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At least 109 records · Page 6Linked to original sources
PubMed2000

[Analgosedation (managed anesthesia care--MAC) with propofol and piritramide for controlled cyclophotocoagulation of the eye].

The new method of controlled cyclophotocoagulation of the eye is an example of a short, non-invasive procedure that is still too painful to be done under local anaesthesia alone. The risks associated with general anaesthesia, on the other hand, seem to be inappropriately high compared to the risks associated with the procedure itself. Therefore, for this procedure, we combined local anaesthesia with 0.5% proxymetacain and 10% cocaine and sedation with propofol and analgesia with piritramide. Our experiences with this method have been positive. We have applied our method to 42 patients undergoing a total of 53 procedures and we have seen no major changes in haemodynamics and only two cases of momentary slight ventilatory depression. Therefore, we conclude that our method of managed anaesthesia care is suitable for patients undergoing cyclophotocoagulation of the eye, combining patient comfort with haemodynamic stability and minimal risk for the patient.

Adult↗
PubMed2000

Effect of pre-emptive hydromorphone administration on postoperative pain relief--a randomized controlled trial.

BACKGROUND AND AIM OF STUDY: Pre-emptive analgesia represents a treatment strategy which tries to prevent the development of pain by inhibiting central reactions to peripheral sensory stimuli. In a prospective randomized double-blind placebo-controlled study, the effect of oral premedication with 4 mg of a slow-release hydromorphone preparation on postoperative piritramide consumption and subjective pain perception is being evaluated. PATIENTS AND METHODS: 96 women undergoing hysterectomy were randomly assigned to four study groups. Patients from groups 1 and 2 received hydromorphone and placebo respectively two hours before surgery, while those from groups 3 and 4 were given the same substances one hour after the end of the operation. Postoperative pain relief was provided by a patient-controlled infusion pump with piritramide. The intensity of postoperative pain as perceived by the patients was quantified on a visual analogue scale. Piritramide consumption and pain scores were recorded at 1 and 24 hours after surgery. Approval of the local Ethics Committee had been obtained beforehand as well as written informed consent from the patients. RESULTS: No significant differences in piritramide consumption were observed in between the four study groups. Visual analogue scale (VAS) ratings at 1 and 24 hours after surgery did not show any significant differences either--irrespective of whether the patients had received hydromorphone or placebo preoperatively or postoperatively. CONCLUSION: In our study, oral administration of 4 mg of slow-release hydromorphone did not show any greater pre-emptive analgesic effect than placebo.

Administration, Oral↗
PubMed2002

[Intrathecal morphine for postoperative analgesia in cardiac surgery].

OBJECTIVE: The aim of study was to evaluate features for spinal morphine in undergoing coronary artery bypass surgery in early postoperative time and side effects of opioids. MATERIAL AND METHODS: Two groups of patients undergoing coronary artery bypass surgery were analyzed. In first group (15 patients) spinal morphine 2 mg and general anesthesia was used, control group (22 patients) - just general anesthesia. Postoperative pain was analyzed with VAS (Visual Analogical Scale). For analgesia, after surgery, was used piritramide via i/v in both groups. Dose of piritramide, extubation time and side effects was analysed after surgery. RESULTS: In first group dose of piritramide was 4.5+/-1.1 mg, in control group - 16.5+/-1.1 mg (p<0.05). Extubation time in both groups (354+/-36 min. and 279+/-17 min.) and side effects (nausea and vomiting) was similar. CONCLUSION: Spinal morphine decreased pain after cardiosurgery and don't increased extubation time and side effects of opioids.

Aged↗
PubMed2003

Postoperative analgesia after preincisional administration of remifentanil.

AIM: The aim of this study was to assess postoperative analgesia after preincisional and postincisional administration of remifentanil. METHODS: Randomized trial, 24 hours. SETTING: University hospital, hospitalized care. PATIENTS: 48 adult patients scheduled for lumbar vertebral surgery. INTERVENTIONS: in group R5, patients received an infusion of 0.2 microg kg(-1) min(-1) remifentanil over 5 minutes, followed by a break of 15 minutes before anesthesia was started. Anesthesia was induced by infusion of 0.25 microg kg(-1) min(-1) remifentanil and a bolus of 1.5 microg kg(-1) propofol, followed by a continuous infusion of 2 to 3 microg kg(-1) h-1 propofol and 0.25 microg kg(-1) min(-1) remifentanil until end of anesthesia. In group R20, patients received 0.05 microg kg(-1) min(-1) remifentanil over 20 minutes before the induction of anesthesia. In group RL, anesthesia was induced and maintained with propofol. After surgery began, a remifentanil infusion of 0.5 microg kg(-1) min(-1) was given for 50 minutes, then reduced to 0.25 microg kg(-1) min(-1). The total remifentanil doses were similar in the 3 groups. MEASURES: patients used patient-controlled analgesia (piritramide) for postoperative pain management. They recorded pain on a numeric rating scale every half hour. STATISTICS: Kruskal-Wallis test, pairwise Mann-Withney U-test, orthogonal polynomials (pain scores). RESULTS: PATIENTS given postincisional remifentanil (RL) had the slowest decrease in postoperative pain scores (p<0.01) and the highest cumulative piritramide consumption (p<0.08). CONCLUSION: The preincisional administration of remifentanil followed by a continuous infusion of 0.25 microg kg(-1) min(-1) appears to reduce pain scores and piritramid consumption when compared with a postincisional regimen.

Adult↗
PubMed1991

[Comparative evaluation of the effectiveness of various narcotic analgesics after intravenous autoanalgesia].

The article is devoted to an investigation of intravenous analgesia with different narcotic analgetic drugs (phentanyl, morphine, dipidolor). A comparative assessment of the influence upon central hemodynamics, lung ventilation, acid-base metabolism and blood gases was performed, as well as the degree of analgesia in using these drugs. A conclusion is made that morphine and phentanyl are preferable for the intravenous postoperative autoanalgesia.

Abdomen, Acute↗
PubMed1991

[The characteristics of epidural anesthesia in operations on the aorta and vessels of the lower extremities].

Under study were the parameters of microcirculation in 84 patients operated on the vessels in the aorto-ilio-femoral zone, in 33 patients operated on the vessels in the femoro-popliteal zone. In all of them epidural anesthesia was used. In 25 patients operations on the aorta and main vessels were fulfilled under conditions of epidural anesthesia with catheterization of the epidural space at two levels. The dynamics of microcirculation parameters allows to state that the epidural anesthesia with catheterization of the epidural space at two levels is more rational for patients in operations on the vessels in the aorto-ilio-femoral zone since it gives adequate anesthesia during operation and better tissue blood flow in lower extremities.

Anesthesia, Epidural↗
PubMed1990

[Identification of pentazocine, piritramide and methadone in blood using thin layer chromatography].

Pentazocine, piritramide and methadone, when extracted from blood or plasma with ether at pH ca. 12, were separated by TLC method on alumina or silica gel by ascending technique on 5 x 20 cm and 2.5 x 7.5 cm plates and also by horizontal development, using suitable mobile phases. The substances were identified by reaction with potassium iodoplatinate or 20% Na2CO3 solution (up to the amount 2 micrograms pentazocine, 0.5 microgram piritramide and 1.5 micrograms methadone.

Chromatography, Thin Layer↗
PubMed1991

[Determination of piritramid in plasma using high pressure liquid chromatography methods].

After alkalization piritramid and codeine (internal standard) were extracted from plasma thrice with ether, solvent was removed, the residue dissolved in a mobile phase (methanol-phosphate buffer pH 4.5. 7:3) and injected on the column (packing Lichrosorb RP-18). The amount (0.5-2.5 micrograms) of piritramid was determined, average recovery was 88%.

Chromatography, High Pressure Liquid↗
PubMed1991

[Postoperative pain treatment].

The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. Considerations which lead to opioid underdosage include: the development of addiction and possible side-effects such as respiratory depression, heavy sedation, possible constipation and urinary retention. The aim in postoperative pain therapy is a time-contingent dosing after careful intravenous titration of the compound in the lower dose range during continuous supervision. Thus, the individual need in the recovery room can be estimated. Only such a procedure helps to keep the patient pain-free over a long period of time, reduces the workload of nurses during the night, results in the reduction of complications and finally may even reduce the hospital stay. Piritramide is a compound which has a number of potential advantages with regard to efficacy and side-effects in postoperative pain therapy. It has the highest analgesic potency among those compounds suitable for postoperative pain therapy; when compared with pethidine, pentazocine or nalbuphine it shows remarkable cardiovascular stability. In comparison to morphine, pethidine and pentazocine, piritramide has a lower incidence of nausea and vomiting. With a mean duration of action of up to six hours, piritramide has an advantage over pentazocine (3 hours), pethidine (2-3 hours) and morphine (5-6 hours). Compared to other mixed narcotic analgesics, piritramide does not induce dysphoric side-effects when given in the higher dose range and does not lead to addiction. It is derived from the same group of agents such as fentanyl or alfentanil which are used in neuroleptanaesthesia so that there is an increase in analgesia one to the interaction with the same receptor site. Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.

Analgesics, Opioid↗
PubMed1991

[A method for placing and using an indwelling epidural catheter for analgesia in incurable cancer patients].

Operative technique for implantation of indwelling epidural catheter produce of the firm "Braun" (Germany) is described. During the implantation the analgesics zone is checked with Lidocaine. The catheter pouch is fixed over a bone pad in a place well visible by the patient. For permanent pain relief Dipidolor is applied twice daily one quarter of the ampoule. This catheter is implanted for pains originating from the lower extremities, the pelvis and the abdomen. The method was applied on 2 patients with very good results obtained with minimal amount of opiates.

Adult↗
PubMed1991

[Intrathecal opiate-spinal anesthesia. Clinical results of a 1-year study using 0.0375-0.15 mg morphine].

In a prospective study, 184 patients were studied after orthopedic operations with regard to analgesic requirements, analgesic effectiveness, and appearance of postoperative complications. In four groups, 0.0375, 0.075, 0.1 or 0.15 mg morphine was given in combination with 0.5% hyperbaric bupivacaine for perioperative analgesia. The patients' ages ranged between 13 and 90 years (means = 62.97). One hundred sixteen patients did not need any analgesics in the first 24 h. The effect of the spinal opiate was found to be pleasant, especially by patients who received a total hip prosthesis: in this group the average duration of analgesia was more than 24 h in 77.9% and 14.5 h in 22.1% of patients. The need for additional postoperative analgesia was seen earliest in the patients who received a knee prosthesis of the sledge type (P less than 0.05). The overall consumption of the analgesic piritramid was clearly reduced and amounted to 7.7 mg on the day of operation, 8.4 mg on the 1st day, 6.0 mg on the 2nd day, and 3.6 mg on the 3rd day after surgery. The degree of postoperative analgesia was the same in all four groups (P greater than 0.05). Blood gas analyses, respiratory rate, blood pressure, heart rate, oxygen saturation, and laboratory parameters were also examined. The application of small doses of opiate close to the spinal cord produced a good and long-lasting reduction of pain with few opiate side effects. In the spinal anesthetics with larger doses of morphine, side effects were rare and hardly different from those accompanying spinal anesthesia without morphine addition. There were no serious complications noted during the opiate anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗