Der Schmerz
-
Pain and pain-related sympathoadrenergic reactions (hypertension, tachycardia) accompanied by nausea, vomiting and shivering are the most common side effects of recovery from anaesthesia. The alpha(2)agonist clonidine acts as a sedative, anxiolytic, antihypertensive, antiemetic, antisialogogue and decreases the incidence of shivering. Thus, we studied the effects of intraoperatively administered clonidine on the recovery period and the postoperative analgesic requirements in patients undergoing maxillofacial surgery. ⋯ Opiates are frequently used as analgesics after maxillofacial surgery, even though their most common side effect-respiratory depression, nausea and vomiting-are particularly dangerous in these patients because of the obstruction of the upper respiratory tract. Self-titration of the opiate dosage on demand can decrease the incidence of serious side effects. Clonidine administered intraoperatively caused a profound reduction in analgesic requirements in this study. Additional opiate administration in the postoperative period was unnecessary in nearly all clonidine-treated patients. The attenuating effect on sympathoadrenergic reactions leads to lowering of the rate-pressure product and may be of advantage for patients suffering from arterial hypertension, angina pectoris or bronchial asthma. The slower emergence from anaesthesia following clonidine administration is probably caused by double-blind study properties preventing full consideration of the decreased isoflurane requirements after clonidine.
-
Interpleural analgesia is a method of postoperative analgesia that was developed by Kvalheim and Reiestad in 1984. The main indication is postoperative pain after unilateral thoracic and upper abdominal surgery. Many authors report good analgesic effects and better postoperative lung function following cholecystectomy. ⋯ The local anaesthetic of choice is bupivacaine (in concentrations of 0.25-0.75%, injection volumes of 10-40 ml, with or without epinephrine, applied as bolus or infusion), but others, such as lidocaine or morphine, are also being tested. Risks involved in this method are pneumothorax when the catheter is placed blind and the systemic toxicity of the local anaesthetic. This review provides information on the mechanism of action, the technique, the clinical use to date and possible risks.
-
Quality assurance with regard to pain treatment is a major concern of the German section of the International Association for the Study of Pain (IASP). For this reason, efforts to reach a consensus on guidelines for diagnostic and therapeutic procedures have been intensified and include educational endeavours as a basis for state-of-the-art practice. The German IASP section has implemented a postgraduate educational programme on pain treatment for psychologists. ⋯ After completion of the training in psychotherapy, a certificate will be issued if the student fulfils the following requirements: (1) attendance at 150 classes on pain syndromes, their anatomical and physiological basis, and their medical treatment, psychological methods of pain assessment and treatment, and effective ingredients of psychological treatment for pain; (2) experience in the treatment of patients with chronic pain; and (3) submission of 10 reports on assessments and treatments of chronic pain patients under supervision. To ensure training on a regular basis, the educational programme is offered to members of the IASP jointly by the German IASP and the Academy of the German Psychological Association. A sequence of eight modules covering the curriculum is repeated at least every 2 years, thus permitting entry to the programme at any time.
-
A review of the literature suggests that patients with tension headache do not differ from normals as much as from each other in psychological traits. The aim of the present study was to identify psychological subtypes of tension headache patients. ⋯ The results are discussed with reference to the literature and to indications for psychological treatment interventions.
-
Pain prophylaxis is an everyday experience in clinical anaesthesia. There is now considerable experimental evidence that short-term nociceptive stimuli evoke a long-lasting excitatory state of the central nervous system. This excitatory state can be largely prevented by relatively small doses of anaesthetics (local anaesthetics, opioids) given prelesionally. ⋯ Pre-emptive analgesia is advantageous in out-patient surgery as well as for routine clinical anaesthesia, and has proved effective in the prevention of phantom limb pain. Many questions on the nature and clinial application of pre-emptive analgesia are still unanswered. However, its ease of performance and the clear clinical advantages of pain prophylaxis mean that it should have a place in the everyday practice of anaesthesia.