Biomedical subjects

K Wiemers

Publications and source records attributed to K Wiemers.

At least 19 recordsLinked to original sources

PubMed1985

Continuous-plus-on-demand epidural infusion of morphine for postoperative pain relief by means of a small, externally worn infusion device.

In this study, 50 patients received an initial bolus epidural injection of 2 mg morphine-hydrochloride followed by a continuous-plus-on-demand epidural infusion of a 0.25% morphine-hydrochloride solution by means of a small, externally worn infusion device, for constant pain relief after abdominal operations. Mean morphine consumption on the operation day (until 8:00 AM on the first postoperative day) was 4.8 +/- 0.2 mg, on the first postoperative day (until 8:00 AM on the second postoperative day) 1.9 +/- 0.2 mg, and on a second postoperative day until 8:00 PM, 0.6 +/- 0.1 mg. The mean morphine consumption over 50 h was 7.1 +/- 0.3 mg; in the first 25 h and in the following 25 h after the operation, 5.44 +/- 0.3 mg and the significantly lower amount of 1.64 +/- 0.2 mg morphine, respectively, were consumed (P less than 0.001). There were no serious side effects. Serum levels of free, unmetabolized morphine immunoreactivity decreased during the treatment. The described method is recommended for treating postoperative pain, as it offers constant analgesia and the possibility of individualized treatment.

Abdomen↗

PubMed1985

[No loss of analgesic effect by peridural low volume morphine administration].

The risk of respiratory depression after epidural bolus injections of morphine can be reduced by lowering the injection volume of bolus epidural injections. The aim of the investigation was to evaluate the analgesic effectiveness of low-volume epidural injections of morphine and to determine the relationship between morphine consumption and the time of commencement of treatment by epidural, on-demand, low-dose infusion of morphine for constant pain relief after abdominal operations. Two mg morphine were administered immediately prior to the epidural infusion at the initial basal rate of 0.16 mg/0.06 ml per hour. The sixteen patients of Group I received an initial morphine bolus injection in a 10 ml volume of saline after complaining of worst post-surgical pain. The 34 patients that comprised Groups II and III in a randomised investigation received the initial 2 mg morphine in 1 ml saline. The treatment of Group II (n = 14) commenced when the patients complained of worst pain, in Group III (n = 20) after the patients had been extubated and were awake but before they complained of pain. Mean morphine consumption of the three groups until 8 a.m. on the first postoperative day did not differ significantly. We may, therefore, conclude that reduction of the injection volume does not result in loss of analgesic effectiveness, and that the treatment should commence as early as possible so as to spare the patient's pain. If the epidural catheter's tip is placed in the spinal area of the maximum nociceptive input, low-volume administration of morphine should be definitely employed.

Abdomen↗

PubMed1985

[Influence of the volume of peridural morphine bolus injections on morphine concentration in the cisterna magna of the dog].

14 dogs received randomly a bolus injection of either 2 mg morphine in 10 ml isotonic saline solution or 2 mg morphine in 1 ml isotonic saline solution epidurally at T6. An epidural infusion of 0.16 mg morphine/0.06 ml/h was applied immediately following the 1 ml bolus injection of morphine. Cisternal cerebellomedullary CSF samples were taken at varying intervals to determine free morphine immunoreactivity by radioimmunoassay. Within 20 min after the 10 ml bolus injection the peak CSF morphine concentration of 3594 +/- 910 ng/ml was reached. Following this, CSF morphine levels decreased exponentially and after 48 h 8 +/- 3 ng/ml were measured. The peak CSF morphine concentration of 139 +/- 51 ng/ml was, however, reached only after 2 h following the 1 ml bolus injection plus the infusion treatment. Despite the additional infused amount of 7.68 mg over 48 h the CSF morphine concentrations decreased also exponentially and after 48 h 16 +/- 4 ng/ml were measured. One may conclude, therefore, that the risk of respiratory depression is negligible under epidural infusion treatment following an initial "Low-Volume"-bolus injection of 2 mg morphine, a recommendable method for treating post-operative pain. High-volume bolus injections of morphine should generally be abandoned in epidural treatment of pain.

Animals↗

PubMed1984