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Emons MI, Maring M, Stamer UM, Pogatzki-Zahn E, Petzke F, Erlenwein J. [Safety and monitoring of patient-controlled intravenous analgesia : Clinical practice in German hospitals]. Anaesthesist 2021; 70:476-485. [PMID: 33373025 PMCID: PMC8190018 DOI: 10.1007/s00101-020-00907-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patient-controlled intravenous analgesia (PCIA) is a well-established technique in acute pain management and available in most German hospitals. Despite its widespread use, information on current clinical practice is limited. This investigation evaluated clinical practice and monitoring as well as PCIA-associated adverse events and critical incidents in German hospitals. METHODS An invitation to participate in this online-survey was sent to 995 heads of anesthesiology departments belonging to the "German Society of Anaesthesiology and Intensive Care Medicine". RESULTS Of the departments receiving the link, 244 took part (response rate 25%). PCIA was used in 193 of these hospitals (79%). All the following statements relate to the hospitals in which PCIA was used. Piritramide was the most frequently used opioid. In parallel with PCIA, additional nonopioid analgesics were used in 94% of the hospitals, and in 38%, additional slow-release oral opioids were used. Parenteral opioids were administered by the ward staff in 4% of the hospitals. In 75% of hospitals, there were standardized indications for PCIA therapy, with almost two thirds of respondents stating that PCIA was the technique of second choice if regional procedures were contraindicated or failed. In all, 76% of the hospitals had an acute pain service. Twenty-four percent of the hospitals regularly used PCIA in non-surgical patients. In pediatric patients, PCIA was used in 62 hospitals (32%). Only 31% of the hospitals reported the use of standardized protocols for the specific monitoring of patients' vital signs on general wards, exceeding general care. Of the department, 158 (82%) reported adverse events in connection with the use of PCIA within the six-month period preceding the survey (most frequently due to patients' noncompliance [52%], dislocated intravenous lines [41%], communication errors [16%], administration of additional analgesics [16%] and/ or sedatives [14%], problems with the pump [16%], programming errors [9%], incorrect opioid concentration in the reservoir [8%], non-observance of contraindications [7%], incorrect dosing [6%] and self-dosing by the patient [4%] or by third parties [3%], filling the reservoir with thewrong medication [2%]; and other problems [5%]). Only 35 of the hospitals (18%) reported no problems associated with PCIA therapy. Seventy-five of the 193 respondents (39%) stated that at least one critical incident had occurred in the context of the use of PCIA. This resulted in a total of 335 cases out of an estimate of 50.000 patients treated with PCIA. The respondents classified these as follows: I) 273 incidents requiring a prolonged stay in the recovery room, but without further complications, II) 58 requiring transfer to the intensive care unit, but without further complications, III) three resulting in permanent harm to the patient and IV) one resulting in the death of the patient. A comparison of the monitoring standards for PCIA showed that critical incidents were reported less frequently in hospitals with less intensive monitoring, and more frequently in hospitals with higher monitoring standards. CONCLUSION PCIA is a frequently used analgesic technique in German hospitals. There were many differences in how PCIA therapy was applied and monitored on general wards. Adverse events occurred to a significant extent, with a considerable part of them, which might be preventable. Critical incidents were perceived more often when standards for monitoring on general wards were higher. Consented current recommendations regarding treatment and monitoring standards as well as the systematic recording of complications when using PCIA are pending.
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Affiliation(s)
- M I Emons
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V., Nürnberg, Deutschland
| | - M Maring
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Deutschland
| | - U M Stamer
- Klinik für Anästhesiologie und Schmerztherapie, Inselspital, Universität Bern und Department of BioMedical Research, Universität Bern, Bern, Schweiz
- Arbeitskreis Akutschmerz, Deutsche Schmerzgesellschaft e. V., Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V., Nürnberg, Deutschland
| | - E Pogatzki-Zahn
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
- Arbeitskreis Akutschmerz, Deutsche Schmerzgesellschaft e. V., Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V., Nürnberg, Deutschland
| | - F Petzke
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Deutschland
- Arbeitskreis Akutschmerz, Deutsche Schmerzgesellschaft e. V., Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V., Nürnberg, Deutschland
| | - J Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Deutschland.
- Arbeitskreis Akutschmerz, Deutsche Schmerzgesellschaft e. V., Berlin, Deutschland.
- Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V., Nürnberg, Deutschland.
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Stamer UM, Stammschulte T, Erlenwein J, Koppert W, Freys S, Meißner W, Ahrens P, Brede EM, Lindig M, Dusch M, Heitfeld S, Hoffmann E, Lux EA, Müller E, Pauli-Magnus D, Pogatzki-Zahn E, Quaisser-Kimpfbeck C, Ringeler U, Rittner H, Ulma J, Wirz S. [Recommendations for the perioperative use of dipyrone : Expert recommendation of the working group on acute pain of the German Pain Society, the scientific working group on pain medicine of the German Society for Anesthesiology and Intensive Care Medicine and the surgical working group on acute pain of the German Society for Surgery with participation of representatives of the Drug Commission of the German Medical Association]. Anaesthesist 2020; 68:520-529. [PMID: 31396674 DOI: 10.1007/s00101-019-0622-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
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Affiliation(s)
- U M Stamer
- Klinik für Anästhesiologie und Schmerztherapie, Universitätsklinik Bern, Inselspital, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz.
| | - T Stammschulte
- Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland
| | - J Erlenwein
- Klinik für Anästhesiologie, GF Schmerzmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - W Koppert
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Freys
- Chirurgische Klinik, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Deutschland
| | - W Meißner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - P Ahrens
- Abteilung Anästhesie und operative Intensivmedizin, Aller-Weser-Klinik, Verden, Deutschland
| | - E-M Brede
- Klinik und Poliklinik für Anästhesiologie, Zentrum Interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - M Lindig
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Deutschland
| | - M Dusch
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Heitfeld
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, UniversitätsSchmerzCentrum Dresden, Dresden, Deutschland
| | - E Hoffmann
- Klinik für Anästhesie, operative Intensivmedizin, Notfall- und Schmerzmedizin, Evangelisches Krankenhaus Herne, Herne, Deutschland
| | - E A Lux
- Klinik für Schmerz- und Palliativmedizin, Katholisches Klinikum Lünen-Werne, Lünen, Deutschland
| | - E Müller
- Klinik für Anästhesiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - D Pauli-Magnus
- Klinik für Anästhesie, Schmerztherapie, Intensiv- und Notfallmedizin, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - E Pogatzki-Zahn
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - C Quaisser-Kimpfbeck
- Abteilung für Anästhesie und Schmerztherapie, Klinikum Freising, Freising, Deutschland
| | - U Ringeler
- Abteilung für Anästhesiologie, Palliativ‑, Intensiv- und Schmerzmedizin, Paracelsus-Klinik Golzheim, Düsseldorf, Deutschland
| | - H Rittner
- Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland
- Klinik und Poliklinik für Anästhesiologie, Zentrum Interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - J Ulma
- Klinik für Schmerzmedizin und Schmerzambulanz, Rotes Kreuz Krankenhaus Bremen, Bremen, Deutschland
| | - S Wirz
- Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, CURA-GFO Kliniken Bonn, Bad Honnef, Deutschland
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Stamer UM, Stüber F. PROSPECT guidelines for oncological breast surgery: the role of non-opioid analgesics. Anaesthesia 2020; 76:139-140. [PMID: 32920847 DOI: 10.1111/anae.15259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - F Stüber
- University of Bern, Bern, Switzerland
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4
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Stamer UM, Stammschulte T, Erlenwein J, Koppert W, Freys S, Meißner W, Ahrens P, Brede EM, Lindig M, Dusch M, Heitfeld S, Hoffmann E, Lux EA, Müller E, Pauli-Magnus D, Pogatzki-Zahn E, Quaisser-Kimpfbeck C, Ringeler U, Rittner H, Ulma J, Wirz S. [Recommendations for the perioperative use of dipyrone : Expert recommendation of the working group on acute pain of the German Pain Society, the scientific working group on pain medicine of the German Society for Anesthesiology and Intensive Care Medicine and the surgical working group on acute pain of the German Society for Surgery with participation of representatives of the Drug Commission of the German Medical Association]. Chirurg 2019; 90:652-659. [PMID: 31359112 DOI: 10.1007/s00104-019-0993-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
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Affiliation(s)
- U M Stamer
- Klinik für Anästhesiologie und Schmerztherapie, Universitätsklinik Bern, Inselspital, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz.
| | - T Stammschulte
- Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland
| | - J Erlenwein
- Klinik für Anästhesiologie, GF Schmerzmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - W Koppert
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Freys
- Chirurgische Klinik, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Deutschland
| | - W Meißner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - P Ahrens
- Abteilung Anästhesie und operative Intensivmedizin, Aller-Weser-Klinik, Verden, Deutschland
| | - E-M Brede
- Klinik und Poliklinik für Anästhesiologie, Zentrum Interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - M Lindig
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Deutschland
| | - M Dusch
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Heitfeld
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, UniversitätsSchmerzCentrum Dresden, Dresden, Deutschland
| | - E Hoffmann
- Klinik für Anästhesie, operative Intensivmedizin, Notfall- und Schmerzmedizin, Evangelisches Krankenhaus Herne, Herne, Deutschland
| | - E A Lux
- Klinik für Schmerz- und Palliativmedizin, Katholisches Klinikum Lünen-Werne, Lünen, Deutschland
| | - E Müller
- Klinik für Anästhesiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - D Pauli-Magnus
- Klinik für Anästhesie, Schmerztherapie, Intensiv- und Notfallmedizin, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - E Pogatzki-Zahn
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - C Quaisser-Kimpfbeck
- Abteilung für Anästhesie und Schmerztherapie, Klinikum Freising, Freising, Deutschland
| | - U Ringeler
- Abteilung für Anästhesiologie, Palliativ‑, Intensiv- und Schmerzmedizin, Paracelsus-Klinik Golzheim, Düsseldorf, Deutschland
| | - H Rittner
- Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland.,Klinik und Poliklinik für Anästhesiologie, Zentrum Interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - J Ulma
- Klinik für Schmerzmedizin und Schmerzambulanz, Rotes Kreuz Krankenhaus Bremen, Bremen, Deutschland
| | - S Wirz
- Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, CURA-GFO Kliniken Bonn, Bad Honnef, Deutschland
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Stamer UM, Stammschulte T, Erlenwein J, Koppert W, Freys S, Meißner W, Ahrens P, Brede EM, Lindig M, Dusch M, Heitfeld S, Hoffmann E, Lux EA, Müller E, Pauli-Magnus D, Pogatzki-Zahn E, Quaisser-Kimpfbeck C, Ringeler U, Rittner H, Ulma J, Wirz S. [Recommendations for the perioperative use of dipyrone : Expert recommendation of the working group on acute pain of the German Pain Society, the scientific working group on pain medicine of the German Society for Anesthesiology and Intensive Care Medicine and the surgical working group on acute pain of the German Society for Surgery with participation of representatives of the Drug Commission of the German Medical Association]. Schmerz 2019; 33:287-294. [PMID: 31342162 DOI: 10.1007/s00482-019-0389-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
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Affiliation(s)
- U M Stamer
- Klinik für Anästhesiologie und Schmerztherapie, Universitätsklinik Bern, Inselspital, Universität Bern, Freiburgstraße, 3010, Bern, Schweiz.
| | - T Stammschulte
- Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland
| | - J Erlenwein
- Klinik für Anästhesiologie, GF Schmerzmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - W Koppert
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Freys
- Chirurgische Klinik, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Deutschland
| | - W Meißner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - P Ahrens
- Abteilung Anästhesie und operative Intensivmedizin, Aller-Weser-Klinik, Verden, Deutschland
| | - E-M Brede
- Klinik und Poliklinik für Anästhesiologie, Zentrum Interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - M Lindig
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Deutschland
| | - M Dusch
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Heitfeld
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, UniversitätsSchmerzCentrum Dresden, Dresden, Deutschland
| | - E Hoffmann
- Klinik für Anästhesie, operative Intensivmedizin, Notfall- und Schmerzmedizin, Evangelisches Krankenhaus Herne, Herne, Deutschland
| | - E A Lux
- Klinik für Schmerz- und Palliativmedizin, Katholisches Klinikum Lünen-Werne, Lünen, Deutschland
| | - E Müller
- Klinik für Anästhesiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - D Pauli-Magnus
- Klinik für Anästhesie, Schmerztherapie, Intensiv- und Notfallmedizin, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - E Pogatzki-Zahn
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - C Quaisser-Kimpfbeck
- Abteilung für Anästhesie und Schmerztherapie, Klinikum Freising, Freising, Deutschland
| | - U Ringeler
- Abteilung für Anästhesiologie, Palliativ‑, Intensiv- und Schmerzmedizin, Paracelsus-Klinik Golzheim, Düsseldorf, Deutschland
| | - H Rittner
- Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland
- Klinik und Poliklinik für Anästhesiologie, Zentrum Interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - J Ulma
- Klinik für Schmerzmedizin und Schmerzambulanz, Rotes Kreuz Krankenhaus Bremen, Bremen, Deutschland
| | - S Wirz
- Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, CURA-GFO Kliniken Bonn, Bad Honnef, Deutschland
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Reist L, Erlenwein J, Meissner W, Stammschulte T, Stüber F, Stamer UM. Dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. A survey of clinical practice in German-speaking countries. Eur J Pain 2018; 22:1103-1112. [PMID: 29377479 DOI: 10.1002/ejp.1194] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Nonopioid analgesics are frequently used for the treatment of acute and chronic pain. Dipyrone is an alternative to NSAIDs and paracetamol, however, data on the frequency of its usage by anaesthesiologists in the perioperative and chronic pain setting are lacking and its adverse reactions are a matter of debate. METHODS The link to a questionnaire on the use of nonopioid analgesics (NSAIDs, COX-2 inhibitors, paracetamol, dipyrone) and the safety of dipyrone in the perioperative and chronic pain setting was mailed to anaesthesiologists and pain physicians. RESULTS A total of 2237 responses were analysed. About 97.4% of the respondents used nonopioid analgesics for the treatment of acute pain, with 93.8% administering dipyrone, 54.0% NSAIDs, 41.8% COX-2 inhibitors and 49.2% paracetamol. Nonopioid analgesics were administered preoperatively by 22.3%, intraoperatively by 86.1% and postoperatively by 73.0% of the respondents. For chronic pain management, 76.7% of the respondents prescribed oral dipyrone in combination with other nonopioid analgesics; 19.9% used dipyrone as sole nonopioid, whereas 2.9% denied its use. Cases of dipyrone-associated agranulocytosis were observed by 3.5% of the respondents of the acute and 1.5% of the chronic pain questionnaire, respectively. The majority of respondents (acute pain: 73.0%, chronic pain 59.3%) performed no blood cell counts to monitor dipyrone therapy. Patients were rarely informed about possible adverse drug reactions. CONCLUSIONS Dipyrone is the preferred nonopioid analgesic in the perioperative and chronic pain setting. Although cases of agranulocytosis occur, benefits apparently outweigh the risks according to anaesthesiologists. Measures like patient information may improve safety. SIGNIFICANCE A survey of anaesthesiologist in German-speaking countries revealed dipyrone as preferred nonopioid analgesic for the treatment of acute and chronic pain. Benefits seem to outweigh the risks, specifically the risk of agranulocytosis. Information of medical staff and patients on adverse drug reactions and symptoms of agranulocytosis should be implemented.
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Affiliation(s)
- L Reist
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - J Erlenwein
- Pain Clinic, Department of Anaesthesiology, University Medical Center Goettingen, Georg-August-University of Goettingen, Goettingen, Germany
| | - W Meissner
- Department of Anaesthesiology, University Hospital, Jena, Germany
| | - T Stammschulte
- Drug Commission of the German Medical Association, Berlin, Germany
| | - F Stüber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - U M Stamer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
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Zhang L, Stuber F, Lippuner C, Schiff M, Stamer UM. Phorbol-12-myristate-13-acetate induces nociceptin in human Mono Mac 6 cells via multiple transduction signalling pathways. Br J Anaesth 2016; 117:250-7. [PMID: 27307289 DOI: 10.1093/bja/aew063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND Nociceptin in the peripheral circulation has been proposed to have an immunoregulatory role with regards to inflammation and pain. However, the mechanisms involved in its regulation are still not clear. The aim of this study was to investigate signalling pathways contributing to the regulation of the expression of nociceptin under inflammatory conditions. METHODS Mono Mac 6 cells (MM6) were cultured with or without phorbol-12-myristate-13-acetate (PMA). Prepronociceptin (ppNOC) mRNA was detected by RT-qPCR and extracellular nociceptin by fluorescent-enzyme immunoassay. Intracellular nociceptin and phosphorylated kinases were measured using flow cytometry. To evaluate the contribution of various signalling pathways to the regulation of ppNOC mRNA and nociceptin protein, cells were pre-treated with specific kinase inhibitors before co-culturing with PMA. RESULTS ppNOC mRNA was expressed in untreated MM6 at low concentrations. Exposure of cells to PMA upregulated ppNOC after nine h compared with controls without PMA (median normalized ratio with IQR: 0.18 (0.15-0.26) vs. 0 (0-0.02), P<0.01). Inhibition of mitogen-activated protein kinases specific for signal transduction reversed the PMA effects (all P<0.001). Induction of nociceptin protein concentrations in PMA stimulated MM6 was prevented predominantly by identity of ERK inhibitor (P<0.05). CONCLUSIONS Upregulation of nociceptin expression by PMA in MM6 cells involves several pathways. Underlying mechanisms involved in nociceptin expression may lead to new insights in the treatment of pain and inflammatory diseases.
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Affiliation(s)
- L Zhang
- Department of Anaesthesiology and Pain Medicine, Inselspital and Department of Clinical Research, University of Bern, Bern, Switzerland
| | - F Stuber
- Department of Anaesthesiology and Pain Medicine, Inselspital and Department of Clinical Research, University of Bern, Bern, Switzerland
| | - C Lippuner
- Department of Anaesthesiology and Pain Medicine, Inselspital and Department of Clinical Research, University of Bern, Bern, Switzerland
| | - M Schiff
- Department of Anaesthesiology and Pain Medicine, Inselspital and Department of Clinical Research, University of Bern, Bern, Switzerland
| | - U M Stamer
- Department of Anaesthesiology and Pain Medicine, Inselspital and Department of Clinical Research, University of Bern, Bern, Switzerland
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8
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Erlenwein J, Koschwitz R, Pauli-Magnus D, Quintel M, Meißner W, Petzke F, Stamer UM. A follow-up on Acute Pain Services in Germany compared to international survey data. Eur J Pain 2015; 20:874-83. [PMID: 26517182 DOI: 10.1002/ejp.812] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND After the introduction of instruments for benchmarking, certification and a national guideline for acute pain management, the aim of this study was to describe the current structure, processes and quality of German acute pain services (APS). METHODS All directors of German departments of anaesthesiology were invited to complete a postal questionnaire on structures und processes of acute pain management. The survey asked for staff, techniques and quality criteria, which enabled a comparison to previous data from 1999 and surveys from other countries. RESULTS Four hundred and eight (46%) questionnaires were returned. APS have increased considerably and are now available in 81% of the hospitals, mainly anaesthesia based. However, only 45% fulfilled the minimum quality criteria, such as the assignment of personnel, the organization of patient care during nights and weekends, written protocols for postoperative pain management, regular assessments and documenting pain scores. Staff resources varied considerably, but increased compared to 1999. Two daily rounds were performed in 71%, either by physicians and nurses (42%), by physicians only (25%) or by supervised nurses (31%). Most personnel assigned to the APS shared this work along with other duties. Only 53% of the hospitals had an integrated rotation for training their specialty trainees. CONCLUSIONS The availability of APS in Germany and other countries has increased over the last decade; however, the quality of nearly half of the APS is questionable. Against the disillusioning background of recently reported unfavourable pain-related patient outcomes, the structures, organization and quality of APS should be revisited.
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Affiliation(s)
- J Erlenwein
- Clinic for Anaesthesiology, Centre for Anaesthesiology, Emergency Medicine and Intensive Care Medicine, University Medical Centre, Georg-August-University of Göttingen, Germany.,Section 'Acute Pain', German Pain Society, Berlin, Germany.,Section 'Pain Medicine', German Society for Anaesthesiology and Intensive Care, Nürnberg, Germany
| | - R Koschwitz
- Clinic for Anaesthesiology, Centre for Anaesthesiology, Emergency Medicine and Intensive Care Medicine, University Medical Centre, Georg-August-University of Göttingen, Germany
| | - D Pauli-Magnus
- Section 'Acute Pain', German Pain Society, Berlin, Germany.,Department of Anaesthesiology, Pain Medicine, Intensive Care and Emergency Medicine, DRK Hospital Berlin Westend, Germany
| | - M Quintel
- Clinic for Anaesthesiology, Centre for Anaesthesiology, Emergency Medicine and Intensive Care Medicine, University Medical Centre, Georg-August-University of Göttingen, Germany
| | - W Meißner
- Section 'Acute Pain', German Pain Society, Berlin, Germany.,Section 'Pain Medicine', German Society for Anaesthesiology and Intensive Care, Nürnberg, Germany.,Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Germany
| | - F Petzke
- Clinic for Anaesthesiology, Centre for Anaesthesiology, Emergency Medicine and Intensive Care Medicine, University Medical Centre, Georg-August-University of Göttingen, Germany.,Section 'Pain Medicine', German Society for Anaesthesiology and Intensive Care, Nürnberg, Germany
| | - U M Stamer
- Section 'Acute Pain', German Pain Society, Berlin, Germany.,Section 'Pain Medicine', German Society for Anaesthesiology and Intensive Care, Nürnberg, Germany.,Department of Anaesthesiology and Pain Medicine, Inselspital, Bern, Switzerland.,Department of Clinical Research, University of Bern, Switzerland
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Barann M, Stamer UM, Lyutenska M, Stüber F, Bönisch H, Urban B. Effects of opioids on human serotonin transporters. Naunyn Schmiedebergs Arch Pharmacol 2014; 388:43-9. [PMID: 25332055 DOI: 10.1007/s00210-014-1056-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/06/2014] [Indexed: 12/25/2022]
Abstract
The serotonin (5-hydroxtryptamine, 5-HT) system plays a role in analgesia and emesis. The aim of this study was to test whether opioids or ketamine inhibit the human 5-HT transporter and whether this increases free plasma 5-HT concentrations. HEK293 cells, stably transfected with the human 5-HT transporter cDNA, were incubated with morphine, hydromorphone, fentanyl, alfentanil, pethidine (meperidine), tramadol, ketamine, and the reference substance citalopram (specific 5-HT transporter inhibitor). The uptake of [(3)H]5-HT was measured by liquid scintillation counting. In a second series of experiments, study drugs were incubated with plasma of ten healthy blood donors and change of 5-HT plasma-concentrations were measured (ELISA). The end point was the inhibition of the 5-HT transporter by different analgesics either in HEK293 cells or in human platelets ex vivo. Tramadol, pethidine, and ketamine suppressed [(3)H]5-HT uptake dose-dependently with an IC50 of 1, 20.9, and 230 μM, respectively. These drugs also prevented 5-HT uptake in platelets with an increase in free plasma 5-HT. Free 5-HT concentrations in human plasma were increased by citalopram 1 μM, tramadol 20 μM, pethidine 30 μM, and ketamine 100 μM to 280 [248/312]%, 269 [188/349]%, and 149 [122/174]%, respectively, compared to controls without any co-incubation (means [95 % CI]; all p < 0.005). No change in both experimental settings was observed for the other opioids. Tramadol and pethidine inhibited the 5-HT transporter in HEK293 cells and platelets. This inhibition may contribute to serotonergic effects when these opioids are given in combination, e.g., with monoamine oxidase inhibitors or selective serotonin reuptake inhibitors.
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Affiliation(s)
- M Barann
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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Stamer UM, Stuber F, Wiese R, Wulf H, Meuser T. Contraindications to regional anaesthesia in obstetrics: a survey of German practice. Int J Obstet Anesth 2007; 16:328-35. [PMID: 17698339 DOI: 10.1016/j.ijoa.2007.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 01/01/2007] [Accepted: 05/01/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed current practice regarding indications and contraindications to regional analgesia and anaesthesia for labour and delivery in Germany. METHODS Questionnaires were mailed to the directors of 918 German departments of anaesthesiology. RESULTS A total of 397 completed replies were received representing 41.3% of all deliveries in Germany. More than half of the respondents never perform spinal or epidural anaesthesia when the platelet count falls below 65x10(9)/L. Preeclampsia, which was not graded for severity, was considered an absolute contraindication to regional block by 15% and placenta praevia by 30% of respondents. If a woman had taken aspirin three days before, the numbers of respondents considering epidural anaesthesia contraindicated (40.2%) were nearly double those considering spinal anaesthesia contraindicated (21.7%) (P<0.001). For a platelet count of 79x10(9)/L, epidural anaesthesia was thought to be contraindicated by 37% and spinal anaesthesia by 22.2% (P=0.001). In departments with <500 deliveries/year, reluctance to use regional blockade was more pronounced than in departments with >1000 deliveries/year. CONCLUSION Clinical practice varies considerably in Germany. Concerns regarding the use of regional blockade were more prevalent in hospitals with small delivery units. Indications and contraindications are not consistent in Germany and some recommendations or guidelines are needed.
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Germany.
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Abstract
The present review addresses common and rare, but potentially severe complications of obstetric anaesthesia. Although several recent randomized and controlled studies on the prevention of spinal hypotension have been reported, the incidence of neurological complications caused by neuraxial blocks is estimated primarily from the results of retrospective investigations and case reports. In order to avoid potential risks in obstetrics, however, vigilance and close monitoring of the patient are critical. The adoption of published recommendations (e.g. those regarding regional techniques and coagulopathy, and difficult airway management) may help to improve the outcome for mother and child.
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
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Stamer UM, Musshoff F, Kobilay M, Madea B, Hoeft A, Stuber F. Concentrations of tramadol and O-desmethyltramadol enantiomers in different CYP2D6 genotypes. Clin Pharmacol Ther 2007; 82:41-7. [PMID: 17361124 DOI: 10.1038/sj.clpt.6100152] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The influence of CYP2D6 genotype and CYP2D6 inhibitors on enantiomeric plasma levels of tramadol and O-desmethyltramadol as well as response to tramadol was investigated. One hundred and seventy-four patients received one hundred intravenous tramadol 3 mg/kg for postoperative analgesia. Blood samples drawn 30, 90, and 180 min after administration were analyzed for plasma concentrations of the enantiomers (+)-, (-)tramadol and (+)-, (-)O-desmethyltramadol by liquid chromatography-tandem mass spectrometry. Different CYP2D6 genotypes displaying zero (poor metabolizer (PM)), one (heterozygous individual (HZ)/intermediate metabolizer (IM)), two extensive metabolizer (EM), and three (ultra rapid metabolizer (UM)) active genes were compared. Concentrations of O-desmethyltramadol differed in the four genotype groups. Median (1/3 quartile) area under the concentration-time curves for (+)O-desmethyltramadol were 0 (0/11.4), 38.6 (15.9/75.3), 66.5 (17.1/118.4), and 149.7 (35.4/235.4) ng x h/ml for PMs, HZ/IMs, EMs, and UMs (P<0.001). Comedication with CYP2D6 inhibitors decreased (+) O-desmethyltramadol concentrations (P<0.01). In PMs, non-response rates to tramadol treatment increased fourfold compared with the other genotypes (P<0.001). In conclusion, CYP2D6 genotype determined concentrations of O-desmethyltramadol enantiomers and influenced efficacy of tramadol treatment.
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MESH Headings
- Adult
- Aged
- Analgesia, Patient-Controlled
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/blood
- Analgesics, Opioid/pharmacokinetics
- Analgesics, Opioid/therapeutic use
- Chromatography, High Pressure Liquid
- Cytochrome P-450 CYP2D6/genetics
- Cytochrome P-450 CYP2D6/metabolism
- Cytochrome P-450 CYP2D6 Inhibitors
- Drug Interactions
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- Female
- Genotype
- Humans
- Infusions, Intravenous
- Injections, Intravenous
- Male
- Middle Aged
- Pain Measurement
- Pain, Postoperative/prevention & control
- Phenotype
- Polymorphism, Single Nucleotide
- Stereoisomerism
- Tandem Mass Spectrometry
- Tramadol/administration & dosage
- Tramadol/analogs & derivatives
- Tramadol/blood
- Tramadol/pharmacokinetics
- Tramadol/therapeutic use
- Treatment Outcome
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Affiliation(s)
- U M Stamer
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
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14
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Abstract
BACKGROUND Initial data from 1996 revealed that in contrast to several other countries general anaesthesia was the preferred anaesthetic technique for Caesarean section in Germany. However, anaesthetic practice for Caesarean section has changed during the last decades world-wide. This investigation was performed to obtain more actual data on anaesthetic procedures in obstetric patients in German hospitals. METHODS Questionnaires on the practice of anaesthesia for Caesarean section were mailed to 918 German departments of anaesthesiology. Furthermore, the survey evaluated severe perioperative complications in obstetric patients. RESULTS The 397 completed replies in this survey represent 41.3% of all German deliveries in 2002. Spinal anaesthesia is now the most common technique (50.5%) for elective Caesarean section. In case of urgent and emergency Caesarean, delivery figures decrease to 34.6% and 4.8%, respectively. Epidural anaesthesia is performed in 21.6% of scheduled and 13.2% and 1.0% of non-scheduled urgent or emergency Caesarean sections, respectively. Four maternal deaths and several non-fatal episodes of gastric content aspiration were reported by the respondents. CONCLUSIONS Compared to data obtained 6 years ago a significant increase in regional anaesthesia for Caesarean section has developed, with spinal anaesthesia being the preferred technique. Surveys can help to initiate discussion and improve current practice of anaesthetic care.
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MESH Headings
- Analysis of Variance
- Anesthesia, Epidural/adverse effects
- Anesthesia, Epidural/statistics & numerical data
- Anesthesia, General/adverse effects
- Anesthesia, General/statistics & numerical data
- Anesthesia, Obstetrical/adverse effects
- Anesthesia, Obstetrical/methods
- Anesthesia, Obstetrical/statistics & numerical data
- Anesthesia, Spinal/adverse effects
- Anesthesia, Spinal/statistics & numerical data
- Cesarean Section/methods
- Drug Therapy, Combination
- Female
- Germany
- Health Care Surveys
- Humans
- Pneumonia, Aspiration/prevention & control
- Pregnancy
- Surveys and Questionnaires
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
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Stamer UM, Höthker F, Lehnen K, Stüber F. [Postoperative analgesia with tramadol and metamizol. Continual infusion versus patient controlled analgesia]. Anaesthesist 2003; 52:33-41. [PMID: 12577163 DOI: 10.1007/s00101-002-0427-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The study compares the i.v. analgesia of tramadol and dipyrone delivered either as continuous infusion or as patient controlled analgesia (PCA). METHODS After approval by the local ethics committee and informed consent 203 patients recovering from abdominal surgery were randomly assigned to pain treatment either by PCA or continuous intravenous infusion. Both groups received the same analgesic drug combination of tramadol (20 mg/ml) and dipyrone (200 mg/ml). The PCA bolus was set to 1 ml, the continuous infusion varied between 0-8 ml/h according to individual needs. Demographic and surgery related data were compared between the treatment groups, as well as pain scores, analgesic consumption and response rates over a 48 hour study period.A patient was assessed as non responder when rescue medication was necessary during the study period or the patient rated analgesia as insufficient during the final interview. RESULTS In total,data of 191 patients (infusion-group: 94, PCA-group: 97) could be analyzed. Tramadol consumption was higher in the infusion group compared to the PCA-group (48 hours: 1009.4+/-494.4 vs. 813.0+/-585.3 mg;p<0.001) with no difference in pain scores. In the infusion group, significantly more interventions were necessary to adjust the infusion rate to individual needs (min-max: 1-15 vs. 0-2). The number of non responders amounted to 30 (31.9%) and 18 (18.6%;p=0.03) in the infusion and PCA group, respectively. CONCLUSIONS PCA with tramadol and dipyrone can be considered an alternative for postoperative pain management and provided a more individualized treatment approach with lower analgesic consumption and more responders compared to a continuous infusion.
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Affiliation(s)
- U M Stamer
- Klinik und Poliklinik für Anästhesiologie und spezielle Intensivmedizin, Rheinische Friedrich-Wilhelms-Universität Bonn.
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Stamer UM, Buderus S, Wetegrove S, Lentze MJ, Stüber F. Prolonged awakening and pulmonary edema after general anesthesia and naphazoline application in an infant. Anesth Analg 2001; 93:1162-4, table of contents. [PMID: 11682387 DOI: 10.1097/00000539-200111000-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPLICATIONS Naphazoline intoxication by intrabronchial overdose caused prolonged unconsciousness of an 18-mo-old child after general anesthesia for tracheal rigid bronchoscopy. The leading symptoms were side effects involving the cardiovascular, pulmonary, and central nervous systems. Intensive care unit admission with the need for mechanical ventilation was necessary. Recovery was uneventful.
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Affiliation(s)
- U M Stamer
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
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Stamer UM, Shu Q, Hoeft A, Stüber F. The influence of endotoxin on the expression of the ORL-1 receptor. Crit Care 2001. [PMCID: PMC3333258 DOI: 10.1186/cc1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
STUDY OBJECTIVE To examine the availability of specialized equipment for the difficult airway management in obstetric units of German departments of anesthesiology. DESIGN AND SETTING An anonymous questionnaire survey was mailed to the directors of 993 German departments of anesthesiology. Completed replies were grouped by number of deliveries performed each year. MAIN RESULTS 55.5% of the hospitals responded. Data of 449 answers were evaluated for this investigation. A difficult airway cart was available in 99.3% of the departments. More detailed investigation revealed that different shaped laryngoscope blades (74.9% of the departments), laryngeal masks (91.0%), a fiberoptic bronchoscope (85.9%), and transtracheal puncture devices (59.9%) were available in the majority of the units. However, only a minority of the departments had these devices directly available in their obstetric operating rooms (OR; laryngeal masks 36.2%, fiberoptic bronchoscope 23.9%, transtracheal puncture set 22.0%). Larger units with more than 1,000 deliveries per year provided their equipment more often directly in the obstetric OR or the facility housing the obstetric unit than did smaller units with less than 1,000 deliveries per year (p< 0.001). CONCLUSIONS The survey of German departments of anesthesia revealed that specialized equipment for the difficult airway management often is not directly available in the obstetric OR. Anesthesiologists must familiarize themselves as to which difficult airway equipment is available in their unit and where it is stored.
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Affiliation(s)
- U M Stamer
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Germany.
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20
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Abstract
Regional anaesthetic techniques in obstetrics have gained more and more importance during the last few years. Several surveys published recently show a remarkable increase in caesarean sections performed under regional anaesthesia, in many countries. Furthermore, epidural analgesia has proved to be one of the most effective methods of pain relief during vaginal delivery. Especially in patients at risk of an abdominal delivery, an epidural catheter already in place during labour can be used for consecutive caesarean section without delay and is used as a strong argument in favour of epidural anaesthesia. This article gives an overview of recent surveys of regional anaesthesia in obstetrics.
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
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22
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Abstract
Epidural analgesia is one of the preferred methods of analgesia for labour. The aim of the present survey was to evaluate current practice in obstetric analgesia in departments of anaesthesia and to make a comparison with former surveys from Germany and other countries. Questionnaires on the practice of pain relief, especially epidural analgesia, during labour and delivery were sent to 1178 anaesthetic departments in Germany in the second half of 1996. Five hundred and thirty-two completed replies were received, which represent 46.9% of all German obstetric units. The majority of the departments of anaesthesia practising epidural analgesia have an epidural rate of less than 10% and 10.2% of the departments do not offer this method to their parturients. In 86.8% of all units performing epidural analgesia, the epidural catheter is placed by an anaesthetist. Only 6.5% of the units provide a 24-h epidural service which is exclusively assigned to labour and delivery. In 77.8% of the units, this service is not exclusively assigned to obstetrics, but also to other duties. Of the obstetric units offering epidural analgesia, 14.7% have no epidural service at night. Plain local anaesthetics for epidural analgesia are used by 55.9% of the departments, a combination of local anaesthetics with epidural opioids by 28.7%. Epidural analgesia is predominantly (82.2%) maintained by intermittent bolus administration. Although the rate of epidural analgesia increased during recent decades, this method is not offered to all parturients. Further improvements in the use of epidural analgesia for labour seem to be necessary.
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Germany
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Abstract
The study compares responders and non-responders to post-operative patient-controlled analgesia (PCA) and evaluates factors that might differ between these two groups in order to identify non-responders during the early post-operative period. A prospective, randomized, double-blinded study design was used. Patients recovering from abdominal surgery were assigned to one of three treatment groups for a study period of 48 h. After titration of an individual loading dose, patients could self-administer 1 mL bolus doses (2 mg of morphine, 20 mg of tramadol or placebo) using a PCA device. Patients responding or not responding to the treatment were identified. In non-responders the escape medication was morphine. There were 96 responders and 65 non-responders. All responders showed similar pain scores, irrespective of the drug they received. Drug consumption of placebo responders was twice as high as that of opioid responders. Pain scores and analgesic consumption of non-responders were significantly higher compared with responders, although those patients received morphine. The loading dose correlated with subsequent analgesic consumption. Altogether, 89.2% of the non-responders were identified after the loading dose. Size of loading dose and pain scores during the first 30 min are useful for assessing the overall response to post-operative pain management. These factors may be valuable for predicting individual pain management.
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Kiel, Germany
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24
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Abstract
BACKGROUND Anaesthetic practice for caesarean section has changed during the last decades. There is a world-wide shift in obstetric anaesthetic practice in favour of regional anaesthesia. Current data concerning anaesthetic practice in patients undergoing caesarean section from Germany are not available. A comparison with figures from the UK, USA, Norway and other European countries might be of general interest. METHODS Questionnaires on the practice of anaesthesia for caesarean section and anaesthetic coverage of the obstetric units were sent to 1178 university, tertiary care, district, community and private hospitals in Germany. RESULTS The 532 completed replies of this survey represent 46.9% of the German obstetric units. Most hospitals (42.3%) have delivery rates between 500 and 1000 per year. General anaesthesia is the most common anaesthetic technique for elective (61%), urgent (83%) and emergency caesarean section (98%). Epidural anaesthesia is performed in 23% of scheduled and 5% of non-scheduled caesarean sections, and spinal anaesthesia in 14% and 10% respectively. Acid aspiration prophylaxis before elective caesarean section is used in 68.7% of the departments. The majority of the departments provide a 24-hour anaesthetic coverage; however, in only 6.2% of the units, this service is assigned to obstetric anaesthesia, exclusively. CONCLUSION Compared to data from 1978, anaesthetic practice for caesarean section has changed with an increase in regional anaesthesia. However, German anaesthetists prefer general anaesthesia for caesarean section. In contrast, anaesthetists in other countries predominantly use regional techniques, and the difference to German practice is striking. International consensus discussion and recommendations as well as comparable European instruments of quality control in obstetric anaesthesia are desirable.
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology, University of Bonn, Germany
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Stamer UM, Maier C, Grond S, Veh-Schmidt B, Klaschik E, Lehmann KA. Tramadol in the management of post-operative pain: a double-blind, placebo- and active drug-controlled study. Ugeskr Laeger 1997; 14:646-54. [PMID: 9466103 DOI: 10.1046/j.1365-2346.1994.00214.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A double-blind, randomized, placebo- and drug-controlled study in which the analgesic efficacy and safety of intravenous (i.v.) tramadol in patients with post-operative pain is reported. One hundred and eighty patients recovering from gynaecological or abdominal surgery were assigned to one of three treatment groups. After titration of an individual loading dose, patients could self-administer tramadol 20 mg, morphine 2 mg or placebo using a patient-controlled analgesia (PCA) device throughout a 48-h period. Criteria of efficacy were a decrease in pain intensity within the first 30 min of at least 20 on a visual analogue scale (VAS) (0 denotes no pain, 100 worst pain imaginable) and satisfactory analgesia in the patient's opinion during the study period. Patients treated with tramadol, morphine and placebo were assessed as responders at 66.7%, 75.0% and 18.3% (P < 0.0001). VAS after the initial bolus were 39.2 +/- 22.1, 35.9 +/- 21.6 and 50.0 +/- 24.2 (P = 0.002), the initial loading dose amounted to tramadol 144.9 +/- 51.2 mg, morphine 12.3 +/- 5.1 mg and placebo 17.2 +/- 4.9 mL. No serious opioid-related adverse events occurred in the patients given tramadol while two patients given morphine developed an impaired respiratory rate and a decreased oxygen saturation to 80% or less. Tramadol proved to be efficacious for PCA treatment of post-operative pain following gynaecological and abdominal surgery.
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Affiliation(s)
- U M Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Kiel, Schwanenweg, Germany
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