The purpose of this study was to investigate the effect of different pain-relief methods (regional and systemic) following thoracotomies on the cardiovascular system, pulmonary gas exchange, various endocrine parameters and subjective perception. A further aspect was to evaluate the benefits of interpleural analgesia as a new regional technique against already established regional techniques, such as intercostal nerve block and thoracic epidural block. All postoperative pain methods led to a significant time-dependent reduction of the adrenaline concentrations in plasma while the noradrenaline concentrations did not change significantly. There were no statistical differences in catecholamine concentrations among the different study groups, although the mean concentrations of adrenaline in patients having a thoracic epidural block for pain relief were lower in comparison to the findings in other groups. The plasma concentrations of the "stress metabolites", such as glucose, free fatty acids and lactate, as well as the haemodynamic (mean arterial pressure, heart rate) and pulmonary parameters (blood gas analyses), showed no significant differences among groups. In contrast to the other pain-relieving methods, interpleural analgesia did not lead to sufficient pain relief in that 7 out of 10 patients needed supplementary systemic opioid therapy. Therefore, interpleural analgesia for pain relief following thoracotomies cannot be recommended.
During spinal anesthesia for elective hip joint replacement, norepinephrine concentrations were greater in plasma than in CSF. CSF dopamine and epinephrine concentrations were essentially undetectable. The changes in CSF-norepinephrine concentrations and the changes of plasma norepinephrine concentrations showed no association with each other; nor were there correlations between clinical stress parameters (HR, MAP) or visual analog scale pain, and the changes in CSF norepinephrine concentrations.
The use of a regional anaesthesia technique or one involving intravenous anaesthesia in combination with the laryngeal mask airway may lead to a reduction in discharge time compared with a balanced anaesthesia technique with endotracheal intubation. Thus, improved use of resources may be achieved.
Autologous platelet gel (APG) was developed in the early 1970s as a byproduct
of the so-called multi-component apheresis. APG is a matrix
composed of fibrin and platelets, and was initially used as a wound sealing.
Due to the effects of both thrombin and calcium, the platelets aggregates,
resulting in a release of several growth factors. There is clinical
evidence that the growth factors released enhance wound healing by
stimulating tissue vascularity due to an increased rate of angiogenesis.
Apart from that, APG acts hemostatic and causes a lymphatic sealing.
This effect leads to less seroma and thus to less pain postoperatively.
The intraoperative production of APG for local application and as source
of growth factors which serves as promoters of wound healing is part of
the perioperative autologous hemotherapy and has to meet the legal
regulations in Germany. The 12th amendment of the German Drug Law
and the latest revision of the German Transfusion Act have aggravated
the legal requirements for the production and application of autologous
blood products. It is predominant regarding the legal question whether
or not one has to account those procedures as drug production in accordance
to the German Drug Law. If one has to account, it is quite obvious
that most of the German hospitals cannot meet the legal requirements
of an intraoperative drug production. Because the German legislator has
so far not defined a clear legal frame for novel perioperative autologous
blood products, this could lead to the end of use of those techniques in
our clinical routine. Thus, leading to the situation that no ‘evidence class
1 study’ will be conducted in order to investigate safety and efficacy of
these novel procedures. The concept of the ‘near patient unit’ is new
and therefore clinically not yet established. For perioperative autologous
hemotherapy this concept defines the minimum legal requirements for
a safe production and application of autologous blood products, outside
of the scope of both, the German Drug Law and the German Transfusion
Act, but still in accordance with the most recent guidelines on hemotherapy,
as published by the Federal Medical Association (Bundesärztekammer).
The legal end points are: no distribution to a third
party, a strict personal identity for the production and application, exertion
only by qualified persons, and an immediate connection to the
planned operation as part of the method. The German legislator should
modify both, the German Drug Law and German Transfusion Act in a
way, to provide a legal certainty for the use of the perioperative hemotherapy.
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