Der Anaesthesist
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Randomized Controlled Trial
[Delta(9)-tetrahydrocannabinol and the opioid receptor agonist piritramide do not act synergistically in postoperative pain].
It is concluded from animal experiments that cannabinoid receptor and mu-opioid receptor agonists act synergistically with respect to antinociception. In order to demonstrate this effect under clinical conditions, we conducted a randomized double blind trial with patients after radical prostatectomy. ⋯ We found neither a synergistic nor even an additive antinociceptive interaction between Delta(9)-tetrahydrocannabinol and the micro-opioid agonist piritramide in a setting of acute postoperative pain.
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Comparative Study
[Operative management in axillary brachial plexus blocks: comparison of ultrasound and nerve stimulation].
Given a case-by-case accounting system, the analysis of medical performance becomes increasingly important. Quality of treatment and the time effort attached play an important role. Anaesthesia procedures require a high level of quality and safety. ⋯ The results revealed a significant increase in the success rate for the patient group where ultrasound was used (98.2% Sono vs 83.1% NStim) and the operation could begin 15 min earlier in the Sono group (5 min vs. 20 min, p<0.001). Furthermore, the duration of anaesthesia was significantly shorter (85 min vs. 120 min, p<0.001) and the necessity for post-operative observation was less (5.4% vs. 32.4%, p<0.001). The data provided in the study indicate that the use of ultrasound for the identification of the nerves can clearly improve quality and time-scales of axillary brachial plexus blocks.
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Comparative Study
[Depth of anaesthesia during intubation: comparison between propofol and thiopentone].
In order to study the depth of anaesthesia during endotracheal intubation, 30 patients received either thiopentone or propofol for anaesthesia induction. The BIS value as a parameter for the depth of anaesthesia and the rate pressure product (RPP) were acquired online. Patients who received thiopentone for anaesthesia induction showed significantly higher BIS values at the moment of intubation and reached BIS values >60 significantly more frequently than patients receiving propofol. ⋯ Therefore, when using thiopentone it is recommended to also use a rapid acting muscle relaxant or to select a high ED95 to compensate for the flat level of anaesthesia. Alternatively, repetetive boluses of the hypnotic shortly before intubation should be considered or to revert to propofol. The dosage and pharmacokinetics of the analgesic should also be taken into consideration because an insufficient analgesia leads to a faster flattening of the depth of anaesthesia.
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A 62-year-old female suffered from therapy-resistant pain in the axilla after lymphadenectomy. The pain ranged from 8-10 on the numeric rating scale (NRS) despite multimodal pain therapy (non-steroid anti-rheumatics, opioids, physiotherapy, acupuncture). ⋯ As the patient responded well, a paravertebral catheter was inserted close to Th 4 directly before the revision operation took place the following day. The case study describes the possibilities of eliminating pain segmentally in the axilla and an alternative technique to a paravertebral block (lamina technique).