Download Local-spinal Therapy of Spasticity by H. Müller, J. Zierski, R. D. Penn (auth.), Prof. Hermann PDF
By H. Müller, J. Zierski, R. D. Penn (auth.), Prof. Hermann Müller MD, Priv.-Doz. Jan Zierski MD, Richard D. Penn MD (eds.)
Historical picture of spinal anaesthesia In 1884 the yankee neurologist J. L. eases. His discovery, notwithstanding, marks the Corning, via blocking off the neural con onset of the period of local anaesthesia. It took nearly 100 years till his duction to the hind extremities of a puppy via injecting cocaine-solution into the lumbar unique proposal of "local medicine of the vertebral interspace, used to be the 1st to according to wire" used to be back reconsidered because of shape spinal (or epidural?) anaesthesia [1]. purposes: at the moment, he used to be ignorant of the neighborhood I. the invention of other drug receptors anaesthetic houses of cocaine (dis within the spinal wire made it attainable, by way of in coated within the similar yr by way of C. Koller, who trathecal injection (or epidural appli cation, if the drug penetrates the dura), utilized cocaine to the attention of 1 of his pa tients [3]) and didn't intend to introduce to change nociceptive or motor transmis an anaesthetic process. Corning's pri sion in the spinal wire. mary goal used to be the appliance of substances in 2. Implantable units for long term appli proximity of the important apprehensive procedure, i. e. cation of substances to precise websites of the spinal wire, so as to deal with or maybe heal physique, together with the spinal areas, have been built through the 1970's.
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In contrast, baclofen has been shown to block bicuculline-induced epileptiform activity in in vitro preparations of the hippocampus [6, 7, 20; but see: 73] and the frontal neocortex [56]. These results also indicate that baclofen's reductions of excitatory synaptic transmission are resistant to blockade by bicuculline and indeed baclofen's reductions of EPSP amplitudes are not antagonized by this GABAA receptor antagonist [56]. The advent of in vitro slice preparations of the mammalian CNS has made it possible to evaluate the action of known concentrations of drugs on neurons in these preparations under steady state conditions.
9. Bromage PR, Camporesi E, Leslie J (1980) Epidural narcotics in volunteers: sensitivity to pain and carbon dioxide. Pain 9: 145 -160 10. Cahill J, Murphy D, O'Brien D, Mulhrall J, Fitzpatrick G (1983) Epidural buprenorphine for pain relief after major abdominal surgery: a controlled comparison with epidural morphine. Anaesthesia 38:760-764 11. Calvillo 0, Henry JL, Neuman RS (1979) Actions of narcotic analgesics and antagonists on spinal units responding to natural stimulation in the cat. Can J Physiol PharmacoI51:652-663 12.
Alternately, the use of synergistic pairs of receptorselective agents acting at different receptors suggests a possible way to slow the general progression of tolerance when chronic treatment is undertaken and large physiological effects are required (as in severe pain). Thus, physiological synergy between two receptor substrates permits a maximum physiological effect to be achieved with a relatively small amount of occupation of either receptor. A reduction in the rate of tolerance development with combined administration of morphine and alpha 2 -agonists has been demonstrated in the primate [109].