Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2011
Review[High volume local infiltration analgesia (LIA) for total hip and knee arthroplasty: a brief review of the current status].
Local infiltration analgesia (LIA) is usually performed intraoperatively by the surgeon who injects 150 mL (300 mg Ropivacain, 30 mg Ketorolac and 0.5 mg adrenalin) into the bone, cartilage, ligament, musculature, or hyperdermis. A tight bandage and ice cooling for 4 - 6 hours lengthen the duration of analgesia, mobilisation can be undertaken about 5 hours after the operation. Besides large observation-in-use studies, there are 11 randomised studies in the fields of total hip and knee arthroplasty that report comparisons with systemic analgesia as well as with epidural or peripheral anaesthesia, all of which showed positive results for LIA. In addition LIA is safe, has favourable costs and does not require any special technical abilities in contrast to epidural and peripheral regional anaesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2011
Review[Acute pain therapy for non opioid-naive patients].
Patients used to opioids belong to 2 groups: patients under opioid therapy due to tumor pain or chronic non malignant pain and, second, opioid addicts with current uncontrolled abuse, under substitution therapy or former opioid addicts ("clean"). Perioperatively these patients are difficult to manage because of the complex medical as well as psychosocial factors. ⋯ Early interdisciplinary cooperation, prevention of withdrawal through substitution of opioids and alternative treatment strategies like regional analgesia or ketamine as well as carefully titration of opioids are the essential components of the treatment of these patients. Furthermore, these patients require a clear and empathic guidance by medical and nursing staff.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2011
Review[Pitfalls of anesthesiologic management in paediatric strabismus surgery].
Strabismus surgery is one of the most common paediatric operation procedures. As associated with congenital syndrome, congenital heart disease and neuromuscular disorder, the anesthesiologic management has to be planned carefully. Considering high incidences of oculocardiac reflex (OCR) and postoperative nausea and vomiting (PONV) anesthesia can be performed to decrease both. ⋯ A combination anti-emetic therapy from different drug classes is recommend to patients at high risk for nausea and vomiting like patients undergoing strabismus surgery. A combination therapy of ondansetron and dexamethasone lead to a risk reduction of PONV to at least 10 %. Further, the incidence of OCR and PONV is significantly reduced in children receiving peribulbar block on top of general anaesthesia.