scholarly journals Evaluation of erythrocyte membrane lipids and proteins in renal disorders

2021 ◽  
Author(s):  
Radhika D. Mhatre ◽  
Sucheta P. Dandekar
Keyword(s):  
Erythrocyte Membrane ◽  
Conformational Changes ◽  
Membrane Lipids ◽  
Protein Profile ◽  
Circulatory System ◽  
Control Group ◽  
Dodecanoic Acid ◽  
Renal Disorders ◽  
Group 2 ◽  
Group 1

Background: Membrane lipids and proteins play a significant part in imparting membrane its rheological properties. These parameters are altered in diseased states. Exploring the conformational changes in renal disorders can widen our understanding of its impact on the circulatory system. This could lead to a new diagnostic parameter to study the progress of a disease.Methods: 120 blood samples collected from 30 kidney donors, 30 stage 3-4 Chronic kidney disease (CKD) patients (group 1) and 30 stage 5 CKD patients on dialysis (pre and post dialysis) (group 2) were lysed and washed to obtain erythrocyte ghost membranes. The proteins extracted from these membranes were estimated colorimetrically using Micro BCA kit. Phospholipids were separated and quantified using HPTLC. Fatty acids and cholesterol were analysed using GCMS.Results: The erythrocyte membrane protein profile showed lower values in group 2 participants than group 1 participants, but this difference was not significant. Distinct decreases in percentages of palmitic acid, myristic acid, stearic acid, dodecanoic acid, cholesterol, phosphatidylserine, phosphatidylcholine and phosphatidylethanolamine were observed in both groups, with the lowest values in patients undergoing dialysis. Sphingomyelin and linoleic acid did not show any such trend across groups.Conclusions: The data is suggestive of an altered membrane structure in participants undergoing dialysis patients than the control group. This could be because of uremic toxins in the circulatory system affecting the membrane lipids. Decreased levels of essential phospholipids can impact the functions and lifespan of the erythrocytes. This could be a reason behind anaemia seen in most patients with CKD.

Antiurolithiatic effect of Cymbopogon Proximus, Alhagi Maurorum, on Sulfadimidine induced urolithiasis in male New Zealand rabbits

2019 ◽  
Vol 20 (1) ◽  
pp. 12-18
Author(s):  
Sameh El-Nabtity
Keyword(s):  
New Zealand ◽  
Intramuscular Injection ◽  
Negative Control Group ◽  
Negative Control ◽  
Control Group ◽  
Aqueous Extracts ◽  
Blood And Urine Samples ◽  
Group 2 ◽  
New Zealand Rabbits ◽  
Group 1

The present study aimed to investigate the prophylactic effect of Cymbopogon proximus and Alhagi maurorum on Sulfadimidine induced urolithiasis in rabbits . Thirty New Zealand male rabbits were allocated into six equal groups (each of five): Group (1) was used as a negative control. Group(2) were administered sulfadimidine (200mg/kg) by intramuscular injection.Groups(3) and (4) were administered sulfadimidine(200mg/kg) by intramuscular injection and 330mg/kg of Cymbopogon proximus alcoholic and aqueous extracts respectively orally.Groups(5) and (6) were administered sulfadimidine(200mg/kg) by intramuscular injection and 400mg/kg of Alhagi maurorum alcoholic and aqueous extracts respectively orally. The period of experiment was 10 days. Blood and urine samples were collected from rabbits on the 10th day. The results recorded a significant decrease in serum creatinine, urea, uric acid and crystalluria in Cymbopogon proximus and Alhagi maurorum groups compared to sulfadimidine treated group.We conclude that Cymbopogon proximus and Alhagi maurorum have a nephroprotective and antiurolithiatic effects against sulfadimidine induced crystalluria.

Influence of Removable Denture Cleaning Agents on Adhesion of Oral Pathogenic Microflora In Vitro: A Randomized Controlled Trial

2021 ◽  
Vol 14 (1) ◽  
pp. 656-664
Author(s):  
I.R. Volchkova ◽  
A.V. Yumashev ◽  
V.V. Borisov ◽  
V.I. Doroshina ◽  
E.A. Kristal ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Candida Albicans ◽  
Test Group ◽  
Control Group ◽  
Removable Dental Prostheses ◽  
Removable Denture ◽  
Group 2 ◽  
Adhesion Index ◽  
Group 1

Introduction: Removable dentures are used by 20% of the population. These may be accompanied by denture stomatitis in 15-70% of patients. The choice of the optimal cleansing agent for removable dental prostheses is of high significance. Aim: The aim of our research was to study the influence of removable denture cleansing products on the adhesion of microorganisms and yeast. Materials and Methods: We manufactured 144 specimens of standardized round shape with a diameter of 10 mm from 4 types of modern polymeric materials used by prosthetic dentistry to produce removable dentures, 12 specimens of each material were placed into suspensions of bacterial cultures of Staphylococcus aureus, Escherichia coli, Candida albicans, then into “ClearaSept” (Test group 1), “Рrotefix active cleanser” (Test group 2), saline solution (Control group), followed by nutrient media. The adhesion index was calculated and analyzed. Results: There was no reliable lowering of adhesion index of Staphylococcus Aureus to all materials detected in Test group 1 (U=6, p>0.05 for Bio XS; U=8, p>0.05 for Dental D, Denotokeep Peek, Vertex Rapid Simplified). In Test group 2, the adhesion index of Staphylococcus Aureus reliably decreased to all materials compared to the Control group (U=0, p≤0.01). The adhesion index of Candida albicans and Escherichia coli to all materials in Test group 1 had a minor to moderate reliable reduction compared to the Control group (U=0, p≤0.01). Test group 2 showed a significant reliable decrease in Candida albicans and Escherichia coli adhesion index to all materials in comparison with the Control group (U=0, p≤0.01). Conclusion: The research showed an unreliable or minor and moderate reliable decrease in microorganisms adhesion index depending on the microorganism species after treatment of denture material specimens by antibacterial soap “ClearaSept” and a reliable significant decrease in microbial and yeast adhesion after application of Protefix active cleaner solution, which demonstrates a more significant antimicrobial effect in comparison to “ClearaSept” against Staphylococcus aureus, Escherichia coli, and Candida albicans.

Dopamine-1 receptor stimulation impairs intestinal oxygen utilization during critical hypoperfusion

2003 ◽  
Vol 284 (2) ◽  
pp. H668-H675 ◽  
Author(s):  
Jorge A. Guzman ◽  
Ariosto E. Rosado ◽  
James A. Kruse
Keyword(s):  
Blood Flow ◽  
Mucosal Blood Flow ◽  
Control Group ◽  
Oxygen Utilization ◽  
Hemorrhage Control ◽  
Receptor Stimulation ◽  
Anesthetized Dogs ◽  
Group 2 ◽  
Increased Susceptibility ◽  
Group 1

Effects of a dopamine-1 (DA-1) receptor agonist on systemic and intestinal oxygen delivery (D˙o 2)-uptake relationships were studied in anesthetized dogs during sequential hemorrhage. Control ( group 1) and experimental animals ( group 2) were treated similarly except for the addition of fenoldopam (1.0 μg · kg−1 · min−1) in group 2. Both groups had comparable systemic criticalD˙o 2(D˙o 2crit), but animals in group 2 had a higher gut D˙o 2crit(1.12 ± 1.13 vs. 0.80 ± 0.09 ml · kg−1 · min−1, P < 0.05). At the mucosal level, a clear biphasic delivery-uptake relationship was not observed in group 1; thus oxygen consumption by the mucosa may be supply dependent under physiological conditions. Group 2 demonstrated higher peak mucosal blood flow and lack of supply dependency at higher mucosalD˙o 2 levels. Fenoldopam resulted in a more conspicuous biphasic relationship at the mucosa and a rightward shift of overall splanchnic D˙o 2crit despite increased splanchnic blood flow. These findings suggest that DA-1 receptor stimulation results in increased gut perfusion heterogeneity and maldistribution of perfusion, resulting in increased susceptibility to ischemia.

Biomarkers of vascular wall damage in patients with cerebrovascular diseases and type 2 diabetes mellitus

2021 ◽  
Author(s):  
М.А. Быковская ◽  
А.А. Раскуражев ◽  
А.А. Шабалина ◽  
К.В. Антонова ◽  
М.М. Танашян
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Asymmetric Dimethylarginine ◽  
Vascular Wall ◽  
Cerebrovascular Diseases ◽  
Control Group ◽  
Normal Body Mass Index ◽  
Group 2 ◽  
Group 1

Введение. Сосудистые осложнения сахарного диабета (СД) являются одной из ведущих причин повышения смертности пациентов трудоспособного возраста. Предполагается, что индуцированный гипергликемией окислительный стресс и нарушение антиоксидантной защиты играют роль в патологическом механизме повреждения сосудов, частично за счет влияния оксида азота (NО). Цель исследования: уточнение взаимосвязей в системах асимметричного диметиларгинина (АДМА) и NO у пациентов с цереброваскулярными заболеваниями (ЦВЗ) на фоне СД 2-го типа (СД-2). Материалы и методы. Обследованы 72 пациента с ЦВЗ со стенозирующим поражением внутренней сонной артерии вне острого периода: группу 1 составили 39 пациентов (18 мужчин и 21 женщина) с СД-2 в возрасте 65 [58; 72] лет; в группу 2 вошли 33 больных (15 мужчин и 18 женщин) без СД-2 в возрасте 66 [56; 74] лет. Контрольную группу составили 30 добровольцев (16 мужчин и 14 женщин) без проявлений церебральной ишемии и нарушений углеводного обмена, с нормальными значениями индекса массы тела, некурящие, в возрасте 62 [50; 66] лет. Проводилось клиническое обследование, нейро- и ангиовизуализационное исследование, спектр биохимических исследований крови, в том числе определение содержания АДМА и показателей системы NO. Результаты. В группе 1 содержание нитрата, нитрита и NO составило 62,1 [56; 68] мкмоль/л, 48,5 [26; 52] мкмоль/л и 13,6 [9; 23] мкмоль/л соответственно, что достоверно отличалось от значений этих показателей в группе 2 — 58,3 [45; 64] мкмоль/л, 39,6 [26,0; 42,3] мкмоль/л и 18,7 [16,1; 24,7] мкмоль/л соответственно. Отмечен также более высокий уровень AДМА в крови у пациентов с ЦВЗ в сочетании с СД-2 — 0,42 [0,21; 0,53] ммоль/л. Заключение. Обнаружена взаимосвязь между уровнями AДМА и NO при ЦВЗ на фоне СД-2. Это требует продолжения исследований биомаркеров повреждения сосудистой стенки для определения их места в патогенезе ишемических церебральных осложнений СД-2. Background. Vascular complications of diabetes mellitus (DM) are one of the leading causes of increased mortality in patients of employable age. Hyperglycemia-induced oxidative stress and impaired antioxidant protection have been suggested to play a role in the pathological mechanism of vascular damage, in part due to the effects of nitric oxide (NO). Objectives: clarification of relationships in the systems of asymmetric dimethylarginine (ADMA) and NO in patients with cerebrovascular diseases (CVD) and type 2 diabetes (DM-2). Patients/Methods. We examined 72 CVD patients with stenosing lesions of the internal carotid artery outside the acute period: group 1 consisted of 39 patients (18 men and 21 women; 65 [58; 72] years old) with DM-2; group 2 consisted of 33 patients (15 men and 18 women; 66 [56; 74] years old) without DM-2. The control group consisted of 30 volunteers (16 men and 14 women; 62 [50; 66] years old) without manifestations of cerebral ischemia and carbohydrate metabolism disorders, with normal body mass index, non-smokers. A clinical examination, neuro- and angio-imaging study, a spectrum of biochemical blood tests, including the concentration of asymmetric dimethylarginine (ADMA) and indicators of NO system were carried out. Results. In group 1, the content of nitrate, nitrite and NO was 62.1 [56; 68] μmol/l, 48.5 [26; 52] μmol/l and 13.6 [9; 23] μmol/l, respectively, that significantly differed from the content of these parameters in group 2 — 58.3 [45; 64] μmol/l, 39.6 [26.0; 42.3] μmol/l and 18.7 [16.1; 24.7] μmol/l, respectively. Noted also a higher blood level of ADMA in patients with CVD combined with DM-2 — 0.42 [0.21; 0.53] mmol/l. Conclusions. A relationship was found between ADMA and NO levels in CVD patients with DM-2. This requires further studies of biomarkers of vascular wall damage to determine their place in the pathogenesis of ischemic cerebral complications of DM-2.

scholarly journals Objective assessment of stiffness in Achilles tendinopathy: a novel approach using the MyotonPRO

2018 ◽  
Vol 4 (1) ◽  
pp. e000446 ◽  
Author(s):  
Gafin Ericson Morgan ◽  
Rhodri Martin ◽  
Lisa Williams ◽  
Owen Pearce ◽  
Keith Morris
Keyword(s):  
Dynamic Stiffness ◽  
Objective Assessment ◽  
Weight Bearing ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Asymptomatic Group ◽  
Musculotendinous Junction ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

ObjectivesThe aim of this study was to establish quantitative values for asymptomatic and symptomatic Achilles tendons.DesignCohort study with a single (cross-sectional) time point of patients diagnosed with unilateral Achilles tendinopathy and an asymptomatic group with comparative homogeneity.MethodsA sample of 50 participants: 25 diagnosed with symptomatic unilateral Achilles tendinopathy (AT group) and 25 with asymptomatic Achilles tendons (control group 2). The asymptomatic side of the AT group was used as a control (control group 1). Measurements at 2 cm intervals on the tendon from its insertion at the calcaneum up to the musculotendinous junction were taken non-weight bearing (NWB) and weight bearing (WB) using the MyotonPRO.ResultsThere was a significant (p<0.005) decrease in natural oscillation frequency (F) at points 2, 3 and 4 of the AT group (NWB condition) and points 2 and 3 for the WB condition. There was a significant (p<0.005) increase in logarithmic decrement (D) at points 2 and 3 signifying a decrease in elasticity. Dynamic stiffness (S) was significantly (p<0.005) reduced in the AT group at points 2 and 3 WB and point 3 WB. There was no significant difference in creep (C) observed between the symptomatic and asymptomatic tendons. There was a significant (p<0.005) increase in mechanical stress relaxation time (R) at point 2 NWB.There was a correlation between body weight and gender on tendon mechanics, with the symptomatic tendons. No significant differences were observed between the control group 1 and control group 2.ConclusionsThe MyotonPRO measured decreased stiffness over a section of the tendon corresponding clinically with Achilles tendinopathy. This may have potential in identifying risk of injury and informing rehabilitation, however further extensive research is required to generate baseline data for specific population groups monitoring variables over time. Age, gender and body mass index appear to have some bearing on the mechanical properties of the tendon but mainly in the tendinopathy group.

Changes in Higher Order Aberrations after Wavefront-Guided Prk for Correction of Low to Moderate Myopia and Myopic Astigmatism: Two-Year Follow-Up

2007 ◽  
Vol 17 (4) ◽  
pp. 507-514 ◽  
Author(s):  
D. Wygledowska-Promienska ◽  
I. Zawojska
Keyword(s):  
Visual Acuity ◽  
Excimer Laser ◽  
Spherical Aberration ◽  
Higher Order ◽  
Control Group ◽  
Higher Order Aberrations ◽  
Order Root ◽  
Group 2 ◽  
Myopic Astigmatism ◽  
Group 1

Purpose To assess efficacy, safety, and changes in higher order aberrations after wavefront-guided photorefractive keratectomy (PRK) in comparison with conventional PRK for low to moderate myopia with myopic astigmatism using a WASCA Workstation with the MEL 70 G-Scan excimer laser. Methods A total of 126 myopic or myopic-astigmatic eyes of 112 patients were included in this retrospective study. Patients were divided into two groups: Group 1, the study group; and Group 2, the control group. Group 1 consisted of 78 eyes treated with wavefront-guided PRK. Group 2 consisted of 48 eyes treated with spherocylindrical conventional PRK. Results Two years postoperatively, in Group 1, 5% of eyes achieved an uncorrected visual acuity (UCVA) of 0.05; 69% achieved a UCVA of 0.00; 18% of eyes experienced enhanced visual acuity of −0.18 and 8% of −0.30. In Group 2, 8% of eyes achieved a UCVA of 0.1; 25% achieved a UCVA of 0.05; and 67% achieved a UCVA of 0.00 according to logMAR calculation method. Total higher-order root-mean square increased by a factor 1.18 for Group 1 and 1.6 for Group 2. There was a significant increase of coma by a factor 1.74 in Group 2 and spherical aberration by a factor 2.09 in Group 1 and 3.56 in Group 2. Conclusions The data support the safety and effectiveness of the wavefront-guided PRK using a WASCA Workstation for correction of low to moderate refractive errors. This method reduced the number of higher order aberrations induced by excimer laser surgery and improved uncorrected and spectacle-corrected visual acuity when compared to conventional PRK.

scholarly journals Effects of long-lasting raloxifene treatment on serum prolactin and gonadotropin levels in postmenopausal women

2002 ◽  
pp. 461-465 ◽  
Author(s):  
A Lasco ◽  
S Cannavo ◽  
A Gaudio ◽  
N Morabito ◽  
G Basile ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Serum Prolactin ◽  
Chronological Age ◽  
Control Group ◽  
T Score ◽  
Lumbar Level ◽  
Receptor Modulator ◽  
Study Results ◽  
Group 2 ◽  
Group 1

OBJECTIVE: To evaluate the effects of a 6 month administration of raloxifene hydrochloride, a selective estrogen receptor modulator which was recently approved for the prevention of osteoporosis, on serum gonadotropin and prolactin (PRL) levels and on TRH-stimulated PRL responsiveness in postmenopausal women who have not undergone estrogen replacement therapy. DESIGN AND METHODS: Sixteen healthy postmenopausal women were divided into two groups on the basis of their bone status, evaluated by dual energy X-ray absorptiometry at the lumbar level. Eight women (chronological age 52.4+/-4.1 (s.d.) years, menopausal age 42.4+/-3.9 years), in whom T-score L2-L4 was less than -2.5 s.d., were treated with raloxifene (60 mg p.o.) administered daily for 6 months (group 1), while the other eight women (chronological age 52.6+/-2.5 years, menopausal age 42.1+/-3.6 years), in whom the T-score L2-L4 ranged between -1 and -2.5 s.d., were used as a control group (group 2). Serum PRL, FSH, LH and 17beta-estradiol (E2) levels were evaluated at baseline and after 3 and 6 months of treatment. In all subjects, PRL responsiveness to TRH (200 microg i.v.) administration was evaluated at baseline and at the end of the study. RESULTS: At baseline, mean PRL, LH and FSH levels were not significantly different in the two groups (PRL 133.6+/-21.7 vs 136.7+/-28.1 mIU/l (NS), LH 25.1+/-6.8 vs 24.4+/-6.7 mIU/ml (NS), FSH 74.4+/-25.0 vs 71.1+/-24.1 mIU/ml (NS), in group 1 and group 2 respectively). No significant variations in serum FSH and LH values, in either group, or in serum PRL levels in group 2, were observed at the 3 and 6 month examinations. On the contrary, serum PRL values decreased significantly in group 1 after 3 months (100.1+/-47.7 mIU/l, P<0.05) and 6 months (81.5+/-30.2 mIU/l, P<0.001). At baseline, no significant differences were observed in the TRH-stimulated serum PRL peak between the groups (1015.4+/-30.5 vs 1030.2+/-25.7 mIU/l in group 1 and in group 2 respectively), while it decreased significantly at the 6 month examination in group 1 (770.5+/-47.4 mIU/l, P<0.001) and it was significantly lower than in group 2 (1068.1+/-301.8 mIU/l, P=0.02). Serum E2 was not detected at baseline and at each examination, in all patients. CONCLUSIONS: The decrease of PRL values induced by long-term raloxifene administration in postmenopausal women could be explained by a direct antiestrogenic effect of raloxifene on lactotrope cells or by the recently suggested increase of opiatergic tone on the hypothalamic-pituitary region.

scholarly journals Effect of Hyperglycemia on the Total Surface Charge of the Erythrocyte Membrane in Patients with Metabolic Syndrome

2019 ◽  
Vol 15 (3) ◽  
pp. 322-327
Author(s):  
V. I. Podzolkov ◽  
T. V. Koroleva ◽  
M. G. Kudryavtseva
Keyword(s):  
Metabolic Syndrome ◽  
Surface Charge ◽  
Erythrocyte Membrane ◽  
Negative Charge ◽  
Fasting Blood Glucose ◽  
Microvascular Blood Flow ◽  
Erythrocyte Membranes ◽  
Vascular Changes ◽  
Group 2 ◽  
Group 1

Aim. To study the effect of hyperglycemia on the total surface charge of the erythrocyte membrane (SCEM) in patients with metabolic syndrome (MS).Material and methods. 112 MS patients were examined (45 men and 67 women) (mean age 61.4±7.2 years, average MS duration 8.7±5.2 years). The level of SCEM was determined by adsorption of a positive cationic dye (cationic blue O) on the surface of the plasma membrane of erythrocytes to completely neutralize their negative charge, followed by photometry of the solution and calculation of the number of charges on the cell surface of erythrocytes.Results. In the main group of patients with MS, abdominal obesity was observed in 100% of patients, arterial hypertension – in 73%, hyperglycemia – in 75%, dyslipidemia – in 80%. The level of glycated hemoglobin (HbA1c) was determined in all patients with MS, which was 7.3±1.9%. Patients with MS were conditionally divided according to the level of HbA1c into 2 groups (group 1 – HbA1c from 6.6 to 7.8%, group 2 – more than 7.8%). In MS patients with hyperglycemia, the SCEM values were significantly lower than in the group of patients without hyperglycemia (1.58±0.05×107 and 1.64±0.03×107, respectively; p=0.001)., Significant negative correlations between SCEM and the fasting blood glucose level, hyperglycemia duration, HbA1c level were found in patients with MS.Conclusion. SCEM indices reliably depended on the presence, severity and duration of hyperglycemia, which indicated the effect of impaired carbohydrate metabolism on the state of electric charge of erythrocyte membranes and, therefore, on the mechanisms of microvascular blood flow, thereby contributing to the development of vascular changes in patients with MS.

Effects of insulin-like growth factor–I and platelet-rich plasma on sciatic nerve crush injury in a rat model

2011 ◽  
Vol 114 (2) ◽  
pp. 522-528 ◽  
Author(s):  
Erhan Emel ◽  
Selma Sönmez Ergün ◽  
Dilcan Kotan ◽  
Esra Başar Gürsoy ◽  
Yeşim Parman ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Rat Model ◽  
Platelet Rich Plasma ◽  
Sensory Function ◽  
Local Administration ◽  
Control Group ◽  
Factor I ◽  
Igf I ◽  
Group 2 ◽  
Group 1

Object Local administration of insulin-like growth factor–I (IGF-I) has been shown to increase the rate of axon regeneration in crush-injured and freeze-injured rat sciatic nerves. Local administration of platelet-rich plasma (PRP) has been also shown to have a measurable effect on facial nerve regeneration after transection in a rat model. The objective of the study was to compare the effects of locally administered IGF-I and PRP on the parameters of the Sciatic Function Index (SFI), sensory function (SF), axon count, and myelin thickness/axon diameter ratio (G-ratio) in a rat model of crush-injured sciatic nerves. Methods The right sciatic nerve of Wistar albino rats (24 animals) was crushed using a Yasargil-Phynox aneurysm clip for 45 minutes. All animals were randomly divided into 3 groups: Group 1 (control group) was treated with saline, Group 2 was treated with IGF-I, and Group 3 was treated with PRP. Injections were performed using the tissue expander's injection port with a connecting tube directed at the crush-injured site. Functional recovery was assessed with improvement in the SFI. Recovery of sensory function was using the pinch test. Histopathological examination was performed 3 months after the injury. Results The SFI showed an improved functional recovery in the IGF-I–treated animals (Group 2) compared with the saline-treated animals (Group 1) 30 days after the injury. In IGF-I–treated rats, sensory function returned to the baseline level significantly faster than in saline-treated and PRP-treated rats as shown in values between SF-2 and SF-7. The G-ratios were found to be significantly higher in both experimental groups than in the control group. Conclusions This study suggests that the application of IGF-I to the crush-injured site may expedite the functional recovery of paralyzed muscle by increasing the rate of axon regeneration.

Postoperative Morphine Use and Hyperalgesia Are Reduced by Preoperative but Not Intraoperative Epidural Analgesia

2003 ◽  
Vol 98 (6) ◽  
pp. 1449-1460 ◽  
Author(s):  
Joel Katz ◽  
Lorenzo Cohen ◽  
Roger Schmid ◽  
Vincent W.S. Chan ◽  
Adarose Wowk
Keyword(s):  
Morphine Consumption ◽  
Gynecologic Surgery ◽  
Control Group ◽  
Epidural Administration ◽  
Blinded Manner ◽  
Group 3 ◽  
Group 2 ◽  
Double Blinded ◽  
Postoperative Morphine ◽  
Group 1

Background The aim of this study was to evaluate the postoperative morphine-sparing effects and reduction in pain and secondary mechanical hyperalgesia after preincisional or postincisional epidural administration of a local anesthetic and an opioid compared with a sham epidural control. Methods Patients undergoing major gynecologic surgery by laparotomy were randomly assigned to three groups and studied in a double-blinded manner. Group 1 received epidural lidocaine and fentanyl before incision and epidural saline 40 min after incision. Group 2 received epidural saline before incision and epidural lidocaine and fentanyl 40 min after incision. Group 3 received a sham epidural control (with saline injected into a catheter taped to the back) before and 40 min after incision. All patients underwent surgery with general anesthesia. Results One hundred forty-one patients completed the study (group 1, n = 45; group 2, n = 49; group 3, n = 47). Cumulative patient-controlled analgesia morphine consumption at 48 h was significantly lower (P = 0.04) in group 1 (89.8 +/- 43.3 mg) than group 3 (112.5 +/- 71.5 mg) but not group 2 (95.4 +/- 60.2 mg), although the hourly rate of morphine consumption between 24 and 48 h after surgery was significantly lower (P &lt; 0.0009) in group 1 (1.25 +/- 0.02 mg/h) than group 2 (1.41 +/- 0.02 mg/h). Twenty-four hours after surgery, the visual analog scale pain score on movement was significantly less intense (P = 0.005) in group 1 (4.9 +/- 2.2 cm) than group 3 (6.0 +/- 2.6 cm) but not group 2 (5.3 +/- 2.5 cm), and the von Frey pain threshold near the wound was significantly higher (P = 0.03) in group 1 (6.4 +/- 0.6 log mg) than in group 3 (6.1 +/- 0.8 log mg) but not group 2 (6.2 +/- 0.7 log mg). Conclusions Preincisional administration of epidural lidocaine and fentanyl was associated with a significantly lower rate of morphine use, lower cumulative morphine consumption, and reduced hyperalgesia compared with a sham epidural condition. These results highlight the importance of including a standard treatment control group to avoid the problems of interpretation that arise when two-group studies of preemptive analgesia (preincisional vs. postsurgery) fail to find the anticipated effects.

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