Biomedical subjects

L Radbruch

Publications and source records attributed to L Radbruch.

59 records · Page 4Linked to original sources

PubMed1996

A comparison of cisatracurium and atracurium: onset of neuromuscular block after bolus injection and recovery after subsequent infusion.

Cisatracurium is a new nondepolarizing muscle relaxant. In patients randomized to receive either cisatracurium (n = 40) or atracurium (n = 20) we compared the time course of neuromuscular block. The initial bolus dose of cisatracurium was 0.1 mg/kg, that of atracurium 0.5 mg/kg. Neuromuscular block, maintained with an infusion of either drug, was reversed with neostigmine 45 micrograms/kg and atropine 20 micrograms/kg in one half of the patients. Neuromuscular transmission was assessed by recording the mechanical twitch response to train-of-four nerve stimulation. Onset times were 3.1 +/- 1.0 min with cisatracurium and 2.3 +/- 1.1 min with atracurium (P = 0.008). The infusion rates for a 95% +/- 4% neuromuscular block were 1.5 +/- 0.4 micrograms.kg-1.min-1 for cisatracurium and 6.6 +/- 1.7 micrograms.kg-1.min-1 for atracurium, 3.3 times those of cisatracurium when referenced to the active cations. After the infusion, the spontaneous recovery intervals 25%-75% of 18 +/- 11 min and 18 +/- 8 min for cisatracurium and atracurium (P = 0.896) were shortened to 5 +/- 2 min and 4 +/- 3 min (P = 0.921) after neostigmine. While attributing different onset times also to differences in the initial doses, we conclude that time profiles for neuromuscular block of both muscle relaxants, when given in equipotent doses, are not different.

Adolescent↗

PubMed1996

A risk-benefit assessment of tramadol in the management of pain.

Tramadol is a cyclohexanol derivative with mu-agonist activity. It has been used as an analgesic for postoperative or chronic pain since the late 1970s, and became one of the most popular analgesics of its class in Germany. International interest has been renewed during the past few years, when it was discovered that tramadol not only acts on opioid receptors, but also inhibits serotonin (5-hydroxytryptamine; 5-HT) and noradrenaline (norepinephrine) reuptake. This review aims to provide a risk-benefit assessment of tramadol in the management of acute and chronic pain syndromes. Tramadol has been used intraoperatively as part of balanced anaesthesia. Such use is under discussion, however, as it was associated with a high incidence of intraoperative recall and dreaming, and postoperative respiratory depression has been described after intraoperative administration of high doses. Postoperatively, intravenous and intramuscular tramadol has been used with good efficacy. Analgesic doses were comparable with pethidine (meperidine) and 10 times higher than morphine. Nausea and vomiting were the most frequently reported adverse effects. In controlled studies, haemodynamic and respiratory parameters were only minimally impaired. The risk of severe respiratory depression in typical dosages is negligible in comparison with other opioids used for postoperative pain management. Tramadol has been used with good results for the management of labour pain without respiratory depression of the neonate. It was also effective for the treatment of pain from myocardial ischaemia, ureteric colic and acute trauma. Good results have been published for cancer pain management with tramadol in several studies. The potential for abuse or addiction seems to be minimal, and serious complications have not been reported. For patients with severe pain, the efficacy of morphine is superior, and most patients with adequate analgesia from tramadol had to be changed to a more potent opioid after a few weeks due to increased nociceptive input during tumour progression. Tramadol can be recommended as a safe and efficient drug for step II according to the World Health Organization guidelines for cancer pain management.

Administration, Oral↗

PubMed1994

[Pain assessment and therapy in bronchial carcinoma].

In the period from 1983-1991 133 patients (102 men, 31 women) with lung cancer were treated in our pain clinic for 8083 days. Pain was associated with tumour infiltration in 86% of patients and related to therapy in 15%. Even in 6 of 8 patients who were admitted with a diagnosis of "postthoracotomy syndrome" and in all 4 patients with "postradiation syndrome" local recurrence was diagnosed during follow-up. All 17 cases of brachial plexus lesions were caused by local tumour spread. Symptomatic treatment according to WHO guidelines resulted in good pain relief in 92% of patients and on 82% of days. The incidence of dyspnea decreased from 51% of the patients to 16%. Strong opioids were used on 56% of treatment days. Parenteral or spinal administration of opioids was necessary on 3% of days only.

Adult↗

PubMed1992

[Therapy for symptomatic pain in advanced breast cancer].

From 1983-1989, 106 patients with breast cancer were treated in our pain management unit on 6767 treatment days. Pain was caused by bone metastasis in 73% of patients. Neuropathic pain was reported by 32% of the patients. In all but four of these patients, new tumour growth was diagnosed. Patients were treated according to WHO analgesic guidelines with non-opioids on 16% of the days, non-opioids in combination with weak opioids on 36% and with strong opioids on 38% (orally 90%, parenterally 4% of the days). Due to the prevalence of bone pain non-steroidal antiinflammatory drugs were given on 56% of the days. The high incidence of neuropathic pain led to frequent use of co-analgesics (antidepressants 17%, anticonvulsants 12%, steroids 12% of the days). Adjuvant therapy for symptoms other than pain was given on 86% of the days. Whilst 92% of patients reported more than moderate pain on admission, 45% obtained complete pain relief beginning from the first days of treatment. On 92% of the days, patients described their pain as moderate or less. Side effects were treated symptomatically and played a minor role in a reason to change therapy.

Adult↗

PubMed1991

[Perineal pain and rectal cancer--prevalence in local recurrence].

Between 1983 and 1989, 85 patients with either carcinoma of the rectum or a recurrence of a previously diagnosed rectal tumour (47 women and 38 men aged 20 to 87 years) were treated in our pain clinic. In 50 patients, the reason for referral was perineal pain which had been present for one week to two years (median six months, 25%-percentile six weeks, 75%-percentile six months). In some patients this was considered to be due to scar tissue formation by the referring doctors. The pain was classified somatic, visceral and neuropathic in approximately equal numbers of patients, and about half of them described more than one type of pain. The other 35 patients were suffering from pain at other sites. In 40 out of 50 patients with perineal pain, local tumour recurrence was diagnosed. In 29 patients, pain symptoms began with a median of 5.5 months before the tumour recurrence was diagnosed. In a further seven patients, other types of tumour dissemination in the pelvis were considered to be the cause of the perineal pain. In only three patients no evidence of tumour was found in the pelvis. A non-neoplastic cause of perineal pain could be definitely confirmed in only one patient on post-mortem examination. 35 patients reported no perineal pain on admission, although in 19 cases a local cancer recurrence was found. 13 of these patients suffered from pain in the area of sensory innervation of the lumbosacral plexus. From 16 patients without a diagnosis of local recurrence, only four reported pain in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗