Biomedical subjects

S Grond

Publications and source records attributed to S Grond.

67 records · Page 4Linked to original sources

PubMed1992

A long-term survey of morphine in cancer pain patients.

We surveyed 550 cancer patients who experienced pain and were treated with morphine for a total of 22,525 treatment days. Sufficient pain relief was achieved during more than 80% of this time using an average oral morphine dose of 82.4 mg--significantly lower than other studies. The use of this low dose, which was possible due to the concomitant administration of nonopioids and specific coanalgesics in most patients, resulted in a low incidence of side effects. Constipation and nausea/vomiting were the most common of these side effects. Physical dependence posed no practical problem in discontinuation of morphine treatment. Long-term opioid intake and development of tolerance did not appear to be linked; an increase in morphine dosage was most often explained by progression of the terminal disease. Addiction was a negligible problem, with only one observed case.

Analgesics↗

PubMed1992

[Clinical comparison of various infusion regimens within the scope of postoperative on demand analgesia with fentanyl].

80 patients (ASA I-III, mean age 40-50 years, mean weight 59-68 kg) recovering from major gynaecological surgery (170-200 min) under balanced anaesthesia were randomly assigned to four groups to self-administer intravenous fentanyl during the early postoperative period. PCA devices were ODAC and Prominject with fentanyl demand doses of 34.5 or 34 micrograms, respectively, and lockout times of 1 or 5 min. Concurrent fentanyl infusion was none (group Prom), fixed-rate with 4 micrograms/h (group ODACf), tail-dose, i.e., a fixed-rate infusion with 17 mg/h for a maximum of 60 minutes following a valid demand (group Prom(t)), or adaptive, starting with 4 micrograms/h and being adapted to individual needs depending on total fentanyl consumption in the latest 60-minute period (group ODACa). Data were collected for fentanyl consumption, venous fentanyl serum concentrations in fixed intervals, actual and retrospective verbal rating pain scores (0-5), haemodynamic variables, respiratory rate, side effects and patients' acceptance. Mean duration of patient-controlled analgesia (PCA) was 15-17 hrs. During this period, an average of 12-18 demands were administered per patient, resulting in an average fentanyl consumption of 36-52 micrograms/h (0.57-0.94 micrograms/kg/h). Analgesic efficacy was good in all groups, mean pain scores ranging from 0.4 to 1.1 (actual) and 1.7 to 2.2 (retrospective). Mean duration of a single fentanyl bolus dose was highly variable, ranging from 58 to 90 min if calculated for the total observation period. Statistically significant differences were found for none of the above mentioned PCA parameters. As a trend, the adaptive-rate infusion strategy was favoured (lowest demand rate, best retrospective pain scores).(ABSTRACT TRUNCATED AT 250 WORDS)

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↗

PubMed1992

Whitacre 22-gauge pencil-point needle for spinal anaesthesia. A controlled trial in 300 young orthopaedic patients.

In a prospective study of 300 young orthopaedic in-patients (less than 40 years) given spinal anaesthesia through a 22-gauge Whitacre (n = 150) or a 25-gauge Quincke spinal needle (n = 150), we found a 5.3% and a 9.3% incidence of post-spinal headache (PSH) respectively. Females (10.6%) had a higher overall incidence of post-spinal headache than males (5.6%) with more than twice as many females being affected in the 25 than in the 22-gauge group (14.5% vs 6.1%). The average duration of post-spinal headache was less in the 22-gauge group (36 h vs 42.4 h) as was the incidence of severe headache. It is concluded that the Whitacre 22-gauge needle is more suited for spinal analgesia in young female patients due to its ease of handling and its lower incidence of post-spinal headache.

Adolescent↗

PubMed1992

Atracurium and vecuronium: repeated bolus injection versus infusion.

The purpose of this study was to compare the characteristics of recovery from neuromuscular blockade after either atracurium or vecuronium given by intravenous infusion or by repeated injection. Four groups of 10 patients each were studied during nitrous oxide narcotic anesthesia. An initial intravenous dose of 2 x ED95 of either muscle relaxant was followed by an intravenous infusion started at 5% recovery of control twitch tension and adjusted for 95% block or by repeated injection of 0.6 x ED95 administered whenever twitch tension had returned to 25% of control. There were no significant differences between the maintenance doses required based on method of administration: atracurium repeated injection, 1.6 +/- 0.3 x ED95 h-1; atracurium infusion, 1.7 +/- 0.3 x ED95 h-1; vecuronium repeated injection, 1.8 +/- 0.5 x ED95 h-1; and vecuronium infusion, 1.6 +/- 0.4 x ED95 h-1. Nevertheless, differences of up to 20 min were noted in the recovery indices in the following order: atracurium repeated injection = atracurium infusion less than vecuronium repeated injection less than vecuronium infusion. A single dose of neostigmine (7 micrograms/kg) significantly reduced the recovery indices, thereby eliminating their differences.

Adult↗

PubMed1992

[Development of a method of continuous monitoring of spontaneous respiration in the postoperative phase. 1. Normal values for cutaneous pO2- and pCO2-partial pressure together with pulse oximetry determined oxygen saturation in healthy young volunteers].

METHODS: Twenty-eight healthy volunteers of both sexes (14 male, 14 female, age 31 +/- 7 years, weight 70 +/- 12 kg) breathing room air were monitored for cutaneous partial pressures of oxygen and carbon dioxide (pctO2, pctCO2) and partial oxygen saturation (psO2) as determined by pulse oximetry. Data triplets were collected and stored by a personal computer at 30-s intervals during a 4-h resting period to establish a confidence range for the devices in use (TCM 3 with a combination electrode E 5270, and Pulse Oximeter, Radiometer). This data range was intended to be used in later noninvasive, continuous respiratory studies with postoperative patients. Means, standard deviations, and ranges were calculated for individual data and data pooled from 15-min intervals. Data distribution over time was calculated for 30-min intervals. RESULTS: Contrary to the saturation data delivered by pulse oximetry, the pctO2 and pctCO2 readings needed about 15 min to stabilize. The mean +/- SD of a total of 12,600 pctO2 measurements (77.2 +/- 10.9 mmHg) could not simply be compared with arterial normal values, whereas the pctCO2 measurements (39.9 +/- 3.6 mmHg) fit well with arterial data from the literature. Interestingly, pctCO2 values in unmedicated healthy adults were not uniformly distributed, suggesting individual differences in either skin permeability of central regulation of respiration. Additionally, the pctO2 readings were characterized by serious inter-subject variability, which confirms earlier studies that pctO2 is not suitable for routine monitoring procedures in adults, the mean +/- SD of a total of 4500 psO2 measurements was 94.9 +/- 1.6%. A statistically significant correlation was found between pctO2 and psO2 (r = 0.358). Cutaneous carbon dioxide readings of greater than 50 mmHg were observed in only 0.06% of all 12,600 data sets (maximum 51.3 mmHg; 28 volunteers), desaturations (less than 90%) in only 0.24% of all 4,500 saturation measurements (minimum 86%; 10 volunteers). DISCUSSION AND CONCLUSION: Monitoring of spontaneous respiration in the recovery room is regarded as essential to prevent serious complications resulting from surgery and anesthesia. This has become particularly true with newer analgesic techniques like spinal opiates or patient-controlled analgesia. Since minor degrees of opiate-induced respiratory depression are easily influenced by external stimulation, it is mandatory that any monitoring of spontaneous respiration must be nonstimulant, and prefereably noninvasive. The present communication is the first of a series of investigations to develop of monitoring technique for postoperative patients. Because normal values for the parameters studied are either lacking or dependent on the monitoring devices in use, the present paper defined the respective data ranges. It is concluded that pulse oximetry and pctCO2 measurement are both useful and sensitive for continuous, non-invasive respiratory monitoring in adults, whereas pctO2 measurements are of lesser value. Results in volunteers treated with opiates and postoperative patients under patient-controlled analgesia using the above mentioned equipment will be reported in following publications.

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↗

PubMed1991

Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life.

The efficacy of the World Health Organization's guidelines for cancer pain relief was examined in 401 dying patients. At the time of death, only 3% of the patients experienced severe or very severe pain; whereas 52% had no pain at all, 24% experienced only mild or moderate pain, and 20% were unable to rate their pain intensity. Analgesic drugs were the mainstay of therapy during the last 24 hr of life, being administered by mouth in 47% and parenterally in 44% of the patients. Only 9% of the patients required no systemic analgesics. Nonopioid analgesics alone were effective in 5% and a combination of nonopioids and "weak" opioids were effective in 16% of the patients. In the remaining 70% of the patients "strong" opioids alone or in combination with nonopioid analgesics were necessary to achieve adequate pain reduction. Additional adjuvant drugs to treat special types of pain or other symptoms were prescribed in 90% of the patients. Nonpharmacological measures, such as radiotherapy, nerve blocks or neurosurgery played only a very minor role at this stage of the disease. This study shows that cancer pain can be treated satisfactorily until death.

Adolescent↗

PubMed1991

Postoperative patient-controlled analgesia with sufentanil: analgesic efficacy and minimum effective concentrations.

Sufentanil has so far seldom been used for intravenous postoperative patient-controlled analgesia (PCA), and the resulting serum concentrations have not yet been determined. Forty ASA I-III patients recovering from major gynecological operations were investigated to evaluate analgesic efficacy, side effects, patient acceptance and threshold concentrations of sufentanil in serum during the early postoperative period, using the On-Demand Analgesia Computer (ODAC). Following an individualized intravenous loading dose of 19.1 +/- 35.7 micrograms (mean +/- 1 s.d.), sufentanil demand doses were 6 micrograms with a concurrent infusion of 1.15 micrograms/h and a maximum hourly dose of 40 micrograms/h; the lockout time was set to 1 min. The duration of PCA was 17.3 +/- 2.1 h. During this time 16 +/- 11 demands per patient were recorded, resulting in an average sufentanil consumption of 131.1 +/- 69.4 micrograms or 7.5 +/- 3.7 micrograms/h (including loading dose). analgesia was mostly judged good. Side effects were only of minor intensity. Sufentanil proved to be about 2.2 to 3.8 times as potent an analgesic as fentanyl when both analgesic effect and duration were considered. Minimum effective sufentanil serum concentration (MEC) as determined by radioimmunoassay varied greatly and could be best described by a log-normal distribution (range less than 0.01-0.56 ng/ml, median 0.024 ng/ml). Intraindividual MEC variability was slightly lower than intersubject variability (76.0 vs. 84.8%). It is concluded that sufentanil is suitable for postoperative PCA. To get into the therapeutic window for analgesia, a serum sufentanil concentration of more than 0.03 ng/ml seems to be necessary.

Adult↗

PubMed1991

The importance of non-opioid analgesics for cancer pain relief according to the guidelines of the World Health Organization.

In a retrospective study of 1070 cancer patients being treated according to guidelines of the World Health Organization during a period of 55,285 days, the importance, efficacy and side-effects of non-opioid analgesics were evaluated. The non-opioids were given alone on 6917 days and in combination with weak opioids on 15,253 days, with strong opioids on 24,246 days and with spinal opioids on 1008 days. In evaluating efficacy and safety, it was not possible to differentiate adequately between the effects of non-opioids, opioids and adjuvant drugs, but it was demonstrated that an adequate combination of these drugs was effective and safe in the treatment of cancer pain.

Aged↗

PubMed1990

[Pain-relieving therapy for 57 patients with malignancies in the head and neck area].

From 1983 to 1988 57 patients with far advanced carcinomas of head and neck received pharmacological treatment of severe cancer pain according to the scheme recommended by the WHO. The evaluation of the collected data revealed that satisfactory pain control could be achieved by administration of oral analgetics. Total relief of pain was achieved in more than 35% of the days, significant relief in more than 50%. Side effects observed during therapy and co-medications are discussed.

Anti-Inflammatory Agents↗

PubMedDate not supplied

Postoperative pain management and respiratory depression after thoracotomy: a comparison of intramuscular piritramide and intravenous patient-controlled analgesia using fentanyl or buprenorphine.

STUDY OBJECTIVE: To compare the analgesic efficacy of fentanyl, buprenorphine, and piritramide and to define the respiratory risk during conventional postoperative pain management and patient-controlled analgesia (PCA). DESIGN: Randomized, single-blind study. SETTING: Department of anesthesiology of an urban hospital. PATIENTS: Sixty patients (ASA) physical status II and III) recovering from unilateral thoracotomy performed under standardized general anesthesia including intercostal blockade. INTERVENTIONS: Patients were treated with intramuscular (IM) piritramide (7.5 to 15 mg as needed) or intravenous (IV) PCA with fentanyl (demand dose 34 micrograms) or buprenorphine (demand dose 80 micrograms) during the early postoperative period, using the On-Demand Analgesia Computer (ODAC, Janssen Scientific Instruments, Beerse, Belgium). MEASUREMENTS AND MAIN RESULTS: The mean postoperative observation period was 24 to 25 hours. During this time, patients requested 55.8 +/- 23.2 mg of piritramide, 1.04 +/- 0.54 mg of fentanyl, or 1.81 +/- 0.78 mg of buprenorphine. Analgesia in all groups was judged mostly good to excellent, with a preference for PCA. Side effects were only of minor intensity in all groups; euphoria or dysphoria occurred only with buprenorphine. Two patients using PCA and five patients having IM analgesia developed short periods of respiratory depression (respiratory rate less than or equal to 8 breaths/minute and/or oxygen (O2) desaturation less than or equal to 90%), which promptly responded to commands to breathe deeply. Respiration rates did not differ, and frequent arterial blood sampling showed normal mean partial pressures of oxygen (PO2) and carbon dioxide (PCO2) and arterial oxygen saturation (SaO2) in all subgroups. CONCLUSIONS: Opioid-induced respiratory depression occurred infrequently during postoperative pain management whether by conventional means or using PCA, even though high doses of opioid analgesics were required intermittently for adequate postoperative pain relief by either technique.

Analgesia, Patient-Controlled↗

PubMedDate not supplied

Adverse effects of systemic opioid analgesics.

Adverse effects of opioids are multiple. They are most often receptor-mediated and inseparable from their desired effects. The most severe mishaps with opioids are related to their respiratory depressant effect, which is widely influenced by factors such as pain, previous opioid experience and awareness. Other relevant central nervous system effects of opioids include cough suppression, nausea and vomiting, rigidity, pruritus and miosis. The cardiovascular adverse effects of opioids are mainly related to histamine release and differ widely between agonists and agonist-antagonists. Gastrointestinal effects such as constipation, reflux and spasms of the bile duct are well described. Adverse effects on endocrine, immunological and haematological functions are possible, while allergic reactions are extremely rare. The adverse effects of long term use are overestimated. Systemic toxicity is negligible and development of tolerance is minimal while treating pain. In the clinical setting of pain control, addiction and withdrawal do not pose significant problems. Nevertheless, the possible effects of opioids on the unborn child should always be considered. Overall, opioids show a good record of safety. Their use should not be unduly limited by unfounded fears of adverse effects, but these effects should be avoided by anticipation and prevention.

Analgesics, Opioid↗