PLASMA CONCENTRATIONS OF METHADONE DURING POSTOPERATIVE PATIENT-CONTROLLED EXTRADURAL ANALGESIA

Plasma concentrations of methadone were measured by gas chromatography in 16 patients receiving extradural methadone by continuous infusion for relief of postoperative pain. Venous blood samples were taken after a loading dose of extradural methadone 2 mg and during infusion of 0.46 mg h−1 plus patient-controlled increments of 0.2-1 mg. Mean (SD) plasma concentration of methadone was 9.8 (2.1) ng ml−1 at 15 min; this did not change significantly during the first 2 h, after which it increased gradually to 32.2 (4.6) ng ml−1 (P < 0.001) at the end of 24 h. The mean quantity of extradural methadone required to produce effective analgesia was 10.3 (1.8) mg during the first 12 h after operation and 6 (1.0) mg for the subsequent 12 h. The mean amount of methadone for effective analgesia on the second day was 7.6 (1.1) mg. No adverse effects were detected during the 2-3 days of methadone therapy. Plasma concentration of methadone increased significantly during patient-controlled infusion of extradural methadone in the first 24 h after operation, suggesting rapid vascular uptake. Systemic activity of the drug contributes to the analgesic effect of extradural methadon

Plasma concentrations of methadone during postoperative patient-controlled extradural analgesia

Plasma concentrations of methadone were measured by gas chromatography in 16 patients receiving extradural methadone by continuous infusion for relief of postoperative pain. Venous blood samples were taken after a loading dose of extradural methadone 2 mg and during infusion of 0.46 mg h−1 plus patient-controlled increments of 0.2-1 mg. Mean (SD) plasma concentration of methadone was 9.8 (2.1) ng ml−1 at 15 min; this did not change significantly during the first 2 h, after which it increased gradually to 32.2 (4.6) ng ml−1 (P < 0.001) at the end of 24 h. The mean quantity of extradural methadone required to produce effective analgesia was 10.3 (1.8) mg during the first 12 h after operation and 6 (1.0) mg for the subsequent 12 h. The mean amount of methadone for effective analgesia on the second day was 7.6 (1.1) mg. No adverse effects were detected during the 2-3 days of methadone therapy. Plasma concentration of methadone increased significantly during patient-controlled infusion of extradural methadone in the first 24 h after operation, suggesting rapid vascular uptake. Systemic activity of the drug contributes to the analgesic effect of extradural methadon

Role of proprioception and vision in handwriting

The objective of this study is to better understand the role of proprioception in handwriting and test earlier conclusions stating that the automated shaping of letters was not impaired by the removal of visual control in deafferentation. To this aim we compared the performance of the deafferented patient GL, who suffers from a complete loss of cutaneous and proprioceptive sensation, with that of eight healthy age- and sex-matched subjects. The word “Parallele”, written within a short sentence with and without visual control, was quantified using a digital writing tablet. Three of the 13 analyzed parameters were strikingly different in patient GL compared to healthy subjects, both with and without vision: increase of number of pen touches, increase in number of inversions in velocity, and decrease of mean stroke frequency. The changes in these three parameters indicate a strong impairment in automated behaviour in the absence of proprioception and touch. This impairment is also supported by the significantly longer movement duration, which is also significantly increased by the removal of visual control. The present study provides for the first time a quantification of handwriting in a completely deafferented patient and reveals the central role of proprioception for the storage, updating, and maintenance of skilled motor programs. The fact that the deficits are already present with visual feedback suggests that the role of vision in handwriting is only secondary