pancuronium and Pain--Postoperative

Topics: Atracurium; Diazepam; Gallamine Triethiodide; Humans; Lidocaine; Muscles; Pain, Postoperative; Pancuronium; Succinylcholine; Tubocurarine

In this study, we examined the effect of choice of neuromuscular blocking drug (NMBD) (pancuronium versus rocuronium) on postoperative recovery times and associated adverse outcomes in patients undergoing orthopedic surgical procedures. Seventy patients were randomly allocated to a pancuronium or rocuronium group. On arrival to the postanesthesia care unit (PACU) and again 30 min later, train-of-four ratios were quantified by using acceleromyography. Immediately after acceleromyographic measurements, patients were assessed for signs and symptoms of residual paresis. During the PACU admission, episodes of hypoxemia, nausea, and vomiting were recorded. The time required for patients to meet discharge criteria and the time of actual PACU discharge were noted. Forty percent of patients in the pancuronium group had train-of-four ratios <0.7 on arrival to the PACU, compared with only 5.9% of subjects in the rocuronium group (P < 0.001). Patients in the pancuronium group were more likely to experience symptoms of muscle weakness (blurry vision and generalized weakness; P < 0.001) and hypoxemia (10 patients in the rocuronium group versus 21 patients in the pancuronium group; P = 0.015) during the PACU admission. Significant delays in meeting PACU discharge criteria (50 min [45-60 min] versus 30 min [25-40 min]) and achieving actual discharge (70 min [60-90 min] versus 57.5 min [45-61 min]) were observed when the pancuronium group was compared with the rocuronium group (P < 0.001). In conclusion, our study indicates that PACU recovery times may be prolonged when long-acting NMBDs are used in surgical patients.. Clinical recovery may be delayed in surgical patients administered long-acting neuromuscular blocking drugs. During the postanesthesia care unit admission, patients randomized to receive pancuronium (versus rocuronium) were more likely to exhibit symptoms of muscle weakness, develop hypoxemia, and require more time to meet discharge criteria.

Topics: Adult; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Double-Blind Method; Female; Humans; Hypoxia; Male; Middle Aged; Monitoring, Intraoperative; Muscle Weakness; Neuromuscular Blocking Agents; Neuromuscular Nondepolarizing Agents; Orthopedic Procedures; Oxygen Inhalation Therapy; Pain Measurement; Pain, Postoperative; Pancuronium; Postoperative Complications; Postoperative Nausea and Vomiting; Rocuronium

To evaluate the efficacy of preemptive analgesia in surgical repair of retinal detachment (RD) using scleral buckle and cryopexy under general anesthesia.. Thirty patients who were scheduled for rhegmatogenous RD surgical repair using scleral buckle and cryopexy and who were American Society of Anesthesiologists physical status I, II, or III were included in this study. The patients were randomly divided into two equal groups. The surgery was done under general anesthesia in both groups, but in Group 2, sub-Tenon anesthesia was given as preemptive analgesia after induction anesthesia and before start of surgery. Both groups were statistically comparable as regards patient age and weight and duration of anesthesia and surgery.. The incidences of intraoperative oculocardiac reflex and postoperative vomiting were significantly lower in Group 2 compared with Group 1 (P < 0.001 and 0.0113, respectively). The time of first postoperative analgesic dose was significantly shorter in Group 1 (46.67 +/- 18.84 minutes) compared with Group 2 (162.67 +/- 29.391 minutes) (P < 0.001). The total analgesic consumption per 24 hours was significantly higher in Group 1 compared with Group 2 (P < 0.001). The time of discharge from the hospital was significantly shorter in Group 2 (8.8 +/- 2.704 hours) compared with Group 1 (12.4 +/- 3.481 hours) (P = 0.0018).. The use of sub-Tenon block as preemptive analgesia after induction of general anesthesia and before the start of rhegmatogenous RD surgical repair was effective in reducing postoperative pain and analgesic requirements compared with an unblocked group. The use of sub-Tenon block was also effective in reducing intraoperative incidence of oculocardiac reflex and postoperative incidence of vomiting.

Topics: Adolescent; Adult; Analgesia; Anesthesia, General; Anesthesia, Local; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics, Local; Bupivacaine; Cryosurgery; Halothane; Humans; Intraoperative Complications; Lidocaine; Middle Aged; Pain, Postoperative; Pancuronium; Procaine; Propofol; Retinal Detachment; Scleral Buckling

Recovery from anaesthesia was compared, in a group of patients (n = 25) receiving a mixture of glycopyrrolate and neostigmine (to reverse non-depolarizing neuromuscular blockade), with recovery in a group of patients (n = 25) receiving an atropine-neostigmine mixture. Recovery following anaesthesia was more rapid in the patients receiving the glycopyrrolate-neostigmine mixture.

Topics: Adult; Atropine; Brain; Female; Glycopyrrolate; Humans; Male; Middle Aged; Neostigmine; Neuromuscular Junction; Opium; Pain, Postoperative; Pancuronium; Pyrrolidines; Succinylcholine; Time Factors

One hundred and ninety-eight patients undergoing minor surgery were assessed for evidence of post-suxamethonium muscle pain on the 1st and 2nd days following surgery. Patients were allocated to nine groups and were given one of four non-depolarizing neuromuscular blocking drugs (vecuronium, gallamine, tubocurarine or pancuronium) 1 or 2 min before the administration of suxamethonium. A control group received an inert medication. Forty-one per cent of patients receiving no pretreatment experienced muscle pain. This frequency was decreased to around 20% following pretreatment. In general, the frequency of pain was less in the groups receiving pretreatment at 1 min, but the difference was not significant. The groups receiving vecuronium before suxamethonium had the lowest overall frequency of pain over the 2 days (19%), although this was not significantly different from other pretreatments.

Topics: Adolescent; Adult; Aged; Creatine Kinase; Female; Humans; Male; Middle Aged; Muscle Contraction; Muscles; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Potassium; Preanesthetic Medication; Succinylcholine; Time Factors; Vecuronium Bromide

Five different non-depolarizing muscle relaxants and a control solution of saline were studied as precurarization agents. Two hundred and twenty-two surgical patients (ASA I-II) were allocated in a double-blind fashion to one of the following groups: d-tubocurarine 0.05 mg/kg, alcuronium 0.03 mg/kg, pancuronium 0.01 mg/kg, gallamine 0.25 mg/kg, ORG NC-45 (vecuronium) 0.01 mg/kg and saline solution 0.005 ml/kg. Pretreatment was performed 4 min before administering a 1.5 mg/kg bolus of succinylcholine (SCh). Fasciculations, intubation conditions, duration of neuromuscular blockade after SCh, serum potassium changes and postoperative myalgias (in 60 patients) were recorded. All the drugs studied prevented fasciculations significantly (P less than 0.05) more than in the control group. d-Tubocurarine and alcuronium were superior to the others in this respect. Intubation conditions were best in the control and pancuronium groups, but there was no significant difference between the pancuronium and d-tubocurarine or between the d-tubocurarine and alcuronium groups. Pancuronium pretreatment prolonged the SCh block significantly, whereas other agents shortened the duration of the SCh block. The antagonism of the SCh block apparently also affected intubation conditions, although intubation remained satisfactory. A statistically significant rise in serum potassium level was measured only in the control and pancuronium groups. In the control and pancuronium groups, four patients out of 10 had postoperative myalgias, whereas in the other groups only one or none out of 10 had them (0/10 vs. 4/10; 0.10 greater than P greater than 0.05). In conclusion, d-tubocurarine and alcuronium seem to have advantages over pancuronium, ORG NC-45 and gallamine for precurarization.

Topics: Adolescent; Adult; Alcuronium; Anesthesia, General; Clinical Trials as Topic; Double-Blind Method; Female; Gallamine Triethiodide; Humans; Hyperkalemia; Male; Middle Aged; Muscle Contraction; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Preanesthetic Medication; Succinylcholine; Toxiferine; Tubocurarine; Vecuronium Bromide

The frequency of post-suxamethonium pain after pretreatment with small doses of non-depolarizing neuromuscular blocking agents was studied in 299 patients. Gallamine 10 and 20 mg, tubocurarine 5 mg and pancuronium 1 mg were equally effective when a 2-min interval was allowed between their injection and suxamethonium administration. Fazadinium was ineffective and caused difficulty with intubation. No evidence supporting the concept that dosage should be related to patient's weight was found. Inpatients suffered from post-suxamethonium pain as much as did outpatients.

Topics: Adolescent; Adult; Aged; Body Weight; Female; Gallamine Triethiodide; Humans; Male; Middle Aged; Neuromuscular Blocking Agents; Pain, Postoperative; Pancuronium; Premedication; Pyridinium Compounds; Succinylcholine; Tubocurarine

Two matched groups of patients with Hodgkin's disease undergoing a staging laparotomy received thiopentone, pancuronium bromide or suxamethonium 1.0 mg kg-1 (group 2) to facilitate tracheal intubation. There were no differences in the sites or degree of postoperative myalgia between the groups. It is concluded that efforts to reduce the frequency of suxamethonium muscle pains in patients having major abdominal operations are not justified.

Topics: Abdomen; Adolescent; Adult; Female; Hodgkin Disease; Humans; Male; Middle Aged; Muscular Diseases; Pain, Postoperative; Pancuronium; Succinylcholine; Time Factors

The authors studied certain effects in the male subject of precurarisation using different doses of pancuronium. The results obtained show that the maximum doses used, corresponding to 0.01 Omg/kg of pancuronium, were associated with subjective symptoms which were well tolerated by the conscious patient, a decreases in the incidence of fasciculations, antagonistic effects against succinylcholine and a decreases in postoperative myalgia. In their conclusion, the authors confirm that the maximum doses of pancuronium used require an increase in doses of succinylcholine in order to avoid the antagonism phenomenon, and that doses ranging from 0.010 to 0.020 mg/kg of pancuronium could be used in order to completely eliminate postoperative myalgia related to succinylcholine.

Topics: Adult; Aged; Dose-Response Relationship, Drug; Fatigue; Humans; Male; Middle Aged; Muscle Contraction; Muscular Diseases; Pain, Postoperative; Pancuronium; Succinylcholine; Vital Capacity

Translational correlates to pain with activities after deep tissue injury have been rarely studied. We hypothesized that deep tissue incision causes greater activation of nociception-transmitting neurons evoked by muscle contraction. In vivo neuronal activity was recorded in 203 dorsal horn neurons (DHNs) from 97 rats after sham, skin-only, or skin + deep muscle incision. We evaluated DHN responses to static, isometric muscle contractions induced by direct electrical stimulation of the muscle. The effect of pancuronium on DHN response to contractions was also examined. Approximately 50% of DHNs with receptive fields in the hindpaw were excited during muscle contraction. One-second .5- and 1.0-g muscle contractions produced greater DHN activity after skin + deep muscle incision (median [interquartile range], 32 [5-39] impulses, P = .021; and 36 [26-46] impulses, P = .006, respectively) than after sham (6 [0-21] and 15 [8-32] impulses, respectively). Neuromuscular blockade with pancuronium inhibited the muscle contractions and DHN activation during electrical stimulation, demonstrating contraction-induced activation. The greater response of spinal DHNs to static muscle contraction after skin + deep muscle incision may model and inform mechanisms of dynamic pain after surgery. PERSPECTIVE: Completion of various activities is an important milestone for recovery and hospital discharge after surgery. Skin + deep muscle incision caused greater activation of nociception-transmitting DHNs evoked by muscle contraction compared with skin-only incision. This result suggests an important contribution of deep muscle injury to activity-evoked hyperalgesia after surgery.

Topics: Animals; Disease Models, Animal; Electric Stimulation; Isometric Contraction; Male; Neuromuscular Nondepolarizing Agents; Nociceptors; Pain, Postoperative; Pancuronium; Posterior Horn Cells; Rats; Rats, Sprague-Dawley

Topics: Analgesics, Opioid; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics, Local; Bupivacaine; Child; Fentanyl; Humans; Intubation, Intratracheal; Isoflurane; Liver Transplantation; Male; Monitoring, Intraoperative; Morphine; Neuromuscular Nondepolarizing Agents; Pain Measurement; Pain, Postoperative; Pancuronium; Propofol

Topics: Adult; Analgesics, Opioid; Anesthesia; Anesthetics, Intravenous; Anticonvulsants; Cardiopulmonary Bypass; Diazepam; Etomidate; Female; Fentanyl; Heart Valve Diseases; Heparin; Humans; Midazolam; Morphine; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Piperidines; Propofol; Remifentanil; Stiff-Person Syndrome

Sufficient analgesia, sedation, and paralysis, if necessary, are cornerstones of extracorporeal membrane oxygenation (ECMO) treatment protocols. However, increased distribution volumes, drug absorption by circuit materials, and impaired drug elimination, as well as alternations of cerebral perfusion and blood brain barrier function, result in the markedly altered pharmacodynamics of applied drugs. Today, narcotics combined with benzodiazepines, sometimes enforced by barbiturates, are commonly used in clinical practice. Paralysis is usually achieved by pancuronium or vecuronium. Although these drugs are used widely, actual efficacy remains uncertain because of the lack of reliable tools to measure pain relief and degree of sedation during ECMO, especially during paralysis. Taking into account the detrimental effects of insufficient pain relief and inadequate sedation in such unstable patients as children during pediatric cardiac ECMO, further studies on this topic seem urgently necessary.

Topics: Absorption; Analgesia; Analgesics; Analgesics, Opioid; Anti-Anxiety Agents; Benzodiazepines; Blood-Brain Barrier; Cerebrovascular Circulation; Child; Clinical Protocols; Extracorporeal Membrane Oxygenation; Humans; Hypnotics and Sedatives; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Surface Properties; Vecuronium Bromide

Nalbuphine-midazolam ataractanalgesia has been studied in anaesthesia and postoperative analgesia. Attention has been applied to the efficiency, pharmacological activity, side effects, adverse reactions of nalbuphine as a fentanyl substitute. Preliminary results show that nalbuphine could be used safely as anaesthesia component and as postoperative analgetic.

Topics: Adult; Anesthesia; Anesthesia Recovery Period; Conscious Sedation; Drug Evaluation; Fentanyl; Humans; Midazolam; Middle Aged; Nalbuphine; Pain, Postoperative; Pancuronium

47 patients who were scheduled for lung resection were assigned to two groups. 23 patients had a neurolept analgesia and postoperatively parenteral analgetics. 24 patients received a combination of thoracic peridural anaesthesia and nitrous oxide-oxygen anaesthesia for surgery. The peridural analgesia was continued for 2-3 days for postoperative pain control. Heart rate and mean arterial pressure were recorded. Before, during and after surgery blood was drawn for determination of plasma glucose and cortisol. Postoperatively vital capacity and FEV1 were measured and blood gas analyses were performed for one week. The combination of peridural and intubation anaesthesia resulted in very stable haemodynamics in comparison with the neurolept analgesia. Heart rate and mean arterial pressure decreased during surgery without peak levels as response to the surgical trauma. Blood glucose and plasma cortisol showed equal responses in both investigation groups. A reduced stress response by means of the peridural anaesthesia could not be demonstrated. During the first 48 h after surgery a significantly higher vital capacity was measured in the patients with peridural anaesthesia. FEV1 was analogously increased, the quotient of FEV1/VC was similar in both study groups. No obstruction was observed. PaO2 and paCO2 showed no clinically relevant differences. During surgery the combination of general and regional anaesthesia results in a lower stress response of the heart and postoperatively it improves lung function which is an important advantage in comparison with systemic analgetics.

Topics: Adult; Aged; Anesthesia, Epidural; Blood Gas Analysis; Blood Glucose; Blood Pressure; Bupivacaine; Female; Fentanyl; Forced Expiratory Volume; Heart Rate; Humans; Hydrocortisone; Intraoperative Period; Male; Middle Aged; Neuroleptanalgesia; Pain, Postoperative; Pancuronium; Pneumonectomy; Postoperative Period; Stress, Physiological; Vital Capacity

Tubocurarine 0.05 and 0.07 mg.kg-1, gallamine 0.1 and 0.2 mg.kg-1 and pancuronium 0.01 and 0.02 mg.kg-1 given three minutes before suxamethonium 1.0, 1.5 and 2 mg.kg-1 in groups of 10 patients each (total 210 patients) to compare ease of tracheal intubation and incidence of post-suxamethonium muscle pain. These were compared with a control group of suxamethonium 1.0, 1.5 and 2 mg.kg-1 given alone after thiopentone 5 mg.kg-1. On analysis, tubocurarine 0.07 mg.kg-1 and suxamethonium 2 mg.kg-1 was the ideal combination with the best intubation conditions and the lowest incidence of post-suxamethonium muscle pains. The second best combination was gallamine 0.2 mg.kg-1 and suxamethonium 2 mg.kg-1. Pancuronium 0.01 mg.kg-1 and 0.02 mg.kg-1 in combination with suxamethonium 2 mg.kg-1 were satisfactory, although less efficient than the combination with either tubocurarine or gallamine.

Topics: Adult; Body Weight; Fasciculation; Gallamine Triethiodide; Humans; Intubation, Intratracheal; Muscles; Pain, Postoperative; Pancuronium; Succinylcholine; Tubocurarine

Topics: Adjuvants, Anesthesia; Adult; Humans; Muscles; Muscular Diseases; Pain, Postoperative; Pancuronium; Preanesthetic Medication; Succinylcholine

The authors have studied the effects of precurarisation by means of pancuronium on 120 female patients by using three multiple doses of pancuronium bromide. The authors have demonstrated that the dose of pancuronium, capable of abolishing almost completely fasciculations and postoperative succinylcholine myalgias, corresponds to 0.009 mg/kg. This dose has proved to be most efficient in causing a considerable increase in subjective precurarisation symptoms (Heavy eye-lids, blurred vision etc.). Such symptoms have never caused even the least discomfort to the patients. The authors have finally demonstrated that the doses of pancuronium employed cause a decrease in V.C. within limits that do not, however, compromise ventilation.

Topics: Adult; Female; Humans; Hysterectomy; Middle Aged; Muscle Contraction; Pain, Postoperative; Pancuronium; Succinylcholine; Vital Capacity

The effectiveness of pancuronium (1.0 to 1.5 mg), d-tubocurarine (3 mg), and gallamine (20 mg) administered three minutes before succinylcholine (1 mg/kg) in preventing muscle fasciculations and postoperative muscle pains was compared in 100 patients. Pretreatment with pancuronium abolished fasciculations and produced rapid and excellent muscle relaxation for endotracheal intubation. Both d-tubocurarine (dTc) and gallamine administered prior to succinylcholine (SCh) were inconsistent in prevention fasciculations. Muscle relaxation was significantly delayed in onset, shorter in duration, and was inadequate for intubation in the majority of patients. The 45% incidence of postoperative muscle pains in the control group decreased after pretreatment with gallamine, dTc, and pancuronium to 20%, 15%, and less than 5%, respectively. It was concluded from the present study that pancuronium is superior to dTc and gallamine for preventing SCh-induced fasciculations and postoperative muscle pains without compromising the muscle relaxation for intubation. However, pancuronium administered for pretreatment may significantly prolong the action of succinylcholine and caution is to be exercised in patients having short surgical procedures and when additional doses of muscle relaxants may be required.

Topics: Adolescent; Adult; Aged; Female; Gallamine Triethiodide; Humans; Male; Middle Aged; Muscle Contraction; Muscular Diseases; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Succinylcholine; Tubocurarine