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Diazepam has been shown to facilitate while dipidolor and pipolphen to inhibit the vasomotor reflexes. Administration of dipidolor after diazepam and pipolphen is conducive to preservation of the inhibitory action of the analgesic on the vasomotor reflexes, the depressant effect of the drug on respiration being eliminated.
The efficacy and safety of IM lofentanil, the most potent morphinomimetic drug available, for rapid control of postoperative pain was compared with IM piritramide and placebo in a study of 120 patients. Piritramide 7.5 mg and 15 mg, lofentanil 0.25 micrograms, 0.50 micrograms and 0.75 micrograms had a rapid onset of analgesic effect. Significant differences in pain intensity and pain relief when compared to placebo were observed at each observation period for each drug. Piritramide 15 mg is significantly more effective at 4, 5 and 6 hours when compared to lofentanil 0.75 micrograms, thus having a longer lasting effect than lofentanil 0.75 micrograms. There were no significant differences in pain relief between the different doses of lofentanil or between the different doses of piritramide. Side effects of very low incidence included nausea, vomiting and sedation in both piritramide and lofentanil groups.
15 patients (12 women and 3 men) undergoing cholecystectomy were randomized into two groups. 8 patients were operated on under continuous thoracic epidural anaesthesia in combination with light general anaesthesia. Postoperatively they were kept painfree by continuous infusion of an 0.125% solution of bupivacaine via epidural catheter at a rate of 0.25-0.3 ml/kg X h over a period of four days. The 7 patients in the control group were operated on under neuroleptanalgesia. Piritramide was given for postoperative analgesia. All patients received 40 ml/kg X day of electrolyte solution during the period of investigation. Blood was collected at 8 am, 12 am, 4 pm, 8 pm, and 12 pm on the day of operation and on the third postoperative day, at 8 am on the first and second postoperative day, and at 8 am, 12 am, and 4 pm on the fourth postoperative day. Plasma glucose, ACTH, cortisol, T4, T3, and reverse T3 were measured. During the operation and for 12 h thereafter a mild hyperglycaemia was observed in the neuroleptanalgesia group but not in the epidural group. The differences were significant. A rise in ACTH was seen in both groups during and shortly after operation. The increase in cortisol concentration following this ACTH release was significant only in the neuroleptanalgesia, but not in the epidural group. From the first to the fourth postoperative day ACTH levels were low and cortisol concentrations within the normal range. On the third day it appeared that a diurnal variation in cortisol levels was again present. Cortisol suppression following the administration of 2 mg dexamethasone on the fourth postoperative day was detectable in both groups. Of the thyroid hormones, T4 remained unchanged and at a normal level during the investigation. T3 decreased and reverse T3 increased significantly, the maximum rise being observed on the second day. There were no differences between the groups. These changes are defined as low T3 syndrome, following caloric deprivation, injury, and stress. The metabolic and hormonal alterations caused by cholecystectomy are marked only during operation and shortly thereafter and only in this period are they influenced by epidural analgesia. From the first postoperative day onwards they are almost negligible so that a mitigation by using continuous epidural analgesia is not to be expected.
30 postoperative patients, who had undergone abdominal gynaecological surgery with standard general anaesthesia were randomly divided into three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramid, or ketamine. The patients rated their pain on a 15 cm pain analogue score. Group I pentazocine: Mean dosage on the day of operation 0.12 mg/kg/h, 0.1 mg/kg/h on the first and only 0.07 mg/kg/h on the second postoperative day. Pentazocine blood levels were on average 50 micrograms/l. Group II piritramid: Mean dosage on the day of operation 0.038 mg/kg/h, 0.024 mg/kg/h on the first and 0.019 mg/kg/h on the second postoperative day. Blood levels of piritramid were not determined because there is no satisfactory assay available. Group III ketamine: mean dosage on the day of operation 0.32 mg/kg/h, 0.28 mg/kg/h on the first and 0.29 mg/kg/h on the second postoperative day. Ketamine blood levels lay between 120 and 180 micrograms/l. The three analgesics did not cause any important haemodynamic or respiratory side effects. Pentazocine and piritramid were the most effective analgesics, ketamine was the least effective with a high incidence of side effects.
Respiratory function was studied in 35 patients after upper abdominal surgery, who had been randomized into two groups. 15 patients (median age: 59 years) were operated on using neuroleptanalgesia and received intramuscular piritramide as postoperative analgesic. A continuous thoracic epidural was placed prior to surgery in 20 patients (median age 52 years). A light general anaesthesia was additionally given when these patients were operated on. Postoperatively, epidural analgesia was continued by infusion of 0.25-0.3 ml/kg X h 0.125% bupivacaine via epidural catheter over a period of 4 days. If pain prevention during coughing and getting up was not complete, top-ups of 6-10 ml 0.25% bupivacaine were given additionally. Respiratory function (FVC, peak expiratory flow, VT, VD/VT, RR, MV, VA, AaDO2(0.21), PaO2 and PaCO2) was investigated before surgery, and on the 1st, 3rd and 5th postoperative day, the patients breathing room air. Results (the median of each groups is plotted, the values of the epidural group being in brackets. 0: preop., 1: first, 3: third, 5: fifth postop. day): FVC 0: 3.05 (3.16) 1: 1.42 (1.40) 3: 1.64 (1.42) 5: 1.39 (2.27) 1. Peak expiratory flow 0: 310 (287) 1: 118 (113) 3: 130 (127) 5: 153 (194) 1/min. Respiratory rate 0: 16 (14.5) 1: 20 (18.5) 3: 16 (18.5) 5: 17 (17) min-1.(ABSTRACT TRUNCATED AT 250 WORDS)
The experience with peridural analgesia used in the postoperative period in 183 patients has shown advantages of morphine, phentanyl and dipydolor over routine methods of analgesia. The peridural injection of the drugs mentioned has been shown to give a longer analgetic effect than local anesthetics, to facilitate stabilization of hemodynamics in the postoperative period.
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Thirty postoperative patients, after undergoing abdominal hysterectomy and standard general anesthesia, were randomly allocated to three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramide, or ketamine. The patients rated their pain on a 15-cm visual analog scale. Patients in group 1 received pentazocine. Mean dosage was 0.12 mg/kg/hr on the day of operation, 0.1 mg/kg/hr on the first postoperative day, and only 0.07 mg/kg/hr on the second postoperative day. Pentazocine blood levels averaged 50 micrograms/L. Patients in group 2 received piritramide. Mean dosage was 0.038 mg/kg/hr on the day of operation, 0.024 mg/kg/hr on the first postoperative day, and 0.019 mg/kg/hr on the second postoperative day. Blood levels of piritramide were not determined because no satisfactory assay is available. Patients in group 3 received ketamine. Mean dosage was 0.32 mg/kg/hr on the day of operation, 0.28 mg/kg/hr on the first postoperative day, and 0.29 mg/kg/hr on the second postoperative day. Ketamine blood levels ranged between 120 and 180 micrograms/L. None of the three analgesics caused any important hemodynamic or respiratory side effects. Pentazocine and piritramide were more effective analgesics than ketamine was. Ketamine also had a higher incidence of side effects.
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Morphine and opiate analogues for pain relief were applied epidurally or intrathecally. Synthetic opioids, eg. pethidine, pentazocine or piritramide proved unsuitable with both modes of administration. Only morphine in doses as low as 2 mg reliably produced analgesia lasting from 16-24 hours. Intrathecal application of morphine is of limited value because of the substance's possible transport to medullary regulating centres and therefore is not recommended in awake patients. Conversely this very side effect may advantageously be employed in patients on ventilator treatment as a method for analgesia and sedation. Lumbar epidural administration of single doses of morphine 2 mg at present is the most effective treatment both for pain following thoracotomy, laparotomy, surgery on the vertebral column, gynecological and urological procedures and pain due to trauma to the chest wall or pelvis, provided supervision in an intensive care ward guards against possible side effects. Epidural or intrathecal opiate is not suitable for the treatment of chronic or functional pain.
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The report deals with the clinical use and effects of tramadol-HCl (Tramal) as an adjuvant in regional anaesthesia. As distinguished from triflupromazine, diazepam, flunitrazepam, droperidol, piritramide and pentazocine this drug can be applied safely, reliably and without secondary effects in patients of all ages for sedation and analgesia without loss of cooperation (no sleep, no pain from body-positioning, no psychic distress) and for the prevention of centralisation in the unblocked region (no trembling- and freezing-reaction, no alteration of the blood-gas-analysis.