Preincisional and postoperative transcutaneous electrical nerve stimulation (TENS) administration reduces postoperative opioid demand in abdominal surgery. Aim of this study was to find out whether a ...comparable effect of TENS applies in major spinal surgery.
Thirty-eight patients of both sex scheduled for lumbar interbody fusion were enrolled and divided randomly into 3 groups. Group A received TENS preincisional and postoperative, group B received this treatment postoperative only, and group C was the sham controlled. The postoperative demand on piritramid to achieve a visual anlog scale pain score <3 was delivered either by nurse or by a patient-controlled analgesia pump, when the patients were alert. The setting of the patient-controlled analgesia pump, bolus of piritramid 2 mg intravenously (IV), lockout time of 20 minutes, and maximum dose of piritramid 15 mg within 4 hours, the coanalgesic therapy diclofenac 75 mg IV, and the rescue medication metamizol 1 g IV was identical for all patients. The total amount of piritramid administered over the first 24 hours after surgery and an optional rescue medication were recorded.
All groups were compared by pairs. The postoperative demand on piritramid differed significantly A versus B (P<0.05), A versus C (P<0.05), and B versus C (P<0.05). Neither sex, body mass index, current, duration, and type of operation nor the occurrence of hypotensive phases showed any significant association with postoperative piritramid demand. The necessity of rescue medication was significantly higher in group C than in group A.
Postoperative TENS as well as the combination of preincisional and postoperative TENS therapy reduce the postoperative demand of piritramid in major spinal surgery in a safe and simple way free of systemic side effects.
Zusammenfassung
Fragestellung
Ziel dieser randomisierten, nichtverblindeten Studie war es, herauszufinden, ob die Schmerzen nach Hämorrhoidenoperation mit einer patientenkontrollierten Analgesie ...verringert werden können.
Patienten und Methoden
Insgesamt 38 Patienten erhielten postoperativ nach einer Ferguson-Hämorrhoidektomie eine Standardschmerzmedikation mit oralen nichtsteroidalen Analgetika (Kontrolle n = 19) oder zusätzlich in den ersten 24 h eine patientenkontrollierte Analgesie mit Piritramid intravenös über eine Infusionspumpe (PCA n = 19).
Ergebnisse
Der postoperative Schmerz in Ruhe war in den ersten 24 h in der Therapiegruppe signifikant geringer als in der Kontrollgruppe (maximaler Schmerz 12 h postoperativ im Mittel: PCA 2,6 vs. Kontrolle 5,7). Die Patienten der Therapiegruppe waren 24 h postoperativ signifikant zufriedener mit der Schmerztherapie als die Patienten der Kontrollgruppe.
Schlussfolgerung
Mit einer patientenkontrollierten Analgesie können die postoperativen Schmerzen in den ersten 24 h nach Hämorrhoidenoperation signifikant verringert werden. Patienten mit patientenkontrollierter Analgesie sind signifikant zufriedener als Patienten unter Standardmedikation.
The aim of this randomised, double-blind study was to determine whether a low-tech patient controlled analgesia (PCA) model with various dose aliquots of piritramid or a combination of ...tramadol/dipyrone is suitable for use in postoperative pain therapy. By suitable the authors mean (a) whether effective analgesia can be attained; (b) whether patients can understand and appropriately use the PCA pump; and (c) whether good patient acceptance is achieved.
The authors studied 82 patients (ASA I–II) aged between 18–70 years. The patients were divided into four subgroups. All patients received a start-up loading dose of the same analgesic which they thereafter received via the PCA pump. The aliquots of drug provided by the PCA pump were always contained in 0.5 ml. This volume, however, contained different amounts of analgesic: piritramid either (1) 1.5 mg (high dose) or (2) 0.75 mg (low dose); (3) tramadol 10 mg with dipyrone 50 mg (high dose mixture); (4) tramadol 5 mg with dipyrone 25 mg (low dose mixture).
The results showed that the PCA device is suitable for use in postoperative pain therapy. The rate of side effects was low. In the first 24 hours, the consumption of analgesics was similar in the low dose aliquot and high dose aliquot groups: Group (1) 43.5 mg piritramid; Group (2) 37.2 mg piritramid; Group (3) 267 mg/1335 mg tramadol/dipyrone; Group (4) 256 mg/1275 mg tramadol/dipyrone.
Analgesia was effective, as judged by visual analogue scale (VAS) scores of 4 or less. Up to the 12th hour the VAS score was noted to be lower (more effective analgesia) in the tramadol/dipyrone group as compared to the piritramid group.
In conclusion, a postoperative PCA regimen using a low-tech PCA device provides effective analgesia with a low rate of side effects and is suitable for use in postoperative patients.
Provider: - Institution: - Data provided by Europeana Collections- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain ...Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
Provider: - Institution: - Data provided by Europeana Collections- Halle (Saale), Universitäts- und Landesbibliothek Sachsen-Anhalt, Diss., 2014- All metadata published by Europeana are available ...free of restriction under the Creative Commons CC0 1.0 Universal Public Domain Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
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