Adult ; Amides ; adverse effects ; Benzene ; adverse effects ; Burns, Chemical ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Nitro Compounds ; adverse effects ; Young Adult

OBJECTIVE: To investigate the effect of pretreatment with neurotrophin-3 (NT-3) on intrathecal ropivacaine in rats. METHODS: A total of 144 male Sprague Dawley rats weighing 280-320 g were successfully implanted with microspinal cather following the improved methods of Yaksh. The rats were randomly divided into 4 groups and given saline (Group NS, n=36), 0.5% ropivacaine (Group M, n=36), 1% ropivacaine (Group R, n=36), and ropivacaine+NT-3 (Group T, n=36). The rats received 0.12 mL/ kg body weight of ropivacaine at 0.5% or 1%, or normal saline only, via an implanted intrathecal catheter at 90-min interval for 12 h in Group NS, M, R and T. In the meantime the rats also received NT-3 0.1 mg/kg in group T. On days 1, 3, 5, 7, 14 and 28, we assessed the paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL), behavioural change and histopathological damage score changed for possible neuronal injury within the spinal cord. RESULTS: Compared with Group NS and Group M, the PWMT and PWTL were significantly higher on 1, 3, 5 d and the histopathological damage score was significantly higher on 1, 3, 5, 7, 14 d in Group R (P<0.05). Compared with Group T, the PWMT and PWTL in Group R were significantly higher on 1, 3, 5 d and histopathological damage score was significantly higher on 5, 7, 14 d (P<0.05). CONCLUSION NT-3 pretreatment in mice has obvious protective effect against repeated intrathecal injection of 1% ropivacaine in the spinal nerve.
Amides ; adverse effects ; Animals ; Injections, Spinal ; Male ; Neurotrophin 3 ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Ropivacaine ; Spinal Cord ; drug effects

BACKGROUNDA wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever. Recently, evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever. The aim of the present study was to investigate the effects of epidural analgesia with 0.075% or 0.1% ropivacaine on the maternal temperature during labor.

METHODSTwo hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine. Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 µg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine, and maintained with 7 ml bolus doses of the above mentioned mixed analgesics every 30 minutes by the patient-controlled epidural analgesia. The measurements included the maternal oral temperature, visual analog scale pain scores, labor events and neonatal outcomes.

RESULTSEpidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation of analgesia and the oxytocin administration during labor compared with the one with 0.1% ropivacaine. Moreover, 0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes.

CONCLUSIONEpidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor.

Adult ; Amides ; administration & dosage ; therapeutic use ; Analgesia, Epidural ; adverse effects ; Analgesia, Obstetrical ; adverse effects ; Body Temperature ; drug effects ; Female ; Fever ; chemically induced ; Humans ; Labor, Obstetric ; Pregnancy ; Young Adult

PURPOSE: Intravenous lipid emulsions have been used to treat the systemic toxicity of local anesthetics. The goal of this in vitro study was to examine the effects of lipid emulsions on the norepinephrine-mediated reversal of vasodilation induced by high doses of levobupivacaine, ropivacaine, and mepivacaine in isolated endothelium-denuded rat aorta, and to determine whether such effects are associated with the lipid solubility of local anesthetics. MATERIALS AND METHODS: The effects of lipid emulsions (0.30, 0.49, 1.40, and 2.61%) on norepinephrine concentration-responses in high-dose local anesthetic (6x10-4 M levobupivacaine, 2x10-3 M ropivacaine, and 7x10-3 M mepivacaine)-induced vasodilation of isolated aorta precontracted with 60 mM KCl were assessed. The effects of lipid emulsions on local anesthetic- and diltiazem-induced vasodilation in isolated aorta precontracted with phenylephrine were also assessed. RESULTS: Lipid emulsions (0.30%) enhanced norepinephrine-induced contraction in levobupivacaine-induced vasodilation, whereas 1.40 and 2.61% lipid emulsions enhanced norepinephrine-induced contraction in both ropivacaine- and mepivacaine-induced vasodilation, respectively. Lipid emulsions (0.20, 0.49 and 1.40%) inhibited vasodilation induced by levobupivacaine and ropivacaine, whereas 1.40 and 2.61% lipid emulsions slightly attenuated mepivacaine (3x10-3 M)-induced vasodilation. In addition, lipid emulsions attenuated diltiazem-induced vasodilation. Lipid emulsions enhanced norepinephrine-induced contraction in endothelium-denuded aorta without pretreatment with local anesthetics. CONCLUSION: Taken together, these results suggest that lipid emulsions enhance the norepinephrine-mediated reversal of local anesthetic-induced vasodilation at toxic anesthetic doses and inhibit local anesthetic-induced vasodilation in a manner correlated with the lipid solubility of a particular local anesthetic.
Amides/adverse effects ; Anesthetics, Local/*adverse effects ; Animals ; Bupivacaine/adverse effects/analogs & derivatives ; Emulsions/*chemistry/*therapeutic use ; Lipids/*chemistry ; Male ; Mepivacaine/adverse effects ; Norepinephrine/*therapeutic use ; Rats ; Rats, Sprague-Dawley ; Vasodilation/*drug effects

OBJECTIVETo investigate the effects, side-effects and security of bupivacaine, ropivacaine combined with fentanyl in postoperative continuous epidural analgesia.

METHODSA total of 1 600 postoperative continuous epidural analgesia patients receiving different agents in SICU were divided into two groups: 0.1% bupivacaine +5 microg/ml fentanyl group (group B, n = 920) and 0.2% ropivacaine +2 microg/ml fentanyl group (group R, n = 680). The effects (visual analog-scale score and content to analgesia), side effects were analyzed retrospectively in the two groups.

RESULTSCompared with group B, patients in group R had higher analgesia contentment (P < 0.05), but no difference in visual analog-scale score was found in the two groups. The incidences of urinary retention, nausea and vomiting, skin itching in group B were significantly higher than those in group R (P < 0.05). In each group, patients over sixty had higher ratio of hypotension than those under sixty (P < 0.05); The female patients had a higher incidence of nausea and vomiting than male patients (P < 0.05); The incidence of debility and numbness of lower limbs in patients with lumbar segments epidural analgesia was higher than those with thoracic analgesia (P < 0.05).

CONCLUSIONS0.1% bupivacaine +5 microg/ml fentanyl and 0.2% ropivacaine +2 microg/ml fentanyl can provide adequate pain relief in postoperative continuous epidural analgesia, and 0.2% ropivacaine +2 microg/ml fentanyl comes with less side effects. The incidence of complication is related with analgesics, age, gender and the position of epidural puncture.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Amides ; administration & dosage ; adverse effects ; Analgesia, Epidural ; adverse effects ; methods ; Analgesia, Obstetrical ; adverse effects ; methods ; Analgesics, Opioid ; administration & dosage ; adverse effects ; Anesthetics, Local ; administration & dosage ; adverse effects ; Bupivacaine ; administration & dosage ; adverse effects ; Female ; Fentanyl ; administration & dosage ; adverse effects ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; prevention & control ; Retrospective Studies

BACKGROUNDIncreased renal sympathetic nerve activity can result in diuretic resistance in patients with chronic congestive heart failure. We investigated the effect of regional renal nerve blockade on the patients with chronic refractory heart failure and diuretic resistance.

METHODSEighteen patients with chronic refractory heart failure were enrolled (mean age (64 ± 11) years). The patients were randomly divided into two groups (renal nerve blockade group and standard therapy group, n = 9 each). Renal nerve blockade was performed by percutaneous injection of local anaesthetic under computed tomographic guidance. Heart rate, mean arterial blood pressure, plasma and urine electrolytes, neurohormones, factional excretion of sodium (FENa), 24-hour urine volume were monitored at baseline and the first 24 hours after therapy. Dyspnea and oedema were also evaluated. The major adverse cardiovascular events (MACE), plasma brain natriuretic peptide (BNP) level and left ventricular ejection fraction (LVEF) were compared between the two groups during the 3 - 12 months follow-up period.

RESULTSNo complication was observed during the acute phase of renal nerve blockade. After renal nerve blockade, the 24-hour urine volume and FENa were significantly increased, while the level of plasma rennin, angiotensin II, aldosterone, BNP and atrial natriuretic peptide as well as dyspnea and oedema were significantly reduced in renal nerve blockade group compared with baseline and standard therapy group. During three to 12 months of follow-up, the rate of MACE and plasma BNP level were significantly lower, while LVEF was significantly higher in renal nerve blockade group than those in standard therapy group.

CONCLUSIONRegional renal nerve blockade may be a safe and effective treatment for patients with chronic refractory heart failure.

Aged ; Amides ; adverse effects ; therapeutic use ; Anesthetics, Local ; adverse effects ; therapeutic use ; Female ; Heart Failure ; drug therapy ; Heart Rate ; drug effects ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Nerve Block ; methods ; Treatment Outcome

Adolescent ; Adult ; Aged ; Amides ; adverse effects ; Analgesia ; Anesthesia, Epidural ; Bradycardia ; chemically induced ; Double-Blind Method ; Humans ; Hypotension ; chemically induced ; Hysterectomy ; Mesylates ; adverse effects ; Middle Aged ; Pain, Postoperative ; drug therapy ; Postoperative Period

BACKGROUNDLowering intraocular pressure (IOP) is currently the only therapeutic approach in primary open-angle glaucoma. and the fixed-combination medications are needed to achieve sufficiently low target IOP. A multicenter prospective study in the Chinese population was needed to confirm the safety and efficacy of Bimatoprost/Timolol Fixed Combination Eye Drop in China. In this study, we evaluated the safety and efficacy of Bimatoprost/Timolol Fixed Combination with concurrent administration of its components in Chinese patients with open-angle glaucoma or ocular hypertension.

METHODSIn this multicenter, randomized, double-masked, parallel controlled study, patients with open-angle glaucoma or ocular hypertension who were insufficiently responsive to monotherapy with either topical β-blockers or prostaglandin analogues were randomized to one of two active treatment groups in a 1:1 ratio at 11 Chinese ophthalmic departments. Bimatoprost/timolol fixed combination treatment was a fixed combination of 0.03% bimatoprost and 0.5% timolol (followed by vehicle for masking) once daily at 19:00 P.M. and concurrent treatment was 0.03% bimatoprost followed by 0.5% timolol once daily at 19:00 P.M. The primary efficacy variable was change from baseline in mean diurnal intraocular pressure (IOP) at week 4 visit in the intent-to-treat (ITT) population. Primary analysis evaluated the non-inferiority of bimatoprost/ timolol fixed combination to concurrent with respect to the primary variable using a confidence interval (CI) approach. Bimatoprost/timolol fixed combination was to be considered non-inferior to concurrent if the upper limit of the 95% CI for the between-treatment (bimatoprost/timolol fixed combination minus concurrent) difference was ≤ 1.5 mmHg. Adverse events were collected and slit-lamp examinations were performed to assess safety. Between-group comparisons of the incidence of adverse events were performed using the Pearson chi-square test or Fisher's exact test.

RESULTSOf the enrolled 235 patients, 121 patients were randomized to receive bimatoprost/timolol fixed combination and, 114 patients were randomized to receive concurrent treatment. At baseline the mean value of mean diurnal IOP was (25.20 ± 3.06) mmHg in the bimatoprost/timolol fixed combination group and (24.87 ± 3.88) mmHg in the concurrent group. The difference between the treatment groups was not statistically significant. The mean change from baseline in mean diurnal IOP (± standard deviation) in the bimatoprost/timolol fixed combination group was (-9.38 ± 4.66) mmHg and it was (-8.93 ± 4.25) mmHg in the concurrent group (P < 0.01). The difference between the two treatment groups (bimatoprost/timolol fixed combination minus concurrent) in the change from baseline of mean diurnal IOP was -0.556 mmHg (95% CI: -1.68, 0.57, P = 0.330). The upper limit of the 95% CI was less than 1.5 mmHg, the predefined margin of non-inferiority. Adverse events occurred in 26.4% (32/121) of the bimatoprost/timolol fixed combination patients and 30.7% (35/114) of the concurrent patients. The most frequent adverse event was conjunctival hyperemia, which was reported as treatment related in 16.5% (20/121) in the bimatoprost/timolol fixed combination group and 18.4% (21/114) in the concurrent group (P > 0.05).

CONCLUSIONSBimatoprost/Timolol Fixed Combination administered in Chinese patients with open-angle glaucoma or ocular hypertension was not inferior to concurrent dosing with the individual components. Safety profiles were similar between the treatment groups.

Adolescent ; Adult ; Aged ; Amides ; administration & dosage ; adverse effects ; therapeutic use ; Bimatoprost ; Cloprostenol ; administration & dosage ; adverse effects ; analogs & derivatives ; therapeutic use ; Female ; Glaucoma, Open-Angle ; drug therapy ; Humans ; Male ; Middle Aged ; Ocular Hypertension ; drug therapy ; Timolol ; administration & dosage ; adverse effects ; therapeutic use ; Young Adult

OBJECTIVETo compare efficacy and side effects of patient-controlled epidural analgesia (PCEA) with levobupivacaine, ropivacaine and racemic bupivacaine after cesarean section.

METHODSIn this prospective, randomized double-blind study, 90 ASA I-II full-term nulliparous women (aged 25-38 years with body weight of 59-87 kg) undergoing elective cesarean section under spinal-epidural anesthesia equally allocated into 3 groups. PCEA was administered with 0.125% levobupivacaine and 20 microg/ml morphine (group L, n=30), 0.125% ropivacaine and 20 microg/ml morphine (group R, n=30), and 0.125% bupivacaine and 20 microg/ml morphine (group B, n=30), respectively. The Visual Analog Scale (VAS) score, satisfaction rate, patients' overall impression of treatment, modified Bromage motor score, and incidence of side effects were recorded at regular intervals after operation.

RESULTSThe three groups were comparable with respect to the efficacy of analgesia, patients' overall impression of treatment, motor blockade and side effects. There was significant difference in patients' satisfaction rate between group R (70%) and the other two groups (93.3% in group L and 96.6% in group B, P<0.05).

CONCLUSIONPCEA with 0.125% levobupivacaine and morphine 20 microg/ml produces better analgesic effect with little side effects after cesarean section.

Adult ; Amides ; administration & dosage ; adverse effects ; Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesia, Patient-Controlled ; Bupivacaine ; administration & dosage ; adverse effects ; analogs & derivatives ; Cesarean Section ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Morphine ; administration & dosage ; Nausea ; chemically induced ; Pregnancy ; Prospective Studies ; Pruritus ; chemically induced ; Treatment Outcome ; Vomiting ; chemically induced

PURPOSE: Several analgesic techniques are available for pain management after a major operation. MATERIALS AND METHODS: From December 2005 to February 2006, a prospective, double-blind study was performed involving 90 patients who had undergone a total knee arthroplasty. Patients were randomly divided into three equal groups (n=30). Demographic data, including age, height, weight, knee score, visual analogue scale (VAS), and range of flexion were evaluated preoperatively. Before wound closure, patients were given intra-synovial injections of the following solutions: patients in group I received 40mL of 300mg ropivacaine with 1:200,000 epinephrine and 5mg morphine; patients in Group II received 40mL of 300mg ropivacaine with epinephrine; and patients in Group III received 50mL normal saline as a control. All patients received an epidural patient-controlled analgesia (PCA) for 24 postoperative hours. Analgesic efficacy was evaluated using the VAS at intervals of 2, 4, 6, 12, 24, 32, 40, and 48 hours postoperatively. During this period, the side effects, the dosage of rescue analgesia required, and the range of knee flexion were recorded for each group. RESULTS: There were no significant differences among the three groups with regards to the VAS and the required dose of rescue analgesia (p > 0.05). None of the groups demonstrated significant differences in the range of knee flexion and the incidence of postoperative nausea and emesis (p > 0.05). CONCLUSION: Therefore, we found that ropivacaine, alone or with morphine, injected into the synovial tissue, along with an epidural PCA has no additional benefits in pain control after a total knee arthroplasty.
Synovial Membrane ; Range of Motion, Articular ; Postoperative Complications/*prevention & control ; Pain, Postoperative/*drug therapy ; Osteoarthritis/surgery ; Morphine/administration & dosage/*therapeutic use ; Middle Aged ; Male ; Knee Prosthesis/*adverse effects ; Humans ; Female ; Double-Blind Method ; Arthritis, Rheumatoid/surgery ; Anesthetics, Local/administration & dosage/*therapeutic use ; Anesthesia, Epidural ; Analysis of Variance ; Analgesia ; Amides/administration & dosage/*therapeutic use ; Aged