tolerability of aceclofenac, a new arylacetic anti-inflammatory drug, was assessed in the treatment of post-episiotomal pain in a controlled double-blind study with paracetamol. Aceclofenac was administered in single 100 mg doses and paracetamol in single 650 mg doses (both drugs in tablet form) to 60 women aged between 18 and 38 years with post-episiotomal pain. They were randomised into two groups of 30 patients. The severity of the pain was assessed by the patients using an analog visual test (Huskisson's test) before treatment and 0.5, 1,2,3,4,5 and 6h after receiving the drug. At the end of the study, the investigator questioned the patients about the evolution of their pain and any side-effects that might have appeared during the 6 h of observation. On the basis of their replies, the investigator evaluated the pain on a semi-quantitative scale of 5 points. The tolerability was assessed on the basis of the appearance of any undesired effects. The patients treated with drug A* showed a progressive and marked reduction of their pain with a significant difference from the baseline score after the second hour of observation (Huskisson's test) and after the first hour (physician's assessment with the 5-point scale), respectively. The antalgic effect of drug B showed a similar evolution over time to drug A but the analgesic efficacy seemed to be much less.(ABSTRACT TRUNCATED AT 250 WORDS)

Successful treatment of biliary colic with intravenous ketoprofen or lysine acetylsalicylate.

In a double-blind trial, 60 patients with biliary colic were allocated at random to receive 200 mg ketoprofen, 1.8 g lysine acetylsalicylate or placebo by intravenous bolus. The patients were asked to rate their pain at intervals within 3 hours of injection and to indicate their overall pain experience on a visual analogue scale. Both ketoprofen and lysine acetylsalicylate proved significantly more effective than placebo in relieving pain, with no significant difference between them. A good analgesic response, reflected by complete or almost complete relief of pain within 30 minutes of injection, was recorded in 4, 17, and 16 patients, respectively, in the placebo, ketoprofen, and lysine acetylsalicylate treatment groups. All drugs were well tolerated. It is concluded that the results provide further evidence for a useful therapeutic role of prostaglandin inhibitors in the treatment of biliary colic.

Regional intravenous guanethidine vs. stellate ganglion block in reflex sympathetic dystrophies: a randomized trial.

Regional intravenous guanethidine blocks and stellate ganglion blocks have been compared in a randomized trial. Nineteen patients, randomly allocated to two groups of therapy and exhibiting severe reflex sympathetic dystrophy following peripheral nerve lesions, have been treated. The performance of the intravenous guanethidine block is of longer duration and superior to stellate ganglion block, as regards some early pharmacological effects (skin temperatures and amplitude of plethysmographic waves recorded before blockade and 15 min, 60 min, 24 h, 48 h after institution of the block). In fact the intravenous guanethidine group shows a persistent and significant increase of the skin temperature and of the plethysmographic traces in the blocked side 24 h and 48 h after blockade in comparison with the patients treated with stellate ganglion block. Concerning the therapeutic effects (changes in pain scores and clinical signs--hyperpathia, allodynia, vasomotor disturbances, trophic changes, oedema and limited motion), recorded at the end of treatment and 1 month and 3 months follow-up, an intravenous guanethidine block carried out every 4 days up to a total of 4 blocks is comparable with a stellate ganglion block every day up to a total of 8 blocks. The results of this study show that regional sympathetic block with guanethidine is a good therapeutic tool in the treatment of reflex dystrophies, especially on account of its negligible risks and contraindications.

[Technique of general anesthesia with tracheal intubation for endoscopic maneuvers in otorhinolaryngologic surgery]. / Metodica di anestesia generale senza intubazione tracheale per le manovre endoscopiche in chirurgia otorinolaringoiatrica.

On the basis of experience of 25 patients subjected to suspension laryngoscopy and bronchoscopy, it is shown that the technique of anaesthesiology conduction adopted responds to the needs of the anaesthesist and the laryngoscopist. Althesin in particular has been found to possess the requisites for this type of diagnostic manoeuvre.

[Muscular pains induced by suxamethonium. Prevention by use of self-taming dose (author's transl)]. / Les douleurs consécutives à l'administration de suxaméthonium. Méthode de la petite dose préventive.

The authors have tried out a new way of administrating suxamethonium called self-taming dose, to sixty adult patients. A little dose of 10 mg is injected 30-60 seconds before the normal dose of 1-1.5 mg/kg. A real diminution of the frequence of muscule pain was found. This method was found of very simple use, in order to avoid post-operative muscle pain.