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191 records · Page 11Linked to original sources
PubMed1995

[Patient-controlled analgesia (PCA) after urologic interventions].

Patient-controlled analgesia (PCA) is a well-accepted technique in postoperative pain management. We used PCA in three different protocols to find the optimum application form. Our study compared 100 patients with radical prostatectomy or transperitoneal tumor nephrectomy in three groups using piritramide. Group 1 (n = 16) received 1.2 mg/h continuously and a 3 mg bolus with a lock-out time of 90 min. Group 2 (n = 30) received 0.8 mg/h continuously and a 3 mg bolus with a lock-out time of 60 min. Group 3 (n = 54) received the same continuous infusion, but the lock-out time was only 30 min. After 24 hours we evaluated the quality of analgesia using VAS scale. The quantity of piritramide was equal in all groups (35.1 mg). An average of seven bolus applications were made during the observation period. In 27.6% of the patients (group 1: 30.4%; group 2: 35.0%; group 3: 23.1%) the bolus demand was refused by programme. The analgesia level was satisfactory in each group, with a VAS value of 27. There was no respiratory depression observed. In conclusion, on-demand analgesia proved to be a good and practicable method in postoperative pain management. Although the dosage of piritramide was not different in the three groups, we recommend the protocol of group 3 because of the lower refusal of bolus application. Therefore, this seems to be the best patient-adapted application form. Even though respiratory complications in the group 3 scheme are not expected, monitoring of respiration and vigilance are recommended.

Adult↗
PubMed1995

[Postoperative analgesia].

In a series of fifty-two patients undergoing abdominal surgery the listed below agents for postoperative analgesia are used: moradol (M), dipidolor (D), droperidol--DNBP, fentanyl (F). The control group is given analgin. During the first six hours, M and D show optimal effect in terms of postoperative pain syndrome relief, without suppression of the hemodynamics and respiration.

Abdomen↗
PubMedDate not supplied

[Use of propofol (diprivan) for induction of anesthesia in neurosurgical patients. I. Pressor reaction to laryngoscopy and intubation of the trachea].

Pressor reaction to laryngoscopy and intubation of the trachea was studied in 32 patients with neurosurgical diseases of the brain (supratentorial tumors and arterial aneurysms) under conditions of induction anesthesia with propofol (diprivan) in the mean dose of 2.85 mg/kg. Diprivan alone did not block the development of pronounced pressor reaction to intubation. Combination of diprivan in the same dose with dipidolor (0.4 mg/kg) ensured complete blocking of the pressor reaction in neurosurgical patients. Combination of diprivan and fentanyl (2.85 mg/kg) blocked the development of a pressor reaction not so effectively and not in all the examinees.

Adult↗
PubMed1996

[Combination of intravenous patient-controlled analgesia with epidural anesthesia for postoperative pain therapy].

The aim of this study was to prove the hypothesis that a combination of epidural anaesthesia with intravenous patient-controlled analgesia (PCA) could improve perioperative pain management. Patients of the urological department undergoing lower abdominal surgery were randomized for two different pain managements. Patients of group 1 (n = 37) were narcotized, intubated and ventilated for the operation; arriving at the recovery room, they were given a PCA-pump, the drug used was piritramide and the parameters were bolus 2.5 mg, blocking time 20 minutes and no basal infusion rate. In group 2 (n = 37) an epidural catheter was inserted preoperatively followed by narcosis with intubation and ventilation. Additionally, epidural anaesthesia was performed intraoperatively using bupivacaine 0.5%. For postoperative pain management, patients of group 2 were also given a PCA-pump (same parameters as mentioned above) and a continuous epidural infusion was started additionally (bupivacaine 0.1875%, infusion rate 8 ml/h). Patients were monitored at the urological ICU for 36 hours. Assessment of pain (6-degree scale), grade of sedation (4-degree scale), cumulative doses of piritramide, heart rate, blood pressure, respiratory rate, in group 2 additional motoric function (Bromage) and degree of epidural anaesthesia were recorded at fixed time intervals: 0, 1, 2, 3, 5, 8, 11, 15, 19, 24, 28, 32, 36 hours. There was no difference regarding age of patients or type of operation. Assessment of pain showed a significant pain reduction in group 2 compared to group 1 during the first 8 hours. This result was underlined by a significantly smaller dose of piritramide. All other parameters showed no differences except lower blood pressure and heart rate in group 2 for the first three hours. The benefits of better pain management contrast with the risks resulting from combining the two techniques. In our patients we found an improvement of pain management in the early postoperative period. The combination of epidural anaesthesia with intravenous patient-controlled analgesia can be regarded as a further possibility for treating postoperative pain in the sense of "balanced pain management".

Adult↗
PubMed1977

[Effect of high dosages of morphine and meperidine on haemodynamics, coronary blood flow and myocardial oxygen consumption in comparison to fentanyl and piritramide (author's transl)].

Although morphine is one of the oldest drugs known to man, it has only recently been used in large doses as an anesthetic agent. The main advantage is the cardiovascular stability. The purpose of this investigation was to study the circulatory response to high equianalgesic doses of morphine and meperidine. In 10 closed chest dogs during normoventilation and light background-anaesthesia (0.5 Vol. % halthane; N2O:O2 = 2:1) 2.0 mg/kg morphine and 15.0 mg/kg meperidine were given at random. Morphine produced a decrease in mean arterial blood pressure by 28%, which was paralleled by an identical fall in total peripheral resistance. No negative inotropic effects were found. In contrast to this, the severe hypotension developing with meperidine (decrease in blood pressure by 54%) was the result of peripheral vasodilatation (46%) and of myocardial depression indicated by a sharp drop in dp/dtmax (59%), dp/dtmax/IP (14%) and in left ventricular ejection fraction (33%). Utilizing the thermodilution technique, the cardiac output remained largely unaffected with both narcotic analgesics, as the increase in heart rate (morphine 27%; meperidine 101%) compensated for the fall in stroke volume (morphine 19%; meperidine 55%). In spite of the altered haemodynamics there was no change in the myocardial energy demand, which was adequately met by the coronary blood flow measured with the pressure-difference technique. Both, morphine and meperidine, produced initially an increase in coronary blood flow and coronary venous oxygen saturation indicating coronary vasodilation. While the mechanism for the change in cardiovascular status with high doses of morphine is vasodilatation probably due to histamine release, the results of this study suggest a peripheral as well as a central (myocardial depression) site of action with meperidine. The results obtained from this study were compared with the data from a previous investigation on equianalgesic doses of fentanyl and piritramide and their clinical implications were discussed.

Animals↗
PubMed1977

[The cardiovascular effects of the inspiratory N2O-concentration during piritramide anaesthesia in the dog (author's transl)].

Administration of nitrous oxide following large doses of narcotics has been reported to impair myocardial performance. In this investigation the effect of the inspiratory N2O-concentration (F1N2O = 0.0; 0.2; 0.4; 0.6; 0.8) upon haemodynamics, inotropism of the heart, coronary blood flow and myocardial oxygen consumption was studied in 8 dogs, which were normoventilated and narcotized with piritramide infused continuously (2.5 mg/kg-h). While 40% N2O(F1N2O = 0.4) decreased cardiac index (18%) and mean arterial pressure (5%) and increased total peripheral resistance (11%) significantly, the remaining inspiratory N2O-concentrations did not affect these parameters considerably. Load data, heart rate and the continuous decrease of LVdp/dtmax from 3170 mm Hg/s (F1N2O - 0.0) to 2175 mm Hg/s (F1N2O = 0.8) indicated negative inotropic properties of high concentrations of nitrous oxide. The myocardial oxygen demand, which was adequately met by the coronary blood flow, decreased with increasing N2O-concentrations initially by 18% (F1N2O = 0.4) due to bradycardia, slight hypotension and reduction in inotropism. Inhalation of 80% N2O, however, returned the energy demand of the heart to control levels (F1N2O = 0.0) resulting from increased myocardial wall-tension (increase in left ventricular end-diastolic pressure by 30%). The efficiency of left ventricular external work decreased from 18.6% (F1N2O = 0.0) to 14.7% (F1N2O - 0.8) indicating that myocardial performance was uneconomically influenced by high inspiratory N2O-concentrations and large doses of narcotics. The clinical implications of the results were discussed.

Anesthesia, General↗
PubMed1996

[Peri- and postoperative pain therapy with mechanical patient-controlled disposable analgesia pumps in general surgery. Report of initial trial].

The patient-controlled analgesia (PCA) or "ondemand analgesia" is a pain-relieving therapy, which is regulated and monitored by the patient himself. Postoperative pain therapy is the main approach for PCA, which facilitates a long-term, individually controlled pain relief. In certain situations we use mechanical PCA-pumps filled with piritramid (Dipidolor) as an opioid-analgetic for reducing postoperative pain. This kind of therapy needs the acceptance and understanding of the patient as a main condition for the success. Beside an increase of patients' comfort and patients' independence of analgetic demand from the medical staff a reduction in postoperative complications can be expected, the time of hospitalisation might be decreased.

Adult↗
PubMed1996

[Clofelin in the anesthesiological support system for surgical operations].

The article presents clinical experience of using Clofelin in 251 patients as a part of general anaesthesia, in postoperative period and in patients with peripheral vascular disease. The experiments on 14 rabbits chinchilla have been done prior to peridural use of Clofelin. The control for adequate use included estimation of hemodynamics parameters, cortizol, vasopressin and B-endorphin levels in plasma on different anaesthesia. The analgetic activity of Clofelin in postoperative period in patients with peripheral vascular disease was estimated by subjective tests using 5 steps of pain estimation scale. The clinical trial demonstrated the efficacy of intravenous and peridural use of Clofelin during surgery and in postoperative period.

Adolescent↗
PubMedDate not supplied

[Balanced regional anesthesia based on epidural blockade in extensive abdominal interventions in aged patients].

A high risk of hemodynamic disorders is the main problem associated with regional blocking in elderly patients subjected to abdominal surgery. There are theoretical reasons for ganglionic blocking without hypotonus as a means preventing hemodynamic complications of regional anesthesia in traumatic interventions. Extensive operations on the abdominal organs were performed in 40 patients aged 60 to 82 years. Before surgery the epidural space at the levels from T12 to T7, depending on the level of the intervention, was catheterized. Epidural blocking was combined with drugs for intravenous anesthesia (dipidolor, diazepam, nitrogen oxide). Pentamine in a dose of 1.36 +/- 0.06 mg/kg/h and dopamine in a dose of 3 to 4 micrograms/kg/h were special component of anesthesia. Intubation of the trachea and forced ventilation of the lungs were used; myorelaxants were administered only before intubation. The intra- and postoperative periods were characterized by hemodynamic and metabolic stability and early postoperative rehabilitation. The authors consider that preventive ganglionic blocking without hypotonus attained by a combination of a dosed injection of a ganglion blocker and injection of a highly selective adrenomimetic dopamine in the microcirculation dose ensure the hemodynamic and metabolic stability of balanced anesthesia based on epidural blocking in elderly and senile patients subjected to extensive abdominal interventions. The proposed method of balanced anesthesia is an effective means of neurovegetative inhibition during epidural blocking as the basic component of anesthesia, which permits minimizing the doses of general anesthetics and ensures positive changes in the respiratory system of elderly patients, manifesting by improved pulmonary and bronchial conduction and improvement of blood gas composition.

Abdomen↗
PubMed1997

[Pain therapy after thoracotomies--systemic patient-controlled analgesia (PCA) with opioid versus intercostal block and interpleural analgesia].

Both regional analgesia and systemic opioid therapy (e.g. PCA) are commonly used for pain relief following thoracic surgery. Many anaesthesiologists are reluctant to use thoracic epidural analgesia on general surgical wards. Therefore, we investigated in a prospective randomised study the efficacy of intercostal blocks (ICB) or interpleural analgesia (IPA) compared to PCA with systemic opioids (PCA). Following ethics committee approval and informed consent, 45 thoracotomy patients were randomised for postoperative pain management: group 1: intravenous PCA with piritramide (PCA-control), group 2: intercostal blocks of the segments concerned with 5 ml bupivacaine 0.5% at the end of surgery and 6 hours thereafter (ICB), group 3: interpleural analgesia with 20 ml bupivacaine 0.25% applied every 4 hours using a catheter placed during surgery near the apex of the pleural space (IPA). Patients in the ICB and IPA groups were able to obtain additional pain relief by PCA with piritramide. Alternative medication for all groups in case of insufficient analgesia was metamizol. Both regional analgesia groups used significantly less piritramide up to the 3rd (IPA) or 7th (ICB) postoperative day than the control group (p < 0.05). The consumption of metamizol was lower as well (n. s.). No significant differences between the study groups were observed with regard to pain scores (visual analogue scale VAS) at rest, during deep inspiration, coughing or mobilisation. Respiratory parameters as forced vital capacity, forced expiratory volume (1 sec) and peak flow (FVC; FEV1; PF) were reduced significantly following thoracotomy and showed a slow restitution in all three study groups without major inter-group differences. Intercostal blocks and interpleural analgesia significantly reduce opioid demand following thoracotomy and are effective means of postoperative pain management. Nevertheless, in contrast to epidural analgesia, both methods have to be supplemented by, or combined with, systemic analgesics in most patients. On the other hand, compared to epidural analgesia, ICB and IPA are less invasive and easier to manage on general surgical wards.

Adult↗
PubMed1998

[Introduction of patient-controlled analgesia--an interim report].

In spite of improved therapeutic methods, the number of patients who suffer from moderate or severe postoperative pain remains high at 30 to 70%. It is accepted that improvement of the organization of postoperative pain therapy is a necessary precondition for changing this situation. Therefore, patient-controlled analgesia (PCA) using pain-pumps should be recognized and the effect on the whole postoperative pain therapy of a university clinic observed. The authors report on the introduction of general therapeutic guidelines for the use of patient-controlled pain-pumps. The recovery ward takes on a central role for both the beginning of pain therapy and the further care of the patient in various peripheral wards. It proved to be advantageous to use a bed-side protocol to document the programming of the pain-pumps and to register the pain-scores and side-effects. Because of these fundamental changes, the frequency of the application of pain-pumps increased six-fold within one year. Additionally, rapid pain treatment based on patients' needs increased clearly from 9.2 to 30.8%. The standardized introduction of PCA had an extremely favourable effect on the whole postoperative pain therapy and can thus be wholeheartedly recommended.

Analgesia, Patient-Controlled↗