Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2018
Review[Patient-controlled Analgesia (PCA): an Overview About Methods, Handling and New Modalities].
Patient-controlled analgesia (PCA) is one of the well established methods for the treatment of postoperative pain. A cochrane-review concluded that PCA is associated with better postoperative pain ratings and improved patient-satifaction compared to traditional way of administering opioids. ⋯ Current PCA modalities (intravenous and epidural routes of application) are expanded by newer, less invasive routes of drug administration, e.g. by the iontophoretic transdermal and the sublingual route. Their role in improving safety and the quality of pain therapy on the one hand side, and costs on the other hand side are discussion.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2018
Review[Peripheral Regional Anesthesia Without Any Complications - a Dream Comes True?!]
Peripheral regional anesthesia procedures, such as femoral nerve block, are relatively safe procedures in clinical anesthesia. Nevertheless, it may lead to typical, usually transient and rarely even persistent complications. This article aims to highlight key aspects of complications in peripheral regional anesthesia and, in particular, strategies to reduce risk. ⋯ In addition to the presentation of the possible complications, this article discusses improvements in the techniques during the last two decades. Due to the use of ultrasound, some side effects nowadays are supposed to occur less likely. An outlook into the future will inform the reader about improved or more selective blockages.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2018
Review[Contra: Is Postoperative Epidural Analgesia the Gold Standard?]
As strategy for postoperative pain therapy, epidural analgesia (EDA) is superior to systemic opiate analgesia after abdominal and thoracic surgery. In addition, EDA may significantly reduce the incidence of complications in some large operations, such as, e.g. cardiac (myocardial infarction, atrial fibrillation) and pulmonary complications (pneumonia, atelectasis), and even reduce mortality. Intestinal motility can also be improved. ⋯ In the meantime, the distinctly different complication rates of epidural bleeding and abscesses after EDA are also known for different surgical interventions. In large open abdominal interventions, open thorax operations, and especially open abdominal aortic surgeries, EDA reduces pain and complications. It should be noted that the positive effects of EDA have so far hardly been directly compared with those of intraoperative lidocaine administration.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2018
Review[Pro: Epidural Analgesia Remains the Gold Standard for Abdominal and Thoracic Surgery].
Pain relief with epidural analgesia is superior compared to systemic opioid analgesia after major abdominal and thoracic surgery. It remains a safe procedure, as long as it is embedded in a concept covering the whole perioperative period. This includes the knowledge of the anesthesiologist how to operate the process of catheter insertion as well as to treat complications like the hypotension, associated with the application of epidural local anesthetics. ⋯ Furthermore, perioperative mortality could be decreased by epidural analgesia. These effects should be considered as "add-on". The excellent pain relief is more than enough to recommend this method.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2018
Review Case Reports[Case Report: Opioid Therapy for Chronic Low Back Pain].
Within this case report we describe and discuss the treatment of a patient with chronic low back pain complaining about severe pain, reduced functionality and symptoms of depression, who was treated with long-term opioids (480 mg morphine equivalents). According to the recommendation of current guidelines we successfully reduced the opioid daily dose and discharged the patient with 28 mg morphine equivalents, improved physical functionality and reduced chronic pain intensity following a specific interdisciplinary pain rehabilitation programme for seniors.