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Biomedical subjects

S Piepenbrock

Publications and source records attributed to S Piepenbrock.

At least 127 records · Page 7Linked to original sources
PubMed1983

[Sublingual buprenorphine tablets: initial clinical experiences in long-term therapy of cancer pain].

Buprenorphine sublingual tablets (0.2 mg) were investigated in therapy of cancer pain. In 67 patients there was a good analgetic effect in 60%, even in those cases treated with other opiates before. The induction time was quite long (60 min.) but is no problem in chronic administration. Effective pain relief was obtained even in final stages of cancer. The mean daily dose of buprenorphine had been 1.2-1.7 mg, the mean duration of analgesia being 6-8 hours with a single dose of 0.2-1.0 mg buprenorphine. Typical opiate-side-effects were registered and well tolerated after some days' treatment. There was no respiratory depression. Buprenorphine sublingual tablets are certainly a good alternative in orally available opioids.

Administration, Oral↗
PubMed1983

[Buprenorphine and pentazocine for postoperative analgesia. A double blind study following abdominal surgery].

A randomized double-blind study was done to test the two opiates buprenorphine (0.3 mg i.v.) and pentazocine (30 mg i.v.) with regard to their applicability for the postoperative phase. These substances were chosen because they are not subject to drug prescription regulations. 60 patients who had undergone epigastric and hypogastric interventions under thiopental-sodium-induced halothane anesthesia received i.v. injections of one of the two analgetics as soon as they requested a pain-killer postoperatively. The subjective pain intensity registered by means of a visual analogue scale shows a gradual decrease after buprenorphine with maximal effects 1-3 h post injectionem (7.3 leads to 1.5). The duration of action is 8.2 +/- 0.7 h on the average (median 8 h; range 4-22 h). The maximal analgetic effect of pentazocine is already attained after 10 min (6.3 leads to 3.2). Thereafter the pain-intensity curve rises again. Pentazocine has a mean duration of action of 2.35 +/- 0.24 h (median 2 h; range 0.5-5 h). The inadequate analgetic effect of pentazocine manifests itself in an only slight initial reduction of the respiratory rate (19.5 leads to 17.5 min-1), which, on the other hand, decreases significantly and continuously under buprenorphine (20.8 leads to 13.5 min-1). Both substances cause increases of PaCO2 (buprenorphine 37.3 leads to 46.8 mmHg; pentazocine 36.3 leads to 43.0 mmHg), values greater than 50 mmHg being attained in individual cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1983

[Peridural opiate analgesia. Clinical results of a 2-year study].

Postoperative pain relief, consumption of analgesics and the incidence of postoperative complications were investigated in a retrospective cohort-study on 470 patients following abdominal surgery. 221 of these patients received epidural morphine or buprenorphine for postoperative pain relief (Group I). Another group of 249 patients received conventional opiate analgesics intravenously or intramuscularly (Group II). On average the analgesia lasted 14 h after epidural morphine and 11 h after epidural buprenorphine. The overall amount of morphine in the postoperative period was 13.3 +/- 14.9 mg and 0.89 +/- 0.55 mg buprenorphine respectively. 5 cases of pneumonia (2.3%) were seen in the epidural group (Group I). 22 pneumonia cases (8.8%) were registered in the group with conventional analgesics (Group II). Besides the advantage of stronger and longer duration, small dosage and minor central depressive side effects, epidural opiate analgesia has proven to result in positive clinical consequences. The low incidence of postoperative pneumonia is due to the strong regional pain relief, which improves mechanical pulmonary function and gas exchange.

Adult↗
PubMed1983

[Buprenorphine as a postoperative analgesic following halothane anesthesia. Hemodynamic and respiratory effects].

In 10 healthy patients, buprenorphine was given as the postoperative analgesic (dosage: peripheral venous injection of 5 microgram/kg BW) after traumatological interventions in the lower extremities, which had been performed under barbiturate-induced halothane anaesthesia. The haemodynamic investigations revealed that buprenorphine has only a minor effect on the high pressure system. In the area of the pulmonary circulation, there was a significant increase in mean pulmonary artery pressure from 15.9 mm Hg to 17.8 mm Hg (+12%), as well as an increase in pulmonary vascular resistance by 16.5%. These changes were most marked 30 to 60 min after the administration of buprenorphine. When 2-3 1 O2/min were administered, none of the patients had PaO2 values of less than 100 mm Hg. 60 min after the injection, the PaCO2 value increased from 33.7 mm Hg to a maximum of 43.9 mm Hg. In 3 patients, PaCO2 increased to more than 45 mm Hg. All patients with greater increases of PaCO2 also evidenced greater increases in the pulmonary vascular resistance. Altogether the haemodynamic changes after buprenorphine administration following halothane anesthesia were not very distinct. In individual cases, however, there were greater increases in PaCO2. The cause of this could involve the additive effects of premedication and anaesthesia medication, and possibly the pain level as well. Both the increase in pulmonary artery pressure and the increase in total pulmonary vascular resistance in these patients were due to hypercapnia (von Euler-Liljestrand mechanism).

Adolescent↗
PubMed1982

[Haemodynamic effects of fentanyl in man during cardiac surgery (author's transl)].

In 93 cardiac patients the effects of low, mean and high fentanyl dosage--0.003 mg/kg, 0.015 mg/kg and 0.03 mg/kg--on haemodynamics, inotropic state and myocardial oxygen consumption were investigated during surgical procedures under basic neuroleptanalgesia. There was an increase in heart rate with the low fentanyl dosage, whereas mean and high doses lowered heart rate. Decreases in arterial pressure, left ventricular pressure, and perfusion pressure during extracorporal circulation as well are interpreted as peripheral vasodilatory effects. Most of the measured and calculated hemodynamic parameters such as PAP, dp/dtmax, CI, TSR decreased. There was, however, no decrease in myocardial contractility, when considering changes in heart rate, pre- and after-load and dp/dtmax. The decrease in heart work and myocardial oxygen consumption may be of advantage especially in patients with coronary heart disease.

Animals↗
PubMed1981

[Prenalterol (CGP 7760 B), a new cardioselective beta 1-adrenoceptor-agonist (author's transl)].

The haemodynamic effects of the new selective beta 1-receptor-agonist prenalterol were investigated in two groups each of 8 patients. Dosages of 500 microgram/5 min and 100 microgram/1 min were given after direct closure of atrial septal defect under neuroleptanalgesia. Prenalterol 500 microgram/5 min increased cardiac index (37.5%), heart rate (19%), stroke index (16.2%), mean arterial pressure (26.5%) and dp/dtmax (84.5%) significantly. Total systemic resistance, total pulmonary vascular resistance and mean pulmonary pressure remained constant. Filling pressures of both ventricles decreased slightly but significantly. Maximal hemodynamic changes after infusion of 100 microgram/1 min prenalterol were half as great as with 500 microgram/5 min and occurred 3 min earlier. The haemodynamic action of prenalterol was rather long lasting. One hour after cessation of the drug-infusion there were still detectable haemodynamic effects. In contrast to investigations in awake patients there was a greater increase in heart rate, which is referred to influences on the vagal reflex caused by anaesthesia.

Adrenergic beta-Antagonists↗
PubMed1981

[Peridural morphine-analgesia. II. Respiratory depression (author's transl)].

In nine healthy young patients ventilatory CO2-response curves and mouth-occlusion pressure were measured after peridural injection of 5 mg morphine hydrochloride diluted in 10 ml saline solution in the lumbar region. Patients were not premedicated. Prior to measurements lower extremity operations were performed under peridural anaesthesia. Five minutes after peridural morphine injection there was a slight reduction in ventilatory response to increasing CO2 (94.7% +!- 15%), which was even more pronounced one hour later (74.5% +/- 14.7%). Mouth occlusion pressure decreased to 86.7% +/- 27.4% after 5 min to 72.4% +/- 13.4% after 60 min. Changes in the relation of the central stimulus P100 to the resulting flow (VT/Ti) was 96.7% +/- 32.5% after 5 min and 95.0% +/- 31.4% after 60 min. These results demonstrate a central respiratory depression after peridural morphine injection with a consequent reduction in ventilatory CO2-response.

Adult↗
PubMed1981

[A double-blind comparison of epidural buprenorphine and epidural morphine in postoperative pain (author's transl)].

Morphine (5 mg) and buprenorphine (0.15 mg) given by the epidural route were compared in 50 patients recovering from abdominal surgery. Pain relief score, sedation score and clinical measures were evaluated in a double-blind study. Both substances produced thorough analgesia with short latency (2-6 min) of long duration (8-9 h). Side effects were encountered in some morphine cases only, but never therapy had to be discontinued. Total lack of side effects with buprenorphine favours its application in epidural pain relief.

Anesthesia, Epidural↗
PubMed1981

[Epidural morphine analgesia. Postoperative period (author's transl)].

50 patients after abdominal surgery received peridural morphine for postoperative pain relief. At the end of operation, 2-3 mg morphine in 10-15 ml 0,9% saline were injected peridurally by a catheter, which was placed preoperatively. The injection was followed by a dissociated analgesia. Diffuse pain and wound pain were diminished. Pin prick and temperature were still perceived. Analgesia started within 2-5 min after injection and lasted 14 h in the mean (range 1-49 h). The degree of analgesia was determined by a visual analogue scoring system. The patients reported a marked pain relief. A new dose of 2 mg morphine was given on demand, when the patients felt pain again. This procedure was continued until the second postoperative day. The overall amount of morphine by peridural application was 8 mg within 3 days. Neither clinically nor by blood gas analyzes here were signs of respiratory depression. There were no severe side effects. The advantages of epidural morphine analgesia are: low dose, long duration, lack of sedation and motor block, lack of respiratory depression, tachyphylaxia and sympathetic block. No pneumonia were seen in the epidural morphine group, whereas 4 cases of pneumonia were seen in the control group (n = 50) with conventional analgetics.

Abdomen↗
PubMed1981

[Comparative clinical investigations on the cardiovascular effects of piritramide (dipidolor) and fentanyl (author's transl)].

In 36 patients with acquired heart disease effects of 0.15 mg/kg piritramide on hemodynamics, inotropic state and myocardial oxygen consumption were investigated during and after cardiac surgery (basic neuroleptanalgesia). It could be demonstrated, that piritramide is not inducing any negative inotropic effects compared to a control group (n = 36) and a fentanyl group (0.003 mg/kg, n = 31). There were only small changes in HR, SV, PRA and PLA. A slight decrease in Part, PLV, and arterial perfusion pressure during extracorporeal circulation is interpreted as a peripheral vasodilatation. The resulting decrease in heart work caused a significant decrease in myocardial oxygen consumption (-18%), which is of special advantage in patients with coronary heart disease.

Anesthesia, General↗
PubMed1981

[Haemodynamic effects of morphine in man (author's transl)].

In 52 patients with acquired heart disease haemodynamic effects of 0,2 mg/kg and 1,0 mg/kg morphine were investigated during surgical procedures under neuroleptanalgesia. The following parameters were measured or calculated: heart rate (HR), arterial pressure (Part, Psyst, Pdiast), pulmonary artery pressure (PAP), right (PRA) and left atrial pressure (PLA), left ventricular pressure (PLV), left ventricular end-diastolic pressure (PLVED), left ventricular peak dp/dt (dp/dtmax), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), total systemic resistance (TSR), total pulmonary resistance (TPR), work index of the right (RVWI) and left ventricle (LVWI). Myocardial oxygen consumption (EG) was calculated according to the method of Bretschneider. There was almost no change in cardiac index and stroke index. In comparison to a control group (n=36) morphine caused a dose-dependent decrease in arterial pressure and in arterial perfusion pressure during extracorporeal circulation. This, however, was mainly attributable to vasodilatation and not to a negative inotropic effect. In accordance with the changes in haemodynamics there was a remarkable decrease in myocardial oxygen consumption (EG: -21.1%; 1,0 mg/kg morphine).

Adult↗
PubMed1981

[Epidural morphine analgesia (PMA). III. Cancer pain (author's transl)].

The effect of PMA in pain therapy was investigated over a period of one year on 52 patients suffering from terminal cancer. These patients, 22 being outpatients, received a total number of 85 peridural catheters. 75 of these catheters were evaluated according to morphine dosage and effect. The onset of PMA resulted in a drastic reduction in the need for high dose systemically applied analgesics. PMA was also successfully applied in cases with rapidly spreading metastases. Our catheters have remained in place up to 170 days. Side effects were rarely observed. Tachyphylaxis did not develop and almost all patients were satisfied with the therapy. Due to special care of the catheter we observed only 7 cases of infected puncture sites. Our clinical studies have proven that peridural morphine analgesia can be successfully applied as pain therapy in patients suffering from terminal cancer.

Adolescent↗
PubMed1981

[Epidural morphine analgesia (author's transl)].

We report our experience with epidural morphine analgesia. Morphine 2-3 mg in 10-15 ml 0.9% saline was given to patients after abdominal surgery, patients with terminal carcinoma and patients with multiple fractured ribs. Mean duration of analgesia was 14 hours and was not accompanied by severe complications.

Aged↗
PubMed1980

[Epidural morphine injections for the treatment of pain].

Morphine in epidural application (2-3 mg in 10 cc saline solution 0,9%) gives a long lasting segmental analgesia. In 15 patients after upperabdominal surgery the overall mean dosage of morphine was 8,85 mg within three days. The effect lasted for about 15 hours per application. No other analgetics were needed. All patients were content with this method of postoperative analgesia. There were no side effects or complications.

Adult↗