Recently, intravenous lidocaine has been reported to relieve chronic pain and to suppress the spontaneous abnormal ectopic discharge in injured nerve. Interest in the use of these modalities has been stimulated by animal researches of neuropathic pain syndromes. We performed this study to evaluate the analgesic responses and the side effects of intravenous(IV) irifusion of lidocaine used in chronic pain patients. Patients received 5 mg/kg of lidocaine, mixed in 150 mL over 40 minutes. The analgesic efficacy was evaluated in 20, 40, 60 minutes after the start of the initial IV lidocaine infusion, by a numeric rating scales (NRS) scores. The responders were received the repeated infusions at one week interval. The results were as follows; 1. Mean NRS scores was 6.7+/-1.9 before the infusion, and changed to 4.2, 2.7, 2.6, in 20,40,60 minutes after the start of the initial IV lidocaine infusion. 2. Eight of ten patients were responders during initial IV lidocaine infusion, and two patients were nonresponders. During the series of repeated lidocaine infusions to eight responders, six were partial relief, and two were complete relief of their pain without any medication. The diagnoses in responders were diabetic neuropathy, ischemic neuropathy, traumatic neuropathy, causalgia, reflex sympathetic dystrophy, erythromelalgia, and spinal stenosis. 3. The side effects, including sedation, dizziness, slurred speech, circumoral numbness, and lightheadedness, were not serious during the period of infusion. The conclusion is that repeated intravenous lidocaine infusions would be effective in the management of chronic pain states. But it needs more studies on the method of infusion and the safety of these modalities.
Analgesia ; Animal Experimentation ; Causalgia ; Chronic Pain* ; Diabetic Neuropathies ; Diagnosis ; Dizziness ; Erythromelalgia ; Humans ; Hypesthesia ; Infusions, Intravenous* ; Lidocaine* ; Neuralgia ; Reflex Sympathetic Dystrophy ; Spinal Stenosis ; Weights and Measures

BACKGROUND: The aim of this study was to evaluate the effects of respiratory depression of IV-PCA using morphine which has potent respiratory depression or nalbuphine which has less potent respiratory depression among opioids. METHODS: Forty patients were divided into two groups; Group M was used morphine, and Group N was used nalbuphine as a drug for IV-PCA. When patient emerges from general anesthesia, Group M was given initial bolus of 0.1 ml/kg of 0.1% morphine solution and connected Basal Bolus PCA infusor R containing morphine 50 mg per 40 ml in normal saline. Group N, similarly Group M, was given initial bolus of 0.1 ml/kg of 0.1% nalbuphine solution, and connected PCA infusor containing nalbuphine 50 mg per 40 ml in normal saline. To compare respiratory depression, arterial blood gas analyses were done preoperatively and at 1, 6 and 12 hour after IV-PCA. Simultaneously, analgesic and side effects were evaluated. RESULTS: There were no remarkable respiratory depression such as hypercarbia(PaCO2 > 50 mmHg), hypoxemia(PaO2 < 60 mmHg) and slow respiratory rate in both groups. Analgesic and side effects were similar in both groups. CONCLUSIONS: We conclude that IV-PCA using morphine or nalbuphine is relatively effective and safe method for the postoperative pain control. Ordinarily, IV-PCA dose not induce respiratory depression unless overdose in careless or mistaken mishaps are developed.
Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Anesthesia, General ; Blood Gas Analysis ; Humans ; Infusion Pumps ; Morphine* ; Nalbuphine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency* ; Respiratory Rate

OBJECTIVES: In order to assess the effects of sera from severe preeclamptic patients on endothelial cell viability in vitro and endothelin-1 synthesis in cultured human umbilical vein endothelial cells. METHODS: The cultured human umbilical vein endothelial cells were incubated with media containing 10% sera from women with either preeclamptic patients or normal pregnancies for 24 hours or 48 hours. After then, their viability was measured by colorimetric MTT{3-(4,5-dimethylthiazol-2yl)2,5-diphenyl tetrazolium bromide} assay and their production of endothelin-1 was measured. We also measured the serum levels of endothelin-1 level in sera obtained from the normal and severe preeclamptic pregnancies. RESULTS: The calorimetric MTT assay revealed that after 24 hours, the absorbances in the media treated with normal pregnancies and severe preeclampsia sera were 0.0718+/-0.0078 and 0.0837+/-0.0129, respectively and after 48 hours, they were 0.1133+/-0.0103 and 0.1268+/-0.0186, respectively. Serum obtained from severe preeclampsia did not affect endothelial cell viability. 2. The serum mean levels of endothelin-1 in normal and severe preeclamptic pregnancies were 22.66+/-8.6 fmol/ml and 48.98+/-25.27 fmol/ml. The mean level in preeclamptic sera was significantly higher than that of normal pregnant women. (P<0.05) 3. After 24 hours, the mean amount of endothelin-1 stimulated by normal pregnant and severe preeclamptic sera were 37.52+/-18.41 fmol/ml and 97.58+/-53.64 fmol/ml, respectively. The mean amount of endothelin-1 in preeclamptic sera-treated cells was significantly higher than that of normal pregnant sera-treated cells. (P<0.05). CONCLUSION: The sera from severe preeclamptic women do not affect cell viability but act selectively on specific activation of their function such as endothelin-1 production. And it is necessary that the identification and isolation of the putative serum factor(s) will be performed to resolve the pathogenesis in future.
Cell Survival ; Endothelial Cells* ; Endothelin-1* ; Female ; Human Umbilical Vein Endothelial Cells* ; Humans ; Humans* ; Pre-Eclampsia ; Pregnancy ; Pregnant Women