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J Jage

Publications and source records attributed to J Jage.

At least 19 recordsLinked to original sources
PubMed2006

Current practice in regional anaesthesia in Germany.

BACKGROUND AND OBJECTIVE: Several new techniques and agents (e.g. ropivacaine) have been introduced in regional anaesthesia to improve patients outcome and safety. The beneficial effects on patient outcome are clear with these techniques, however, no information is available about their pattern and frequency of use in clinical practice. This study presents data concerning the current practice of regional anaesthesia in Germany. METHODS: A questionnaire was sent to every German anaesthesia department (n = 1381). Questions focused on the frequency and range of regional anaesthetic procedures employed, with attention also to the organizational structural of the individual institution. RESULTS: Six hundred and sixty-seven questionnaires were returned anonymously, representing a return rate of 48.3%. In hospitals with less than 200 beds, the number of regional anaesthetics was markedly higher compared to large hospitals with more than 400 beds. In contrast, small hospitals tended to provide only basic techniques of regional anaesthesia, whereas larger hospitals implemented more advanced techniques. Bupivacaine remains the most commonly used long-lasting local anaesthetic. Staff structure was also different in small departments - patient care was performed by board certified anaesthesiologists while residents were responsible for the patients in larger departments. CONCLUSIONS: In small hospitals a majority of board certified anaesthesiologists rely on basic regional anaesthesia techniques. In large departments some consultants provide the entire spectrum of regional anaesthesia, with the majority of cases transferred to the residents responsibility. These results indicate the strong need to improve residency programs with regard to regional anaesthesia.

Anesthesia Department, Hospital↗
PubMed2006

[Anesthesia and analgesia in addicts: basis for establishing a standard operating procedure].

Addicts have an exaggerated organic and psychological comorbidity and in cases of major operations or polytrauma they are classified as high-risk patients. Additional perioperative problems are a higher analgetics requirement, craving, physical and/or psychological withdrawal symptoms, hyperalgesia and tolerance. However, the clinical expression depends on the substance abused. For a better understanding of the necessary perioperative measures, it is helpful to classify the substances into central nervous system depressors (e.g. heroin, alcohol, sedatives, hypnotics), stimulants (e.g. cocaine, amphetamines, designer drugs) and other psychotropic substances (e.g. cannabis, hallucinogens, inhalants). The perioperative therapy should not be a therapy for the addiction, as this is senseless. On the contrary, the characteristics of this chronic disease must be accepted. Anesthesia and analgesia must be generously stress protective and sufficiently analgesically effective. Equally important perioperative treatment principles are stabilization of physical dependence by substitution with methadone (for heroin addicts) or benzodiazepines/clonidine (for alcohol, sedatives and hypnotics addiction), avoidance of stress and craving, thorough intraoperative and postoperative stress relief by using regional techniques or systematically higher than normal dosages of anesthetics and opioids, strict avoidance of inadequate dosage of analgetics, postoperative optimization of regional or systemic analgesia by non-opioids and coanalgetics and consideration of the complex physical and psychological characteristics and comorbidities. Even in cases of abstinence (clean) an inadequate dosage must be avoided as this, and not an adequate pain therapy sometimes even with strong opioids, can potentially activate addiction. A protracted abstinence syndrome after withdrawal of opioids can lead to increased response to administered opioids (e.g. analgesia, side-effects).

Analgesics↗
PubMed2006

[Post-operative pain management in orthopaedic surgery and traumatology].

Provision of sufficient post-operative pain therapy is an obligation in the clinical management of patients. A wide range of medical, technical and organizational options is used to improve post-operative pain management in orthopaedic surgery. Measurement of pain is as important as the correct use of analgesics and application techniques. Standardized pain therapy algorithms should facilitate autonomous treatment of patients. Additional procedures like patient-controlled analgesia or local catheter for pain are necessary for individualized or operation-specific pain therapy. The balanced combination in postoperative pain therapy could reduce side effects and complication rates, increase mobility and enhance patient satisfaction.

Analgesics↗
PubMed2005

[Pain assessment in invasive diagnostic procedures. Comparison of an eleven-point numerical rating scale and a six-point verbal rating scale for pain measurement in bone marrow puncture].

BACKGROUND AND OBJECTIVE: Pain measurement during diagnostic procedures is an accepted prerequisite for appropriate therapy. In this study, the agreement between rankings of pain intensity on a numerical and a verbal rating scale was analyzed. METHODS: Patients attending a haematological outpatient clinic who underwent bone marrow puncture were requested to assess pain intensity perceived during the procedure on a elen-point numerical and a six-point verbal rating scale. RESULTS: Analysis of patients' pain ratings in 263 bone marrow punctures showed a very good correlation between numerical and verbal rating scale (Spearman correlation coefficient 0,86). By means of a transfer instruction categories of the verbal rating scale were assigned to figures of the numerical rating scale (0 - no pain, 1 or 2 - mild p., 3, 4 or 5 moderate p., 6 or 7 severe p., 8, 9 or 10 - very severe and worst possible pain). The resulting transfer table showed a good agreement with a weighted kappa of 0.72 (95% confidence interval: 0.66-0.79). CONCLUSION: Both scales can be employed efficiently for pain assessment during diagnostic procedures. Verbal categories can be assigned to numerical values and vice versa numerical values to verbal categories. However, in view of the inter-individual variations it appears appropriate to re-assure pain perception with each patient in order to avoid over- or undertreatment.

Biopsy↗
PubMed2005

[Risk factors for substance abuse and dependence in opioid therapy for chronic noncancer-related pain].

Opioids are valuable analgesics, capable of providing pain relief and functional improvement not only in patients with cancer-related pain, but also in chronic noncancer-related pain patients. However, recent data have shown that the increasing prescription of opioids is associated with a rise in aberrant drug-related behaviour. The causes of this behaviour are multifactorial. Some pharmacotherapeutic, but in particular psychosocial risk and etiologic pain factors have been identified. The indication for the prescription of opioids must be very carefully weighed in the presence of any risk factors. In these cases the integration into a multimodal, interdisciplinary therapy programme is mandatory. A contractual agreement on the opioid therapy including goals, side effects, controls including urine drug testing and criteria to finish the opioid therapy are advisable. Assessment of the progress of therapy is based on the following factors: analgesic efficacy, adverse side effects, functional status and aberrant drug-related behaviour. In the absence of a successful opioid therapy, the treatment must be discontinued to avoid iatrogenic damage, substance abuse and illegal diversion. After discontinuation of the therapy, a comprehensive interdisciplinary re-evaluation is required.

Analgesics, Opioid↗
PubMed2005

Efficacy of vertical infraclavicular plexus block vs. modified axillary plexus block: a prospective, randomized, observer-blinded study.

BACKGROUND: Despite containing severe risks, infraclavicular approaches to the brachial plexus gained increasing popularity. Likewise, the vertical infraclavicular plexus block improved anesthesia compared to the standard axillary approach but contains the risk of pneumothorax. Therefore we modified the standard axillary technique by inserting a proximal directed catheter, referred to as a high axillary plexus block. We prospectively compared quality and onset of neural blockade after vertical infraclavicular plexus block (VIP) and high axillary plexus block (HAP) in two randomized groups (30 patients in each). METHODS: In group VIP the insulated needle was inserted midway between the ventral process of the acromion and the jugular notch. In group HAP, first an axillary needle was placed. Through this a stimulating catheter was inserted in a proximal direction (10-15 cm); correct placement was confirmed by nerve stimulation. All patients received 40 ml ropivacaine 0.75% (300 mg). Discriminating between analgesia and anesthesia, a blinded observer assessed progression of neural blockade every 5 min for 60 min by pin prick. Incomplete blocks were supplemented 60 min after initial injection. RESULTS: All patients in both groups demonstrated sufficient surgical anesthesia. No patient needed systemic supplementation or general anesthesia. However, vertical infraclavicular plexus block indicated superior anesthesia compared to high axillary plexus block, regarding musculocutaneous, axillary and radial nerve, which were completely blocked with a higher success rate and in a shorter time interval (P < 0.05). CONCLUSIONS: While both techniques provide sufficient surgical anesthesia, vertical infraclavicular plexus block demonstrated a partially higher success rate and a faster onset than high axillary plexus block.

Adult↗
PubMed2003

[Cancer pain therapy and palliative medicine. Concepts and results of a project at the cancer center of Rhineland-Palatinate from 1995-2001].

The cancer center of Rhineland-Palatinate conducted the project "Cancer Pain Therapy and Palliative Medicine" from 1995 to 2001. Questionnaires were circulated among physicians in Rhineland-Palatinate in 1995 and 1998. Positive changes were registered with regard to attitudes toward highly potent opioids and cooperation with outpatient hospice services. Responses to questions on knowledge of tumor pain therapy were better answered in 1998, but all in all only about one-third of the physicians replied appropriately. Similarly, development of a functioning network for medical counseling for tumor pain therapy was only possible to a limited extent. To achieve comprehensive inclusion of knowledge on palliative medicine in counseling programs, initiatives for continuing education should not be bound to a time-limited project.

Cancer Care Facilities↗
PubMed2002

[Postoperative morphine excess or rational therapy? An exceptional case of applying the morphine equivalent].

UNLABELLED: We report on a 51-year-old female with a 7 year history of breast cancer. In August 2000 surgical replacement of the 8th thoracic vertebra was performed. From November 2000 the patient developed progressive pain, due to additional spine metastases, leading to pain therapy (according to the patient record) as follows: MST 320 mg oral 4 times daily, Durogesic 100 micrograms/h transdermal, Sevredol 40 mg oral 3 times daily and Ibuprofen 800 mg oral 3 times daily. Due to the risk of spinal instability and persisting pain a thoracic spondylodesis from Th 4-L2 was performed. Parallel to arrival in the PACU the patient developed extremely intensive pain. Pain control was achieved by fractional injection of overall 660 mg morphine in the first 120 min. After interviewing the patient, opioid consumption surprisingly turned out to be 60% higher than presumed. Pain therapy was continued by infusion and PCA with morphine in a daily intravenous dosage of 600-800 mg. Consecutively the pain therapy was switched to oral morphine and co-analgesics and the patient was discharged home 14 days postoperatively. PROBLEM: Some patients with chronic cancer pain are used to increased opioid dosages prior to planned surgery. In the perioperative setting these dosages have to be continued and adapted to current requirements, otherwise analgesic undersupply occurs. In our case report we describe a serious sequence of postoperative analgesic undersupply in an opioid consuming patient. The main principles of post-operative dosing and logistic pitfalls are illustrated.

Analgesia, Patient-Controlled↗
PubMed2002

The treatment of pain in urology.

Contemporary medicine is characterized by sophisticated specialization of the individual physician. The specialist in urological surgery may undertake one of the most important and primary medical tasks, the mitigation and therapy of pain. This review aims to provide an overview of the concepts of pain therapy in urology. Most patients benefit from basic concepts of analgesia, including measuring and documenting pain scores at the bedside by the nursing staff. Patients undergoing very painful operative procedures require more potent techniques of analgesia, e.g. intravenous patient-controlled analgesia and epidural analgesia. These techniques need adequate supervision by an acute pain service, but their implementation improves the outcome in some situations. Pain in acute renal obstruction varies in intensity and duration; hence, analgesic therapy has to be tailored to the individual patient. Pain syndromes from cancer can be more complex than those after surgery. Neuropathic pain is probably the most difficult to manage and requires consultation with a pain-management specialist. In the case of neuropathic pain, treatment only with opioids is of limited efficacy and combination with co-analgesics is necessary. In addition, invasive analgesic therapies should sometimes be considered.

Analgesia, Patient-Controlled↗
PubMed2002

Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery.

BACKGROUND: Ketorolac is approved for the relief of postoperative pain but concerns have been raised over a possible risk of serious adverse effects and death. Two regulatory reviews in Europe on the safety of ketorolac found the data were inconclusive and lacked comparison with other non-steroidal anti-inflammatory drugs. The aim of this study was to compare the risk of serious adverse effects with ketorolac vs diclofenac or ketoprofen in adult patients after elective major surgery. METHODS: This prospective, randomized multicentre trial evaluated the risks of death, increased surgical site bleeding, gastrointestinal bleeding, acute renal failure, and allergic reactions, with ketorolac vs diclofenac or ketoprofen administered according to their approved parenteral and oral dose and duration of treatment. Patients were followed for 30 days after surgery. RESULTS: A total of 11,245 patients completed the trial at 49 European hospitals. Of these, 5634 patients received ketorolac and 5611 patients received one of the comparators. 155 patients (1.38%) had a serious adverse outcome, with 19 deaths (0. 17%), 117 patients with surgical site bleeding (1.04%), 12 patients with allergic reactions (0.12%), 10 patients with acute renal failure (0.09%), and four patients with gastrointestinal bleeding (0.04%). There were no differences between ketorolac and ketoprofen or diclofenac. Postoperative anticoagulants increased the risk of surgical site bleeding equally with ketorolac (odds ratio=2.65, 95% CI=1.51-4.67) and the comparators (odds ratio=3.58, 95% CI=1.93-6.70). Other risk factors for serious adverse outcomes were age, ASA score, and some types of surgery (plastic/ear, nose and throat, gynaecology, and urology). CONCLUSION: We conclude that ketorolac is as safe as ketoprofen and diclofenac for the treatment of pain after major surgery.

Acute Kidney Injury↗
PubMed1999

[12 basic rules in drug therapy of tumor pain].

Successful pharmacologic treatment of cancer pain is founded upon careful assessment and measurement of pain before and during therapy. Strong opioids should be used timely in accordance to the WHO 3-step analgesic ladder. The oral route should always be favored. Frequent opioid side effects include constipation, temporary nausea and vomiting and are to be treated adequately. Slow release morphine preparations are to be administered every 12 hours. Adjustment of dose follows pain intensity. Immediate release morphine for breakthrough pain should be provided routinely to patients maintained on a 12-hourly regimen of slow release morphine. The appropriate rescue dose will be 1/6 of the total daily morphine dosis. In case of changement of route of administration the relative potency ratio of oral morphine to parenteral morphine is about 3:1. The coadministration of nonopioids is essential for the relief of cancer pain in many cases. Adjuvant drugs may provide pain relief in specific types of pain (e.g. neuropathic pain).

Analgesics↗
PubMed1999

Postoperative pain therapy after lumbar disc surgery.

OBJECT: This study was undertaken to determine whether a special postoperative pain administration of tramadol and diclofenac provides any benefits in patients who underwent microsurgical lumbar discectomy. METHODS: The study consisted of 60 patients undergoing microsurgical lumbar discectomy. Patients were randomly divided into two groups based on the postoperative pain management: 1) Group A (n = 30); no standardized pain therapy; these patients received on demand different analgesics and at variable dosages which were selected by the neurosurgeons; 2) Group B (n = 30); standardized pain therapy with specific dosages of tramadol and diclofenac in regular time intervals during the first 48 hours after surgery. After surgery follow-up data from a special standardized questionnaire were obtained for all 60 patients during the first 48-72 postoperative hours. The patients were asked for course and intensity of pain as well as about some specific circumstances of clinical therapy after surgery. The postoperative pain intensity of patients treated with the special combination of tramadol and diclofenac was significantly diminished (24 hours after surgery: p = 0.0002, 48 h: p = 0.0047, 72 h: p = 0.0034) in relation to the group without standardized pain therapy. Similarly, the frequency of breakthrough pain was significantly reduced (24 h: p = 0.0001, 48 h: p = 0.003, 72 h: p = 0.004). CONCLUSIONS: The results suggest that the application of tramadol and diclofenac during the first 48 hours after lumbar microdiscectomy results in a reduction in postoperative pain without complications. We suggest that the use of this combination can be a beneficial adjunct to lumbar disc surgery.

Adult↗
PubMed1999

[Opioids in pain therapy].

In this article were described opioids with different analgesic efficacy, their dosage, application, elimination and side effects. On the basis of WHO step ladder rules are opioids important analgesic substances not only for cancer related pain therapy, but also for some well defined non cancer related pain therapy.

Analgesics, Opioid↗
PubMed1998

[Results of extracorporeal shock-wave application in lateral elbow tendopathy].

AIM: This review article focuses on a possible pain-alleviating effect of shock-wave application in persistent lateral epicondylopathy of the elbow and compares the effects with data on other non-operative and operative procedures. METHODS: Patients who suffered from chronic tennis elbow for more than 12 months and were therefore referred for a surgical procedure were assigned at random to two groups of low-energy shock-wave therapy. Group I received a total of 3000 (3 x 1000) impulses of 0.08 mJ/mm(2), while group II (control group) received a total of 30 (3 x 10) impulses of 0.08 mJ/mm(2). Follow-up examinations were carried out after 3, 6, and 24 and 52 weeks. RESULTS: There was a significant improvement of pain and function in group I, with a good or excellent outcome in 52% of cases compared to 6% in group II at the last evaluation. CONCLUSION: Extracorporeal shock-wave application has a dose-dependent pain-relieving effect on chronic tendopathy of the lateral elbow.

Clinical Trial↗
PubMed1998

Physico-chemical stability of infusion solutions for epidural administration containing fentanyl and bupivacaine or lidocaine.

This study examines the physico-chemical stability of infusion solutions for epidural administration containing bupivacaine hydrochloride 0.06% or 0.125% or lidocaine hydrochloride 0.25% in 0.9% sodium chloride, each with fentanyl 0.0002%. The solutions were prepared in polyvinyl chloride (PVC) infusion bags and stored without overwrap at room temperature (25-30 degrees C) or refrigerated (4-8 degrees C). Over a period of 32 days stability was determined by visual inspection, pH measurement, and HPLC assay of drug concentrations. Admixtures of bupivacaine/fentanyl and lidocaine/fentanyl proved to be chemically stable over a 32 day period, but physical incompatibility (sorption) with PVC-bags was discovered. The stability of the admixtures was influenced by pH and storage temperature. In none of the tested admixtures with an initial pH value lower than 6, did the concentrations of fentanyl or the local anesthetic decrease under 90% of the initial concentrations. A solution of fentanyl and lidocaine with an initial pH of 6.7 exhibited a rapid decrease of drug concentrations. Supposing fentanyl loss was due to sorption, buffered single drug fentanyl solutions of pH 5.5, 5.8, 6.3, and 6.7 were prepared in glass and PVC containers and stored under the same conditions. All solutions in PVC bags showed relevant fentanyl loss which was more evident at higher pH, whereas fentanyl concentration remained unchanged in glass containers at any of the tested pH values.

Analgesics, Opioid↗
PubMed1997

[Extracorporeal shockwave therapy in orthopedics. Positive results in tennis elbow and tendinosis calcarea of the shoulder].

Since the beginning of the 1990s scientific investigations on the use of extracorporeal shock wave therapy (ESWT) in the field of orthopedics have been carried out at the Orthopedic Department of the University of Mainz. Prospective studies demonstrated beneficial effects in chronic lateral humeral epicondylitis (tennis elbow), and in calcifying tendinitis of the shoulder in more than 50% of the cases. Additional indications for which positive results of prospective studies have been published during the past 2 years are plantar calcaneodynea and pseudoarthrosis. On the basis of the results achieved, it may be concluded that, for specific indications, extracorporeal shock wave therapy may now be taken out of the clinical testing stage and introduced into routine practice.

Calcinosis↗
PubMed1997

[Postoperative epidural analgesia with Bupivacaine-HCl 0.06%/Fentanyl 0.0002%. Experiences and physicochemical stability in infusion bags].

Continuous epidural infusion of bupivacaine with the opioid fentanyl represents an effective analgesic method in the therapy of strong postoperative pain after major surgery. Preparation of the required infusion solution in syringes with a volume of 50 ml immediately prior to administration is routinely performed by nursing staff in Germany. The effort required for the preparation is associated with logistical and pharmaceutical difficulties. The preparation of a mixture of bupivacaine hydrochloride 0.06% and fentanyl 0.0002% in 250 ml infusion bags at the pharmacy of the University Hospital Mainz is described. To determine the physicochemical stability, the concentration of bupivacaine-HCl and fentanyl was assessed using HPLC over a period of 32 days; in addition the pH values were determined. After 32 days 95% of the bupivacaine hydrochloride and fentanyl baseline values were recorded. The pH baseline value had decreased from 5.48-5.52 to 0.5-0.7 units. The measured values confirm the physicochemical stability of the mixture of bupivacaine hydrochloride 0.06% and fentanyl 0.0002% over a period of 32 days. The infusion bag can be stored for 4 weeks at room temperature.

English Abstract↗