Philip A.M. Rogers MRCVS

AP Analgesia


Galoic-Krleza_R (1991) AP and neuroleptanalgesia. Lijecnicki Vjesnik Sep-Oct 113(9-10):327-332. In Serbo-Croatian. In search of a way to inhibit responses to surgical stress, we tried a new method of anaesthesia, a combination of neuroleptanalgesia (NLA) and traditional AP. The aim was to increase the level of endogenous opioid peptides, and thus decrease the need for exogenous opiates and limit the body's response to surgical stress. Combined use of NLA and AP was evaluated in the pre-, intra- and post- operative period. 40 metabolically healthy patients were randomly allocated to a control and experimental group. Hyperglycaemia, cortisol and aldosterone response, fentanyl and dehydrobenzperidol (DHBP) requirements, and its postoperative analgesic and antiemetic efficacy were monitored. AP, combined with NLA, significantly reduced requirements for fentanyl and DHBP, significantly suppressed hyperglycaemia and cortisol response to surgical stress, but did not influence aldosterone mechanism. Postoperative vomiting and pain, and requirements for of analgesic medication were significantly less. A combination of AP and neuroleptanalgesia is easy to use in surgery and is recommended to suppress significantly the response to surgical stress (intraoperative hyperglycaemia and hypercortisolism) and postoperative vomiting and pain.

Hashimoto_T; Akita H; Aikawa S (1993) Analgesia induced by manual AP: its potency and implication. Kitasato Arch Exp Med Apr 65 Suppl: 73-82. Dept of Physiology, Sch of Hygienic Sci, Kitasato Univ, Kanagawa, Japan. In urethane-anaesthetized rats, unitary discharges of wide dynamic range (WDR) neurons were extracellularly recorded from the lumber cord. Repetitive electroshocks were given through needle electrodes in the receptive field with sufficient strength to activate C fibres. The number of evoked discharges was compared before manual AP to LI04 or ST36 and after 30 s. The effects of AP were followed up to 5 min after removal of the AP needle. Two different analgesic effects were observed: AP to LI04 gave long-lasting inhibition after insertion of the needles and stimulation of ST36 produced short-term and long-lasting inhibition similar to that seen in AP to LI04.

Janssens_LAA1 (1993) The Role of AP in Analgesia. Tijdschr Diergeneesk Mar 118(Suppl.):S11-S12. Oudestr 37, B-2610 Antwerp, Belgium.

Kitade_T; Odahara Y; Shinohara S; Ikeuchi T; Sakai T; Morikawa K; Minamikawa M; Toyota S; Kawachi A; Hyodo M; et al (1990) Studies on the enhanced effect of APA by DPA (2nd report): schedule of administration and clinical effects in low back pain and tooth extraction. AETRIJ 15(2):121-135. Dept of Oriental Med, Meiji Coll of Oriental Med, Kyoto, Japan. DPA is known to block the activity of carboxypeptidase, an enzyme which degrades enkephalins, endogenous morphine-like substances. Therefore, it is considered that DPA administered as an inhibiting drug of this degrading enzyme might prolong APA. 1) 30 patients suffering from chronic low back pain were treated with AP 30 min after the oral administration of 4 g of DPA. Results: excellent in 7 cases, good in 11, fair in 6 and poor in 6. Cases graded excellent and good were then compared with a placebo group. The effect was increased 26% in the DPA-AP group, which shows no statistically significant difference (p <0.1). 2) In 56 patients, tooth extraction was performed under APA: 18 had received 4 g DPA (oral) 30 min earlier. Results: excellent in 8, good in 6, fair in 3, and poor in 1. The excellent and good cases were compared with 38 placebo cases. The effect in the DPA-APA group was significantly increased by 35% (p <.01). 3) In order to determine the best time to administer DPA, 2 schedules were compared: 1. DPA was given 1 d previously in 3 doses of 0.5 g (26 cases); 2. A single dose of 4 g was given 30 min before treatment (30 cases). In the "excellent", "good" and "fair" cases, a 16% increase in effectiveness occurred when DPA was given 1 d previously. This was not statistically significant (p <0.1), but strongly suggested a tendency to increase. DPA enhances APA in clinical practice.

Klide_AM (1992) AP-produced surgical analgesia: Physiol, indications, techniques, and limitations. Probl Vet Med Mar 4(1):200-206. Dept of Clinical Studies, Sch of Veterinary Med, Univ of Pennsylvania, Philadelphia 19104. Experimentally and clinically, APA sufficient for surgery has been shown to occur in many species. Advantages of APA for surgery: it avoids the need for depressant drugs, which may be especially useful in veterinary practice in very sick patients, geriatric patients, or in patients requiring Cesarean section. Disadvantages: AP-produced surgical analgesia involves an unfamiliar technique, requires special equipment and very good restraint, requires an unpredictable induction-time and has inconsistent analgesic effects.

Klide_AM (1992) AP-Analgesia. Vet Clin N Am Small Anim Mar 22(2):374-379. Univ Penn, Sch Vet Med, Dept Clin Studies Philadelphia, Small Anim Anaesthesia Sect, Philadelphia, PA 19104 USA. AP-produced surgical analgesia has been shown in many species under experimental and clinical circumstances. The main advantage of APA is that no depressant drugs need to be used. The disadvantages are unfamiliarity, the need for special equipment, inconsistent effects, and lack of restraint.

Ouyang_B; Tan S; Tan S (1990) [The relations between APA and changes of level of serum metallic ion]. Chen Tzu Yen Chiu 15(2):143-146. Dept of Anaesthesia, First Affiliated Hospital, Guangzhou Med Coll, PRC. 40 patients treated by thyroidectomy received superficial cervical plexus block or EAP at LI04 and PC06 bilaterally. All patients were assigned at random into 4 anaesthetic groups: A1, A2 and A3=(EAP-analgesia; C=EAP + pethidine iv. Serum level of Na+, K+, Ca++, Cu++, Mg++ and Zn++ were measured before and during anaesthesia or EAP-analgesia, and postoperation. The analgesic effect of 4 groups did not differ significantly (p >.05). Serum Ca++ level fell during EAP-analgesia (p <.05-0.01), with no difference between group A1 and group A2 (p >.05). EAP decreased serum Ca++ reduced. There was no additive effect for the influence of serum Ca++ when EAP stimulated LI04 and PC06 simultaneously with iv Pethidine (1.3 mg/kg). 3. 5% Glucose injection iv during the operation probably disturbed the serum Ca++ level, but had no effect on analgesia. 4. AP significantly changed the level of serum Na+, Cu++, Mg++ and Zn++ but with wide variation. More research is needed on the mechanisms of these changes.