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Cell Calcium May 2023Our sensory environment is permeated by a diverse array of auditory and somatosensory stimuli. The pairing of acoustic signals with concurrent or forthcoming tactile... (Review)
Review
Our sensory environment is permeated by a diverse array of auditory and somatosensory stimuli. The pairing of acoustic signals with concurrent or forthcoming tactile cues are abundant in everyday life and various survival contexts across species, thus deeming the ability to integrate sensory inputs arising from the combination of these stimuli as crucial. The corticothalamic system plays a critical role in orchestrating the construction, integration and distribution of the information extracted from these sensory modalities. In this mini-review, we provide a circuit-level description of the auditory corticothalamic pathway in conjunction with adjacent corticothalamic somatosensory projections. Although the extent of the functional interactions shared by these pathways is not entirely elucidated, activation of each of these systems appears to modulate sensory perception in the complementary domain. Several specific issues are reviewed. Under certain environmental noise conditions, the spectral information of a sound could induce modulations in nociception and even induce analgesia. We begin by discussing recent findings by Zhou et al. (2022) implicating the corticothalamic system in mediating sound-induced analgesia. Next, we describe relevant components of the corticothalamic pathway's functional organization. Additionally, we describe an emerging body of literature pointing to intrathalamic circuitry being optimal for controlling and selecting sensory signals across modalities, with the thalamic reticular nucleus being a candidate mechanism for directing cross-modal interactions. Finally, Ca bursting in thalamic neurons evoked by the thalamic reticular nucleus is explored.
Topics: Thalamus; Neurons; Analgesia
PubMed: 36931195
DOI: 10.1016/j.ceca.2023.102717 -
BMC Pregnancy and Childbirth May 2023Neuraxial labor analgesia has been associated with fetal heart rate changes. Fetal bradycardia is multifactorial, and predicting it poses a significant challenge to...
BACKGROUND
Neuraxial labor analgesia has been associated with fetal heart rate changes. Fetal bradycardia is multifactorial, and predicting it poses a significant challenge to clinicians. Machine learning algorithms may assist the clinician to predict fetal bradycardia and identify predictors associated with its presentation.
METHODS
A retrospective analysis of 1077 healthy laboring parturients receiving neuraxial analgesia was conducted. We compared a principal components regression model with tree-based random forest, ridge regression, multiple regression, a general additive model, and elastic net in terms of prediction accuracy and interpretability for inference purposes.
RESULTS
Multiple regression identified combined spinal-epidural (CSE) (p = 0.02), interaction between CSE and dose of phenylephrine (p < 0.0001), decelerations (p < 0.001), and the total dose of bupivacaine (p = 0.03) as associated with decrease in fetal heart rate. Random forest exhibited good predictive accuracy (mean standard error of 0.92).
CONCLUSION
Use of CSE, presence of decelerations, total dose of bupivacaine, and total dose of vasopressors after CSE are associated with decreases in fetal heart rate in healthy parturients during labor. Prediction of changes in fetal heart rate can be approached with a tree-based random forest model with good accuracy with important variables that are key for the prediction, such as CSE, BMI, duration of stage 1 of labor, and dose of bupivacaine.
Topics: Pregnancy; Female; Humans; Heart Rate, Fetal; Bradycardia; Retrospective Studies; Analgesia, Epidural; Analgesia, Obstetrical; Bupivacaine
PubMed: 37211590
DOI: 10.1186/s12884-023-05632-3 -
European Journal of Pain (London,... Jul 2021Research on placebo analgesia commonly focuses on the impact of information about direction (i.e., increase or decrease of pain) and magnitude of the expected analgesic...
BACKGROUND
Research on placebo analgesia commonly focuses on the impact of information about direction (i.e., increase or decrease of pain) and magnitude of the expected analgesic effect, whereas temporal aspects of expectations have received little attention so far. In a recent study, using short-lasting, low-intensity stimuli, we demonstrated that placebo analgesia onset is influenced by temporal information. Here, we investigate whether the same effect of temporal suggestions can be found in longer lasting, high-intensity pain in a Cold Pressor Test (CPT).
METHODS
Fifty-three healthy volunteers were allocated to one of three groups. Participants were informed that the application of an (inert-)cream would reduce pain after 5 min (P5) or 30 min (P30). The third group was informed that the cream only had hydrating properties (NE). All participants completed the CPT at baseline and 10 (Test 10) and 35 min (Test 35) following cream application. Percentage change in exposure time (pain tolerance) from baseline to Test 10 (Δ10) and to Test 35 (Δ35) and changes in heart rate (HR) during CPT were compared between the three groups.
RESULTS
Δ10 was greater in P5 than in NE and P30, indicating that analgesia was only present in the group that was expecting an early onset of analgesia. Δ35 was greater in P5 and P30 compared to NE, reflecting a delayed onset of analgesia in P30 and maintained analgesia in P5. HR differences between groups were not significant.
CONCLUSIONS
Our data suggest that 'externally timing' of placebo analgesia may be possible for prolonged types of pain.
SIGNIFICANCE
Research on placebo effects mainly focuses on the influence of information about direction (i.e., increase or decrease of pain) and magnitude (i.e., strong or weak) of the expected effect but ignores temporal aspects of expectations. In our study in healthy volunteers, the reported onset of placebo analgesia followed the temporal information provided. Such 'external timing' effects could not only aid the clinical use of placebo treatment (e.g., in open-label placebos) but also support the efficacy of active drugs.
Topics: Analgesia; Humans; Models, Theoretical; Pain Management; Pain Measurement; Placebo Effect
PubMed: 33619820
DOI: 10.1002/ejp.1752 -
British Journal of Anaesthesia Dec 2019
Topics: Analgesia; Anesthetists; Communication; Cooperative Behavior; Humans; Interprofessional Relations; Surgeons
PubMed: 31564374
DOI: 10.1016/j.bja.2019.08.020 -
Medicina (Kaunas, Lithuania) May 2023Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech...
Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor analgesia (epidural analgesia (EA) vs. remifentanil patient-controlled analgesia (PCA)) and intrapartum cesarean sections (CS), and maternal and neonatal adverse outcomes in breech and twin vaginal births. A retrospective analysis of planned vaginal breech and twin deliveries at the Department of Perinatology, University Medical Centre Ljubljana, was performed for the period 2013-2021, using data obtained from the Slovenian National Perinatal Information System. The pre-specified outcomes studied were the rates of CS in labor, postpartum hemorrhage, obstetric anal sphincter injury (OASI), an Apgar score of <7 at 5 min after birth, birth asphyxia, and neonatal intensive care admission. A total of 371 deliveries were analyzed, including 127 term breech and 244 twin births. There were no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups in any of the outcomes studied. Our findings suggest that both EA and remifentanil-PCA are safe and comparable in terms of labor outcomes in singleton breech and twin deliveries.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Cesarean Section; Remifentanil; Analgesia, Patient-Controlled; Analgesia, Epidural; Retrospective Studies; Delivery, Obstetric
PubMed: 37374230
DOI: 10.3390/medicina59061026 -
Turkish Journal of Medical Sciences Jun 2021Water immersion and epidural analgesia are the most preferred pain relief methods during the labor process. Adverse effects related to these methods, impact on the...
BACKGROUND/AIM
Water immersion and epidural analgesia are the most preferred pain relief methods during the labor process. Adverse effects related to these methods, impact on the labor, and perception of pain is well studied in the literature. We aimed to investigate the cord blood level of copeptin, total serum oxidant (TOS), antioxidant (TAS), interleukin (IL)-1, IL-6, and oxytocin after the labor with water immersion, epidural analgesia, and vaginal birth without pain relief.
MATERIALS AND METHODS
The study was conducted with 102 healthy pregnant women admitted to the obstetric delivery unit for noncomplicated term birth. Copeptin, oxytocin, TAS, TOS, IL-1, and IL-6 levels of cord blood and obstetric and neonatal results after vaginal birth were compared.
RESULTS
The study included a total of 102 patients (group 1 = 30, group 2 = 30, and group 3 = 42). We found no significant difference between the three groups in terms of BMI, age, gravidity, parity, birth week, birth weight, interventional birth, perineal trauma, breastfeeding, duration of labor, oxytocin, IL-1 and IL-6 levels (p > 0.05). Neonatal intensive care unit (NICU) need, TAS, TOS, and copeptin levels were higher. Apgar scores were lower in the epidural group (p = 0.011, p = 0.036, p = 0.027, p < 0.001, and p < 0.001 respectively).
CONCLUSION
Epidural analgesia has deteriorated oxidative stress status and lower neonatal Apgar scores with higher NICU administration compared with water birth and vaginal birth without pain relief.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Female; Humans; Immersion; Immunity, Cellular; Infant, Newborn; Interleukin-1; Interleukin-6; Oxidative Stress; Oxytocin; Pain; Pregnancy; Water
PubMed: 33600095
DOI: 10.3906/sag-2009-181 -
Korean Journal of Anesthesiology Oct 2020Pain management plays a fundamental role in enhanced recovery after surgery pathways. The concept of multimodal analgesia in providing a balanced and effective approach... (Review)
Review
Pain management plays a fundamental role in enhanced recovery after surgery pathways. The concept of multimodal analgesia in providing a balanced and effective approach to perioperative pain management is widely accepted and practiced, with regional anesthesia playing a pivotal role. Nerve block techniques can be utilized to achieve the goals of enhanced recovery, whether it be the resolution of ileus or time to mobilization. However, the recent expansion in the number and types of nerve block approaches can be daunting for general anesthesiologists. Which is the most appropriate regional technique to choose, and what skills and infrastructure are required for its implementation? A multidisciplinary team-based approach for defining the goals is essential, based on each patient's needs, and incorporating patient, surgical, and social factors. This review provides a framework for a personalized approach to postoperative pain management with an emphasis on regional anesthesia techniques.
Topics: Analgesia; Analgesics; Anesthesia, Conduction; Anesthetics, Local; Arthroscopy; Humans; Pain Management; Pain, Postoperative; Precision Medicine
PubMed: 32752602
DOI: 10.4097/kja.20323 -
Journal of Anesthesia Feb 2023At present, there is no objective and absolute measure of nociception, although various monitoring techniques have been developed. One such technique is the Analgesia... (Review)
Review
At present, there is no objective and absolute measure of nociception, although various monitoring techniques have been developed. One such technique is the Analgesia Nociception Index (ANI), which is calculated from heart rate variability that reflects the relative parasympathetic tone. ANI is expressed on a non-unit scale of 0-100 (100 indicates maximal relative parasympathetic tone). Several studies indicated that ANI-guided anesthesia may help reduce intraoperative opioid use. The usefulness of ANI in the intensive care unit (ICU) and during surgery has also been reported. However, some limitations of ANI have also been reported; for example, ANI is affected by emotions and some drugs. In 2022, a high frequency variability index (HFVI), which was renamed from ANI and uses the same algorithm as ANI, was commercialized; therefore, ANI/HFVI are currently in the spotlight. Unlike ANI, HFVI can be displayed along with other biometric information on the Root monitor. ANI/HFVI monitoring may affect the prognosis of not only patients in the perioperative period but those in ICU, those who receive home medical care, or outpatients. In this article, we present an updated review on ANI that has been published in the last decade, introduce HFVI, and discuss the outlooks of ANI/HFVI.
Topics: Humans; Nociception; Pain; Analgesia; Pain Management; Heart Rate
PubMed: 36272031
DOI: 10.1007/s00540-022-03126-8 -
The Journal of Maternal-fetal &... Dec 2023Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including the duration of labor analgesia, gestational age, and body mass index (BMI). This study aims to provide an updated analysis of the incidence of conversion from epidural analgesia to general anesthesia, while evaluating and analyzing potential risk factors contributing to the failure of this transition to cesarean section anesthesia.
METHODS
We conducted an extensive literature search utilizing databases such as PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WANGFANG, and the Chinese Biomedical Literature Database (CBM) up to September 30, 2022. The meta-analysis was performed using STATA 15.1 software. The quality of the included studies was assessed using the 11-item quality assessment scale recommended by the Agency for Healthcare Research and Quality (AHRQ).
RESULTS
A total of 9,926 studies were initially retrieved, and after rigorous selection, 19 studies were included in the meta-analysis. The overall incidence of conversion from epidural analgesia to general anesthesia was found to be 6% (95% confidence interval [CI]: 5-8%). Our findings indicate that, when compared to patients in the successful conversion group, those in the failure group tended to be younger (weighted mean difference [WMD] = -1.571, 95% CI: -1.116 to -0.975) and taller (WMD = 0.893, 95% CI: 0.018-1.767). Additionally, the failure group exhibited a higher incidence of incomplete block in epidural anesthesia, received a higher dosage of additional epidural administration, experienced a greater rate of emergency cesarean sections, and received anesthesia more frequently from non-obstetric anesthesiologists. However, no statistically significant differences were observed in gestational age, depth of the catheter insertion into the skin, epidural catheter specifics, duration of epidural analgesia, infusion rate of epidural analgesia, primiparity status, cervical dilatation during epidural placement, BMI, or weight.
CONCLUSION
Our study found that the incidence of conversion from epidural analgesia to cesarean section under general anesthesia was 6%. Notably, the failure group exhibited a higher rate of incomplete block in epidural anesthesia, a greater incidence of emergency cesarean sections, a more frequent provision of anesthesia by non-obstetric anesthesiologists, a higher dosage of epidural administration, and greater height when compared to the success group. Conversely, women in the failure group were younger in age compared to their counterparts in the success group.
Topics: Pregnancy; Humans; Female; Cesarean Section; Analgesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Epidural; Risk Factors; Anesthesia, General; Analgesia, Obstetrical
PubMed: 37926901
DOI: 10.1080/14767058.2023.2278020 -
British Journal of Anaesthesia Jul 2021Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The evidence, exclusively based on retrospective studies, is contradictory.
METHODS
In this prospective, multicentre study, patients scheduled for elective colorectal cancer surgery between June 2011 and May 2017 were randomised to TEA or patient-controlled i.v. analgesia (PCA) with morphine. The primary endpoint was disease-free survival at 5 yr after surgery. Secondary outcomes were postoperative pain, complications, length of stay (LOS) at the hospital, and first return to intended oncologic therapy (RIOT).
RESULTS
We enrolled 221 (110 TEA and 111 PCA) patients in the study, and 180 (89 TEA and 91 PCA) were included in the primary outcome. Disease-free survival at 5 yr was 76% in the TEA group and 69% in the PCA group; unadjusted hazard ratio (HR): 1.31 (95% confidence interval [CI]: 0.74-2.32), P=0.35; adjusted HR: 1.19 (95% CI: 0.61-2.31), P=0.61. Patients in the TEA group had significantly better pain relief during the first 24 h, but not thereafter, in open and minimally invasive procedures. There were no differences in postoperative complications, LOS, or RIOT between the groups.
CONCLUSIONS
There was no significant difference between the TEA and PCA groups in disease-free survival at 5 yr in patients undergoing surgery for colorectal cancer. Other than a reduction in postoperative pain during the first 24 h after surgery, no other differences were found between TEA compared with i.v. PCA with morphine.
Topics: Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Analgesia, Patient-Controlled; Anesthesia, Intravenous; Colorectal Neoplasms; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies
PubMed: 33966891
DOI: 10.1016/j.bja.2021.04.002