Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The effect of puncture needle on the subarachnoid catheter position in continuous spinal ansthesia].
The subarachnoid position of the microcatheter has an impact on the outcome of continuous spinal anaesthesia (CSA). The present prospective, randomised study investigated the influence of two different spinal needles on the radiographically documented subarachnoid positions of microcatheters in CSA. In addition, the influence of the subarachnoid position of the microcatheter on onset time of analgesia, dose requirement of local anaesthetics, and level of analgesia was examined. ⋯ CONCLUSIONS. Sprotte needles provide a higher number of cranially directed microcatheters, which are associated with faster onset of analgesia, lower dose requirement of local anaesthetics, and higher analgesic levels in CSA. The results suggest more effectiveness and probably more safety in microcatheter CSA using Sprotte needles for catheter insertion.
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Many articles in the literature document the fact that postoperative pain therapy has not improved for decades despite new insights into pain physiology, the availability of powerful analgesics and the development of new techniques. This project was set up to develop practical, effective, safe, and easy to run acute pain therapy. METHODS. ⋯ The difficulties in realizing such a concept are described. The importance of thorough teaching is underlined in a nurse-based system. However, it is not yet clear whether this pain treatment has resulted in reduced morbidity, reduced mortality and a shortened hospital stay of the patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Total intravenous anesthesia (TIVA) in geriatric surgery. S-(+)-ketamine versus alfentanil].
In this prospective, randomized study, two regimens of total intravenous anaesthesia (TIVA), with propofol and S(+)-ketamine (S-ketamine) and with propofol and alfentanil, were compared with reference to endocrine stress response, circulatory effects and recovery. METHODS. The investigation was conducted in two groups of 20 ASA I-III patients over 60 years of age who were scheduled for endoprothetic orthopaedic surgery. ⋯ On the other hand, TIVA with propofol and alfentanil showed sympatholytic properties, with negative circulatory effects and a remarkable reduction of endocrine stress response. This might be beneficial in patients with hypertension and states of endocrine hyperfunction. Both regimens were accompanied by such typical side effects as dreams, delayed recovery, reduced ventilation, and emesis, which should also be considered.
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Pre-emptive analgesia is based on the idea that analgesia initiated before a nociceptive event will be more effective than analgesia commenced afterwards, and that its effects will outlast the pharmacological duration of action of the analgesic used. The idea of pre-emptive analgesia is based upon experimental neurophysiological work demonstrating that afferent nociceptive impulses result in alterations of central nervous system function. These changes, most easily elicited by C-fibre afferents, particularly affect the spinal dorsal horn. ⋯ Clinical studies have so far only used short-term analgesia. To permit extrapolation from the experimental to the clinical situation, pre-emption in the surgical context must correspond adequately to the duration and extent of the nociception involved. Studies of pre-emptive analgesia in a clinically relevant form, i.e. where nociception and analgesia are correctly matched, are called for.