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Biomedical subjects

M Zenz

Publications and source records attributed to M Zenz.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Analysis of the therapy of chronic pain. A comparison of previous therapy and specialized pain therapy].

In Germany patients with chronic pain are often undertreated. It is necessary to establish more specialized institutions for pain therapy. As pain therapy is time consuming and labor intensive the costs must be justified by quality and efficiency. METHODS. We analyzed the new patients who came to our pain clinic in 1990 and compared the previous nonspecialist pain-related treatment with our pain therapy. For each patient we recorded the duration of pain therapy in the past, the number of physicians involved in the treatment, the number and duration of hospital stays and the number of operations carried out to relieve pain. For our pain therapy we recorded the number of treatments on an outpatient basis, the number of patients who were hospitalized and the number of hospital days. The outcome of our pain therapy was determined on a visual analogue scale (VAS). Pain relief of more than 50% was defined as adequate pain therapy. RESULTS. In 1990 we treated 379 new patients in our pain clinic. The largest group (140, 37%) had pain of the muscle or skeletal system. A further 75 patients (18%) had neuropathic pain, 66 (17%) suffered from cancer pain, several types of headache were found in 57 patients (15%), 19 patients (5%) had phantom limb pain, 11 (3%) suffered from reflex sympathetic dystrophy, and we diagnosed psychogenic pain in 11 patients (3%). On average the patients had been treated for their pain over a period of 10 years by eight different physicians. Patients suffering from migraine had the longest duration of preliminary therapy (19.2 years), while patients with cancer pain were pretreated for 2, 3 years in the period before. 80% (n = 302) of all patients were hospitalized at least once. A total of 20,959 hospital treatment days was registered. At least one operation was performed in 34% of the patients (n = 130) to relieve the pain. For all patients the pain relief afforded by the preliminary therapy was insufficient. In our pain therapy the patients had on average 6.5 outpatient appointments. We hospitalized 45 patients (12%), for a mean of 11 days. During the observation period 74% of the patients (n = 280) obtained pain relief of more than 50% in comparison with the start of treatment. CONCLUSION. The findings of our retrospective study demonstrate that specialized pain therapy is evidently effective. If such therapy is instituted early enough, chronic pain can be prevented. Shorter duration of disease, fewer stays in hospitals and less absence from work could reduce the economic costs of chronic pain. It is necessary to make specialised pain therapy a regular component of clinical practice; this means redoubling our efforts concerning education and experimental and clinical studies. The efficiency of pain therapy must be documented in order to improve the care of patients with chronic pain.

Chronic Disease↗
PubMed1993

[The anterior sonographic-guided celiac plexus blockade. Review and personal observations].

The coeliac plexus block is an approved method for the relief of upper abdominal pain due to cancer of the upper intra-abdominal viscera or to chronic pancreatitis. While there are many reports concerning the posterior approach to the coeliac plexus block, little attention has been given the anterior approach. There are two ways of implementing the anterior approach to the coeliac plexus: CT-guided and the ultrasound guided approach. METHODS. The ultrasonic-guided anterior approach to the coeliac plexus block is used with the patient in the supine position. The aorta and discharge of the truncus coeliacus or the a. lienalis respectively, are ultrasonographically presented at two levels. After setting local cutaneous and subcutaneous anaesthesia, a 15-cm-long 25 G-needle is introduced into the epigastrium. The point of the needle is--ultrasonographically guided--inserted into the pre-aortic area near the discharge of the truncus coeliacus. The position of the needle point is ultrasonographically controlled on two levels. For the enforcement of a diagnostic coeliac plexus block after careful aspiration on two levels, 10 ml of bupivacaine 0.5% is injected. The spread of the solution is evaluated by ultrasound. If the needle position is correct; a few minutes later the patient has a feeling of warmth in the upper abdominal region. For the enforcement of a neurolytic coeliac plexus block 10 ml ethanol 96% and 10 ml prilocaine 1% can be administered. The two solutions are applied as small volumes in permanent succession. Thus the burning pain, which is often observed after the injection of alcohol, is avoided. RESULTS. In the literature there are only a few reports, about the results and side-effects after use of the anterior approach in the coeliac plexus block. The results of these investigations and our own show total pain relief or at least good pain reduction by at best 85%. The reduction in pain achieved continues in as many as 60% of the treated patients. There is the possibility to stop or at least reduce the analgesic premedication. These results are comparable with those after using the posterior approach to the coeliac plexus block. When carrying out the anterior approach in the coeliac plexus block, most of the patients showed increased intestinal motility. Therefore, about 60% of all patients had transitory diarrhoea. In 12-25% of the patients orthostatic hypotension was observed. This side-effect is avoided by an appropriate infusion before enforcement of the block. In a frequency of 4-100% the occurrence of burning pain was reported during injection of the alcohol. No serious side-effects were observed. CONCLUSIONS. The results concerning total pain relief or at least pain reduction are comparable to the posterior approach for the block. Nevertheless, there are some advantages to the ultrasound-guided anterior approach. There is less risk using this technique. No methodological complications have been observed so far. There is no risk of neurological complications such as paraplegia. Because the patients remain in the supine position, the anterior approach to the coeliac plexus block is suitable for terminally ill patients, who are not able to tolerate the prone position and need careful supervision and good ventilation. Also, no contrast medium is necessary. Only a small volume of local anaesthetics or alcohol is required. We prefer the anterior approach of the coeliac plexus block as a fast, safe and cost-effective method, which should receive increasing attention during the next few years.

Abdominal Pain↗
PubMed1992

No psychological dependence after oral administration of morphine to rats.

Rats subjected to forced oral self-administration of morphine solutions without or in combination with two daily i.p. injections of morphine preferred drinking water when this was offered in addition to morphine solutions. The daily intake of morphine during the terminal phase of self-administration of morphine was 50-80 mg/kg (oral application alone) or 270 mg/kg (oral and i.p. application). Morphine treated animals showed withdrawal symptoms on administration of naloxone 1 mg/kg i.p. during the period of self-administration, but not when they had started drinking exclusively water. The tail-flick test revealed no tolerance during prolonged treatment with morphine. The results indicate that no psychological dependence developed when morphine was applied orally and regularly.

Administration, Oral↗
PubMed1992

Long-term oral opioid therapy in patients with chronic nonmalignant pain.

In contrast to the use of opioids for the treatment of acute and chronic cancer pain, the administration of chronic opioid therapy for pain not due to malignancy remains controversial. We describe 100 patients who were chronically given opioids for treatment of nonmalignant pain. Most patients experienced neuropathic pain or back pain. We used sustained-release dihydrocodeine, buprenorphine, and sustained-release morphine. Pain reduction was measured with visual analogue scales (VAS), and the Karnofsky Performance Status Scale was used to assess the patient's function. Good pain relief was obtained in 51 patients and partial pain relief was reported by 28 patients. Only 21 patients had no beneficial effect from opioid therapy. There was a close correlation between the sum and the peak VAS values (r = 0.983; p less than 0.0001) and pain reduction was associated with an increase in performance (p less than 0.0001). The most common side effects were constipation and nausea. There were no cases of respiratory depression or addiction to opioids. Our results indicate that opioids can be effective in chronic nonmalignant pain, with side effects that are comparable to those that complicate the treatment of cancer pain.

Adult↗
PubMed1992

[Drug dependence in therapy of chronic pain].

The use of drugs in pain therapy is characterized by the fear of addiction. As a result strong analgesics are underused. To compensate the missing analgesic effect the additional use of psychotropic drugs is common. There is still little knowledge that just this therapeutic strategy of underuse leads to iatrogenic addiction. To avoid misunderstandings and irritations in the discussion around addiction, there must be clearly distinguished between physical and psychological dependence. There is sufficient evidence that especially tranquilizers and mixed analgesics induce the development of psychological dependence. In pain therapy there is no indication for these substances. In contrast opioids can be used without causing psychological dependence, presuming the guidelines of drug therapy in chronic pain (e.g. WHO guidelines) are attended.

Adult↗
PubMed1991

[Histamine release and cardiovascular reactions to implantation of bone cement during total hip replacement].

Cardiovascular reactions to acrylic bone cement in patients with total hip replacement are a common complication. Hypotension and arrhythmias are the most frequently observed symptoms. Elderly patients with fractures of the femoral neck constitute a special risk group. In some patients these reactions can be fatal. The mechanisms suggested to explain these reactions are embolism of air, polymer or fat, reaction to the heat, and toxic or vasodilating effects of the acrylic monomer. In a pilot study and in a case report a significant rise of the plasma histamine was described following cementation of the femur. We therefore performed an investigation to find whether application of bone cement to the femur caused histamine release in elective hip surgery, and, independently of this, also investigated whether premedication with H1- + H2-antagonists had any effect on the cardiovascular reactions due to bone cement implantation into the femoral shaft in elderly patients with hip fracture. METHODS. Part I. In all, 40 patients, scheduled for elective surgical hip replacement were anesthetized by general or epidural anesthesia. Patients were continuously monitored by ECG. Blood pressure was recorded noninvasively at 2-min intervals during the study. Blood samples for the determination of the plasma histamine were taken immediately before implantation of the bone cement into the femur, and 2, 5, and 10 min after. Part II. A further group of 20 patients aged greater than or equal to 70 years with fractures of the femoral neck and in whom total hip replacement was planned were included in the study. In this group, 10 patients were randomly assigned to receive 4 mg clemastine + 400 mg cimetidine i.v. about 15 min before implantation of the bone cement. All patients were operated on under general anesthesia. ECG was monitored continuously and blood pressure was monitored at 2-min intervals during the study. Changes of the blood pressure and heart rate and therapeutic interventions following the implantation of the bone cement were documented. RESULTS. Part I. In 11 of the 40 patients (27.5%) plasma histamine increased by greater than 0.5 ng/ml (9 patients greater than 1 ng/ml). In comparable groups (patients with a control systolic blood pressure less than or equal to 130 mmHg) the histamine responders showed a significantly greater reduction in systolic blood pressure (-5.7 +/- 14.7 vs -17.7 +/- 8.6 mmHg). Part II. In the control group we observed a significantly greater fall in systolic blood pressure than in premedicated patients (41.5 +/- 25.4 vs 11.0 +/- 13.4 mmHg). In the control group 7 of the 10 patients required therapeutic interventions, while in the premedicated group only one therapeutic intervention was necessary (P less than 0.05). DISCUSSION. We have demonstrated that the implantation of acrylic bone cement into the femur may increase plasma histamine by greater than 1 ng/ml. In elderly patients with preexisting cardiac diseases or/and hypovolemia even moderate histamine release can cause serious, sometimes potentially fatal, cardiovascular complications. In this special risk group with hip fractures we found a significant reduction in the frequency of cardiovascular reactions to bone cement implantation in patients premedicated with H1 + H2 antagonists. Because we also observed significant falls in systolic blood pressure in premedicated patients, we assume that the pathogenesis of cardiovascular reactions to bone cement implantation is multifactorial. It may be that potentially lethal complications only occur if two or more of the predisposing factors (hypovolemia, myocardial insufficiency, arrhythmia, embolism, histamine release) are present simultaneously. Pre- and intraoperative measures therefore have to be instituted to eliminate all possible risk factors.

Aged↗
PubMed1991

Morphine myths: sedation, tolerance, addiction.

Morphine and other strong opioids are still, more than 180 years after the syntheses of morphine, not adequately used in clinical practice and many patients suffer unnecessarily severe pain in consequence. Governments limit morphine usage by legal restrictions. The underuse of morphine and its restriction in many countries is mostly due to prejudice and myths which clinical experience does not show to be true. Morphine is a very safe drug, correctly prescribed in chronic pain therapy, the only severe side effect being constipation.

Arousal↗
PubMed1989

[Retard morphine in the long-term therapy of severe tumor pain].

35 patients with severe cancer pain received oral retard morphine. Pain reduction was achieved in each case; duration of effectiveness was between 8 and 12 hours. Mean daily dose was 230 mg morphine, but in individual cases the maximal daily dose had to be over 800 mg. The Karnofsky index of physical capacity was increased in all patients. The main side effect was constipation, which actually increased in the course of treatment. On the other hand, nausea and vomiting decreased after a few weeks. No dependence developed in any of the patients. This form of morphine medication thus was effective over long periods and it has become an important part in the range of strongly effective analgesics.

Adult↗
PubMed1989

[A new positioning aid for administering axillary plexus anesthesia].

A "plexus-table" is introduced as a new help to place an arm for application of the axillary plexus block. A modified Maquet arm posturing device offers a sufficient big plate, which is adjustable in all planes. The plate is fixed closely to the operation table. A more comfortable placement of the patient's arm is possible, due to the reduction of the externally rotation of the shoulder. The new table can be adapted to patients with restrictions of the movements of the shoulder. For the anaesthetist this results in a good presentation of the axillary region.

Anesthesia, Conduction↗
PubMed1988

The use of roxatidine acetate in fasting patients prior to induction of anaesthesia as prophylaxis against the acid aspiration syndrome.

Aspiration pneumonitis is one of the major causes of anaesthesia related deaths. H2-receptor antagonists are effective drugs for the prevention of the acid aspiration syndrome (Mendelson's syndrome). The new long-acting H2-receptor antagonist roxatidine acetate may be the first H2-receptor antagonist which could effectively reduce acid secretion following a single bedtime premedication on the evening before an operation. A prospective controlled randomised double-blind study was conducted in 60 elective patients undergoing gynaecological operations requiring tracheal intubation. 30 patients received oral roxatidine acetate 150 mg at 10 pm, the other 30 patients received placebo. Immediately after intubation, at 15 minutes and at the end of the operation gastric pH and the volume of the aspirate were measured. In the placebo group, 13 patients (43%) had gastric pH values below the critical value of 2.5, while in the roxatidine acetate group gastric pH values were raised above 2.5 in all but 3 patients (10%) [p less than 0.05]. In the roxatidine acetate group pH values were significantly higher than in the placebo group (p less than 0.01). The mean gastric volume in the placebo group was 23.3 +/- 27.1 ml, compared to 14.5 +/- 9.4 ml for roxatidine acetate. The 5 highest gastric volumes were observed in the placebo group (max 146 ml). A single bedtime oral premedication with roxatidine acetate 150 mg ensures a gastric pH above 2.5 until 11 am the following day.

Adult↗
PubMed1988

[Cardiovascular reactions and histamine release following atracurium--a problem of dosage?].

All muscle relaxants can induce allergic or pseudo-allergic reactions. The medium-long-acting, nondepolarizing muscle relaxant atracurium has been shown to be a potent histamine liberator. Up to now it is unknown if a clinical dosage of atracurium exists where no clinically relevant histamine release occurs. In a prospectively controlled study we therefore investigated the effects of different dosages of atracurium on cardiovascular reactions and histamine release.

Adult↗
PubMed1987

[Therapy of perioperative sinus tachycardia with the new calcium antagonist falipamil].

The haemodynamic responses after application of 100-200 mg falipamil (5,6-dimethoxy-2-(3-((alpha (3,4-dimethoxy)-phenylethyl) methylamino)propyl)phthalimidine, AQ-A 39) a new calcium channel blocker with specific action on the sinus node, was studied in 11 patients with perioperative sinus tachycardia (greater than 120/min). A drop in the heart rate of at least 10% could be observed in all patients. In 8 patients 100 mg falipamil decreased the mean heart rate from 130 +/- 19 to 97 +/- 8/min 5 min after the application (p less than 0.001). In the resting 3 patients a second dose of falipamil was injected because of insufficient clinical response. In these patients the mean heart rate dropped from 162 +/- 27 to 125 +/- 40/min 10 min after the second dose. No significant changes of the blood pressure could be observed. Falipamil may become a valuable drug for the therapy of sinus tachycardia due to catecholamines during the perioperative period.

Adult↗
PubMed1987

[Clinical and toxicologic study of axillary plexus block with prilocaine or mepivacaine].

A prospective controlled double-blind study was designed to compare the efficacy and the toxicity of mepivacaine and prilocaine for the axillary blockade of the brachial plexus. Twenty patients in each group received 40 ml of either 1.5% mepivacaine or 1.5% prilocaine. The sensory and the motor blockade achieved in both groups were comparable. The mean plasma levels attained following mepivacaine were significantly higher than those attained after prilocaine (peak-plasma level (mean +/- SD): 2.02 +/- 0.28 micrograms/ml vs 5.37 +/- 1.83 micrograms/ml). In four patients of the mepivacaine group, the plasma levels entered the toxic range. While no methemoglobinemia could be detected following mepivacaine, four of the patients receiving prilocaine developed methemoglobinemia with a maximum level of 10%. No complications due to methemoglobinemia were observed in any of the patients. Because of its significantly lower toxic potential, prilocaine seems to be the better local anaesthetic for axillary blockade of the brachial plexus.

Adult↗
PubMed1987

[Therapy of pain caused by gastrointestinal tumors].

Therapy of pain induced by malignant diseases is an important task for any physician. A proper diagnosis is necessary for an adequate treatment. Pain in the bones can be treated successfully with peripherally acting analgesics such as acetylsalicylic acid, paracetamol or metamizole. On the other hand, certain tumors require local blockade as in cases with pancreatic or perianal tumors. If such a therapeutic approach is not possible or if pain is felt all over the body then centrally acting analgesics such as opiates are necessary. Opiates should be administered according to a tight schedule and not on demand. Combinations of certain analgesic drugs are often quite useful. Apart from their peripheral application opiates can also be administered epidurally or intrathecally which reduces the required dosage.

Acetaminophen↗
PubMed1986

Prevention of histamine-induced cardiovascular reactions during the induction of anaesthesia following premedication with H1- + H2-antagonists i.m.

In a prospective controlled double-blind study, 60 elective surgical patients were randomly assigned to three premedication groups. Twenty patients received promethazine 0.5 mg kg-1 i.m. 45 min before induction of anaesthesia; a further 20 patients received an additional i.m. injection of cimetidine 400 mg 120 min before induction. The third group (n = 20) served as the control group. Following vecuronium 0.02 mg kg-1, anaesthesia was induced with fentanyl, and etomidate. All patients then received suxamethonium 1.5 mg kg-1 i.v. The combined administration of H1- + H2-antagonists as premedication led to a significant reduction in the increase in heart rate when compared with the effects in the other groups.

Adult↗
PubMed1986

[Sympathetic block after plexus anesthesia. Comparison with stellate ganglion block].

Plethysmographic measurements of the upper extremity were performed in ten patients after axillary plexus block and in eight patients after stellate ganglion block. Axillary plexus block was followed by a mean increase of 396% in arterial blood flow. After stellate ganglion block, the arterial blood flow increased by 232% (P less than or equal to 0.001) compared to the pre-block value. There was no change in venous capacity after either method. The results indicate that both blocks can alternatively be used, as they have the same effects regarding increased arterial flow and stable venous capacity.

Adult↗