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Biomedical subjects

M V Fischer

Publications and source records attributed to M V Fischer.

11 recordsLinked to original sources
PubMed1996

[Preventive pain therapy. Preventive tramadol infusion versus bolus application in the early postoperative phase].

Even today, adequate postoperative analgesia is still a great problem. Based on positive results of former studies using a continuous infusion of tramadol for postoperative pain relief, we aimed to improve this regimen. In order to investigate the effectiveness of preventive analgesia, one group of patients was given 100 mg tramadol (Tramal) at the time of extubation, followed by a maintenance infusion. The other group was treated with single boluses of tramadol on demand, thus representing common pain treatment. METHODS. 112 patients undergoing abdominal surgery were chosen at random for this double-blind study. Half of them (preventive group) received an injection of 100 mg tramadol at the time of extubation; the others (on-demand group) were given a placebo instead. A continuous infusion of 500 ml NaCl 0.9% (administered with 30 ml/h) followed, either containing 200 mg tramadol (preventive group) or a placebo (on-demand group) and was maintained until the end of the study. At the first expression of pain, patients in the preventive group received 50 mg tramadol (representing the first subsequent injection) whereas patients of the on-demand group were given 100 mg tramadol as a loading dose. For further treatment of pain, the members of both groups received 50 mg tramadol when necessary. The level of pain was assessed by means of VAS (visual analogue scale) every hour and additionally at first expression of pain, and finally by VRS (verbal rating scale) after eight hours at the end of the study. RESULTS. 112 patients were chosen at random. 18 had to be excluded--two treatment failures, twelve violations of the study protocol and four patients of the on-demand group, who did not ask for treatment for pain and therefore did not receive any tramadol. Hence only 94 patients could be statistically evaluated. 50% of the remaining 48 patients in the preventive group needed none or only one subsequent injection of tramadol, the other 50% needed two or more subsequent injections. However the patients in the on-demand group, now 46, split up into 71.7% who where administered up to one subsequent injection and 28.3% who received more than one subsequent injection. The number of patients who asked for treatment for pain twice or more during the study period totalled 50% in the preventive group and 58.7% in the on-demand group. The average interval between extubation and first expression of pain was 106.3 +/- 84.2 min in the preventive group, and 75.0 +/- 22.7 min in the on-demand group. The intensity of pain evaluated by VAS as that time was comparable: 55.6 +/- 22.7 (preventive) versus (63.4 +/- 18.3 (on demand). The pain relief obtained, shown by the VAS-differences between the first expression of pain and following assessment, came up to 27.7 +/- 22.9 in the preventive group and 30.3 +/- 23.4 in the on-demand group within a period of 46.2 +/- 17.2 min (preventive) and 43.7 +/- 17.2 min (on-demand). Retrograde assessment of pain (VRS) showed that 85.5% of the preventive group found pain relief excellent or good and 78.3% of the on-demand group were of the same opinion. Total consumption of tramadol totalled 281.4 +/- 53.6 mg in the preventive group in comparison with 150.0 +/- 53.7 mg in the on-demand group. CONCLUSIONS. Only 28.3% of patients of the on-demand group received more than one subsequent injection of tramadol in comparison with 50% of the preventive group--an unexpected result. However, it has to be considered that the injection of tramadol given at the first expression of pain in the preventive group was counted as the first subsequent injection already. The patients in the preventive group asked, on average, 30 min later for treatment for pain. The subsequent pain relief in both groups was comparable, although the amount of tramadol administered at that time was higher in the on demand group than in the preventive group (100 mg versus 50 mg+ amount given by infusion). These facts show the efficacy of the preventive infus

Analgesics, Opioid↗
PubMed1994

[Postoperative analgesia with tramadol. Continuous infusion versus repetitive bolus administration].

Postoperative pain relief can be achieved by several methods, including the use of systemic opioids and regional anaesthesia with intrathecal or epidural opioids or local anaesthetics. On-demand analgesia using a PCA (patient-controlled analgesia) system is regarded as the ideal option for systemic opioid analgesia. While PCA devices are not yet commonly used in all recovery units, the use of repetitive boluses on demand is still the most frequent form of administration in postoperative pain therapy. The objective of the present study was to show if continuous infusion of the opioid tramadol could produce better analgesia than repetitive administration of boluses. METHOD. In a study under double-blind conditions 135 ASA I and II patients were assigned at random to group I (infusion group) or group B (bolus group) when they first requested pain treatment after abdominal surgery. The patients in group I received an initial intravenous loading dose of 100 mg tramadol, followed by an infusion of 12 mg/h tramadol for 24 h; if necessary, repeated boluses of 50 mg tramadol were given. In group B the patients received a placebo infusion instead of the tramadol infusion; otherwise, the procedure was the same. Pain relief was monitored by means of a VAS (visual analogue scale) up to 6 h after surgery. We investigated the retrograde assessment of analgesia by the patients after 6 h, how often repetitive boluses were required, and the amount of analgesics administered in 6 and 24 h. RESULTS. The pain relief was assessed as excellent or good by 76.5% of group I and 65.6% of group B; 19.1% of group I and 26.9% of group B assessed the analgesic effect as satisfactory; 4.4% of group I and 7.5% of group B complained of insufficient analgesia. In group I 69.2% requested only one or no repetitive bolus, compared with 40.3% in group B, while two or more boluses were demanded by 30.8% in group I und 59.7% in group B. The average analgesic consumption after 6 h was 223.5 +/- 53.7 mg tramadol in group I and 176.6 +/- 63.1 mg tramadol in group B, respectively. After 24 h it was 449.5 +/- 66.0 mg tramadol in group I and 201.6 +/- 83.9 mg tramadol in group B. While the consumption during the first 6 h was comparable, from then on the consumption in group I increased significantly. Side effects were reported by 25% in both groups. They were clinically irrelevant and did not necessitate termination of the clinical trial in any case. During the study period pulse and blood pressure remained within the normal range and did not show any significant changes. CONCLUSION. The fact that the patients in group I requested far fewer repetitive boluses than those in group B and the assessment by the patients led to the conclusion that treatment in the infusion group is better than that in the bolus group. Concerns that a significantly higher consumption of analgesics would cause unwanted side-effects have proven unfounded. Six hours after surgery, when analgesia was evaluated by the patients, there was no significant difference between the two groups. Not until the maintenance infusion had been administered for a further 18 h, was the tramadol consumption within the infusion group significantly higher. Thus, we should consider continuing unreduced administration of the maintenance infusion 6 h after operation.

Abdomen↗
PubMed1991

Clinical evaluation of electrostimulation anaesthesia for hysterectomy.

A prospective randomized study was undertaken to evaluate the efficacy of electrostimulation anaesthesia (ESA) when compared with neurolept anaesthesia (NLA). One hundred patients scheduled for hysterectomy received either ESA or NLA. Higher levels of mean arterial pressure and heart rate in the ESA group make this technique less suitable for patients with a history of arterial hypertension. A higher dose of muscle relaxants was used in the ESA group. Measured stress variables like plasma glucose, cortisol, and iron indicate maintenance of the stress response during ESA. The postoperative questionnaire revealed intraoperative recall in 12% of ESA patients. We conclude that "pure" ESA based on a N2O regimen should be avoided.

Adult↗
PubMed1987

[Diagnostic and therapeutic blockade of the celiac ganglia].

Neurolytic celiac plexus block is the therapy of choice for visceral upper abdominal pain that is resistant to therapy. In order to ensure that the treatment is indicated a temporary block for diagnostic purposes (application of a local anesthetic) has to be carried out. A diagnostic block can be performed as a blind puncture according to anatomic criteria if new computed tomograms are available providing the necessary information on the patient's anatomy. In 18 patients who underwent a diagnostic block by this procedure no side effects could be observed. If neurolytic substances (e.g. ethanol 96%) are used, a contrast medium should be added to make roentgen control and documentation possible. Computed tomography is a very suitable procedure for these purposes. The location, angle and depth of the puncture can be calculated by the computer tomograph. Of 14 patients in whom we performed a CT-guided block of the celiac ganglion, 10 were free from pain afterwards or showed considerably reduced pain symptoms. The side effects that could be observed were but slight and passed after a few days.

Abdomen↗
PubMed1986

[Pain therapy in tumor patients].

The incidence of pain associated with advanced cancer is very high. In addition, most patients are also suffering from emotional and social problems. In the choice of pain treatment the different processes of nociception have to be considered. Thus non-narcotic analgesics and psychotropic agents may be combined to reduce opiate requirements. Oral medication is to be preferred and should be given on a strict schedule. Pain syndromes irresponsive to this pharmacological treatment are indications for neurosurgical procedures, epidural opiates and neurolytic nerve blocks.

Analgesics↗
PubMed1984

Acupuncture--a therapeutic concept in the treatment of painful conditions and functional disorders. Report on 971 cases.

The results in 971 outpatients who have been treated with acupuncture for different diseases are reported. The outcome of treatments and number of sessions are discussed in relation to the different diseases. Acupuncture treatment was regarded as successful when 1. the patients had no pain at all without medication and 2. there was a significant improvement (no long-term medication, only mild pain under unusual strain, minimal medication under such circumstances). We obtained positive results in cephalalgias , sinusitis, cervical spine syndrome, shoulder-arm syndrome, ischialgias , back pain, constipation, herpes zoster, allergic rhinitis and disturbances of peripheral blood flow. For the following ailments, in order to reduce the medication, we recommend acupuncture despite a high rate of recurrence: Trigeminal neuralgia, colitis ulcerosa, bronchial asthma and cancer pain. Results in the treatment of mental disturbances were unsatisfactory, and in cases of tinnitus results were negative.

Acupuncture Therapy↗
PubMed1983

[Circulatory behavior under electrostimulation anesthesia (ESA)].

A comparative study was made of the circulatory conditions during ESA via paravertebral electrodes and halothane anaesthesias and neurolept analgesia. During 654 operations (cholecystectomies, struma-surgery, vein by-pass grafting and varicotomies) heart rate and mean arterial pressure before the onset of anaesthesia and the highest intraoperative measured rates were compared. The same parameters after intubation/before the start of the operation respectively before and after the start of the operation were compared with regard to the specific type of anaesthesia. Before the start of surgery no marked reactions of the circulatory system were observed during ESA compared to other anaesthesia techniques. No difference in heart rate and mean arterial pressure were found during the start of the operation with the different anaesthetic techniques. For struma surgery the reaction of the circulatory system during ESA was significantly better than in halothane anaesthesia while during surgery of the upper abdomen and vein by-pass grafting in ESA patients there were significantly greater rises in heart rate and mean arterial pressure.

Blood Pressure↗
PubMed1983

[Use of muscle relaxants under electrostimulation anesthesia (ESA)].

A comparative study was made of the consumption of muscle relaxants during electrostimulation anaesthesia (ESA) in comparison to halothane anaesthesia and neurolept anaesthesia. 441 operations (struma surgery, saphenous vein bypass grafts, varicotomies) showed a significantly raised consumption of muscle relaxants when performed under ESA. For struma surgery and varicotomies the consumption was 17.2% respectively 13.9% higher than during halothane anaesthesia and for vein bypass grafting 14.3% higher than during neurolept anaesthesia. The potentiating effect of inhalation anaesthetics on muscle relaxants and the possibility of an activation of the reticular formation via electrical stimulation of muscular and nervous tissues under ESA are discussed.

Anesthesia↗
PubMed1982

[Acupuncture therapy in the outpatients-department of the University Clinic Heidelberg (author's transl)].

Encouraged by the good results obtained using acupuncture anaesthesia, we started therapeutic acupuncture in our institute of anaesthesiology four years ago. In the meantime acupuncture is as important a therapeutic method in our out-patients department as are therapeutic local anaesthesia, transcutaneous electrical nerve stimulation and biofeedback. The results in 520 patients who have been treated with acupuncture for different diseases are reported. The success of treatment, the number of sessions and the recurrence-rate within one and a half years are discussed for the different diseases. Acupuncture treatment was regarded successful when 1, the patient had no complaints at all without medication, and 2, when there was significant improvement (no long term medication, only mild complaints with unusual strain, which were responsive to minimal medication). Thus treatment in cephalgia was successful in 83% with no recurrences (NR) in 84%. In cervical pain syndromes the respective percentages were 80% (NR = 74%) in constipation 80% (NR = 72%), sinusitis 86% (NR = 100%), insomnia 100% (NR = 100%). Good results, albeit with high recurrence rate were achieved in cases of trigeminal neuralgia in 90% (NR = 23%), colitis ulcerosa in 100% (NR = 0%), in bronchial asthma 70% (NR = 50%) and in tumour pain 61% (NR = 0%). Treatment in patients suffering from parathymic conditions were unsatisfactory and results in cases of tinnitus were negative.

Acupuncture Therapy↗