[Acute pain management in the elderly - Pharmaceutics and psychosocial approaches].

Post-operative pain management of elderly patients requires special attention. In addition to the organic functional impairments, age-related changes in psychological and social factors play an important role. Also life experiences, painful medical history and a range of different complaints of old age influence the expectations to the treatment of pain.

[Acute pain management after orthopaedic surgery].

Provision of sufficient post-operative pain therapy is an obligation in the clinical management of patients. A wide range of medical, technical and organizational options is used to improve post-operative pain management in orthopaedic surgery. Measurement of pain is as important as the correct use of analgesics and application techniques.

[Postoperative pain management. Application of an iontophoretic patient-activated transdermal system].

Intravenous patient-controlled analgesia (i.v. PCA) for parenteral postoperative pain control is considered standard therapy as patients can individually titrate the amount of analgesic as needed.

[Drugs for postoperative analgesia: routine and new aspects: Part 2: opioids, ketamine and gabapentinoids].

In part 1 of this review, perioperative aspects of the use of non-opioids (acetaminophene, dipyrone, traditional NSAR, coxibs) were discussed. In part 2 the perioperative aspects of opioids (weak opioids: tramadol, tilidine with naloxone, strong opioids: morphine, piritramide, oxycodone, hydromorphone, fentanyl, methadone, buprenorphine) and coanalgesics (gabapentinoids; ketamine) will now be presented. The main aim of the review is to describe the use, risks and cost of some substances to facilitate the differential indication.

[Drugs for postoperative analgesia: routine and new aspects. Part 1: non-opioids].

In part 1 of this review the perioperative aspects of the use of non-opioids (acetaminophen, dipyrone, traditional NSAR, coxibs) and in part 2 of opioids (weak opioids: tramadol, tilidine with naloxone, strong opioids: morphine, piritramide, oxycodone, hydromorphone, fentanyl, methadone, buprenorphine) and coanalgesics (gabapentinoids, ketamine) will be discussed. The main aim is to describe the relationship between analgesic efficacy and side effects to make clinical decisions easier in patients with preoperative renal, gastrointestinal, cardiovascular and other diseases. Some new aspects concerning perioperative administration of gabapentinoids and ketamine in patients with perioperative neuropathic pain are discussed.

Intraoperative tramadol reduces shivering but not pain after remifentanil-isoflurane general anaesthesia. A placebo-controlled, double-blind trial.

Background And Objective: Postoperative shivering and pain are frequent problems in patients recovering from anaesthesia with particularly high incidences being observed after remifentanil-isoflurane-based general anaesthesia. The opioid tramadol is generally effective in preventing shivering and treating pain, but its effects are not characterized after remifentanil-based general anaesthesia. This randomized, placebo-controlled, double-blind study evaluated the effects of intraoperative intravenous tramadol on postoperative shivering and pain after remifentanil-based general anaesthesia.

Management of incomplete regional anaesthesia in Germany: results of a nation-wide survey.

Background: Regional anaesthesia (RA) provides well-defined benefits with known attendant risks. However, incomplete blockade may introduce unanticipated risks depending on the compensatory measures employed. Until now, no data were available characterizing the pattern of response of German anaesthesiologists in this situation.

Epidural ropivacaine -- where are the benefits? A prospective, randomized, double-blind trial in patients with retropubic prostatectomy.

Background: In comparison with bupivacaine, ropivacaine exhibits comparable anaesthetic effects but with less motor impairment and systemic toxicity. However, the analgesic potency may differ. For example, ropivacaine during obstetric epidural analgesia provides an approximately 40% lower analgesic potency than bupivacaine.

[Standardised postoperative analgesic system in orthopaedic surgery].

In order to treat patients with postoperative acute pain effectively, we have developed a standardised algorithm for analgesia. This process includes three levels and the appropriate supply of medication. The therapy level is defined based on the scale of the operation.

[Anesthesia and analgesia in addicts: basis for establishing a standard operating procedure].

Addicts have an exaggerated organic and psychological comorbidity and in cases of major operations or polytrauma they are classified as high-risk patients. Additional perioperative problems are a higher analgetics requirement, craving, physical and/or psychological withdrawal symptoms, hyperalgesia and tolerance. However, the clinical expression depends on the substance abused.

Current practice in regional anaesthesia in Germany.

Background And Objective: Several new techniques and agents (e.g. ropivacaine) have been introduced in regional anaesthesia to improve patients outcome and safety.

[Post-operative pain management in orthopaedic surgery and traumatology].

Provision of sufficient post-operative pain therapy is an obligation in the clinical management of patients. A wide range of medical, technical and organizational options is used to improve post-operative pain management in orthopaedic surgery. Measurement of pain is as important as the correct use of analgesics and application techniques.

[Risk factors for substance abuse and dependence in opioid therapy for chronic noncancer-related pain].

Opioids are valuable analgesics, capable of providing pain relief and functional improvement not only in patients with cancer-related pain, but also in chronic noncancer-related pain patients. However, recent data have shown that the increasing prescription of opioids is associated with a rise in aberrant drug-related behaviour. The causes of this behaviour are multifactorial.

Efficacy of vertical infraclavicular plexus block vs. modified axillary plexus block: a prospective, randomized, observer-blinded study.

Background: Despite containing severe risks, infraclavicular approaches to the brachial plexus gained increasing popularity. Likewise, the vertical infraclavicular plexus block improved anesthesia compared to the standard axillary approach but contains the risk of pneumothorax. Therefore we modified the standard axillary technique by inserting a proximal directed catheter, referred to as a high axillary plexus block.

[Pain assessment in invasive diagnostic procedures. Comparison of an eleven-point numerical rating scale and a six-point verbal rating scale for pain measurement in bone marrow puncture].

Background And Objective: Pain measurement during diagnostic procedures is an accepted prerequisite for appropriate therapy. In this study, the agreement between rankings of pain intensity on a numerical and a verbal rating scale was analyzed.

Methods: Patients attending a haematological outpatient clinic who underwent bone marrow puncture were requested to assess pain intensity perceived during the procedure on a elen-point numerical and a six-point verbal rating scale.

Opioid tolerance and dependence -- do they matter?

The use of opioids has long been accepted as the standard of care in patients with cancer and acute pain. Opioids can further be used effectively in specific subgroups of patients with chronic nonmalignant pain states. While the development of tolerance and physical dependence are known effects of opioids in cancer and noncancer pain populations, these patients can not be regarded as addicted.

[Cancer pain therapy and palliative medicine. Concepts and results of a project at the cancer center of Rhineland-Palatinate from 1995-2001].

The cancer center of Rhineland-Palatinate conducted the project "Cancer Pain Therapy and Palliative Medicine" from 1995 to 2001. Questionnaires were circulated among physicians in Rhineland-Palatinate in 1995 and 1998. Positive changes were registered with regard to attitudes toward highly potent opioids and cooperation with outpatient hospice services.

[Results of extracorporeal shock-wave application in lateral elbow tendopathy].

Aim: This review article focuses on a possible pain-alleviating effect of shock-wave application in persistent lateral epicondylopathy of the elbow and compares the effects with data on other non-operative and operative procedures.

Methods: Patients who suffered from chronic tennis elbow for more than 12 months and were therefore referred for a surgical procedure were assigned at random to two groups of low-energy shock-wave therapy. Group I received a total of 3000 (3 x 1000) impulses of 0.

The treatment of pain in urology.

Contemporary medicine is characterized by sophisticated specialization of the individual physician. The specialist in urological surgery may undertake one of the most important and primary medical tasks, the mitigation and therapy of pain. This review aims to provide an overview of the concepts of pain therapy in urology.

[Postoperative morphine excess or rational therapy? An exceptional case of applying the morphine equivalent].

Unlabelled: We report on a 51-year-old female with a 7 year history of breast cancer. In August 2000 surgical replacement of the 8th thoracic vertebra was performed. From November 2000 the patient developed progressive pain, due to additional spine metastases, leading to pain therapy (according to the patient record) as follows: MST 320 mg oral 4 times daily, Durogesic 100 micrograms/h transdermal, Sevredol 40 mg oral 3 times daily and Ibuprofen 800 mg oral 3 times daily.

Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery.

Background: Ketorolac is approved for the relief of postoperative pain but concerns have been raised over a possible risk of serious adverse effects and death. Two regulatory reviews in Europe on the safety of ketorolac found the data were inconclusive and lacked comparison with other non-steroidal anti-inflammatory drugs. The aim of this study was to compare the risk of serious adverse effects with ketorolac vs diclofenac or ketoprofen in adult patients after elective major surgery.

Postoperative pain therapy after lumbar disc surgery.

Object: This study was undertaken to determine whether a special postoperative pain administration of tramadol and diclofenac provides any benefits in patients who underwent microsurgical lumbar discectomy.

Methods: The study consisted of 60 patients undergoing microsurgical lumbar discectomy. Patients were randomly divided into two groups based on the postoperative pain management: 1) Group A (n = 30); no standardized pain therapy; these patients received on demand different analgesics and at variable dosages which were selected by the neurosurgeons; 2) Group B (n = 30); standardized pain therapy with specific dosages of tramadol and diclofenac in regular time intervals during the first 48 hours after surgery.

[Opioids in pain therapy].

In this article were described opioids with different analgesic efficacy, their dosage, application, elimination and side effects. On the basis of WHO step ladder rules are opioids important analgesic substances not only for cancer related pain therapy, but also for some well defined non cancer related pain therapy.