Beurteilung von Schmerzempfinden und Sedierungsgrad bei beatmeten Neugeborenen und Säuglingen: Validierung eines Schmerz- und Sedierungs-Scores (Hartwig-Score)

Hünseler, C; Merkt, V; Gerloff, M; Eifinger, Frank; Kribs, A; Roth, B

doi:10.1055/s-2006-946511

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“…The inefficacy of piritramide was assigned by pain scores or by the personal impression of the physician in charge. Both of the pain scores we used are validated to measure pain and showed excellent correlation with the Toddler-Preschooler Postoperative Pain Scale (TPPS) [7], the COMFORT score, and the visual analog scale in respect to pain (Hartwig score) [11] in ventilated infants. A suitable and better comparable solution to determine the indication for the administration of a specified rescue medication (e.g., fentanyl) would have been to rely exclusively on the pain scores.…”

Section: Discussionmentioning

confidence: 96%

“…In defined time intervals of 15, 45, 60, 90, 120, 180, 240, 300, 360, 540, and 720 min after the bolus dose of piritramide, a pain score was assessed and the transcutaneous oxygen saturation, respiratory rate, heart rate, and non-invasive blood pressure were documented in the case report file. To assess pain, two different pain scales were used: the Children's and Infant's Postoperative Pain Scale (CHIPPS) [7] for non-ventilated postsurgical infants and the pain score for ventilated children according to Hartwig scores [10,11] for the ventilated patients. A CHIPPS score of more than 3 points and a Hartwig score of more than 13 points were defined as pain with the necessity of pharmacological treatment.…”

Section: Methodsmentioning

confidence: 99%

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Prospective evaluation of the pharmacodynamics of piritramide in neonates and infants

et al. 2007

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Piritramide is a synthetic opioid commonly used in Germany and Austria for the analgesia of pediatric patients. Little pharmacokinetic and pharmacodynamic data for the pediatric population is available. The aim of this investigation was to gain pharmacodynamic data on postsurgical analgesia and the side effects of piritramide. The study was approved by the Ethics Committee of the Medical Faculty. Data were collected in an open, prospective clinical trial. After obtaining the parents' informed written consent, patients received a bolus of piritramide 50 mug/kg for postsurgical analgesia or to prevent pain resulting from invasive procedures. Titration doses of 15 microg/kg were allowed. Vital signs and pain intensity were closely monitored. Data from 39 patients could be included in the analysis. Of the patients, 95% were in the immediate postsurgical course, 5% had piritramide for invasive procedures, and 46% of the patients were ventilated. The mean piritramide dosage was 64 +/- 24 microg/kg. Pharmacodynamic analysis showed adequate analgesia for at least 50% of the spontaneously breathing patients for 120 min after piritramide bolus. More than 50% of the ventilated patients showed inadequate analgesia at any point in time after piritramide bolus. Fifty-nine percent (59%) of the ventilated patients received additive analgesia versus 31% of spontaneously breathing patients. No relevant changes of vital signs could be observed. One patient received naloxone for apnea. We conclude that dosages of more than 50-70 microg/kg are needed for sufficient analgesia in ventilated postsurgical infants. In spontaneously breathing patients, 50-70 microg/kg provides a 120-min period of analgesia for more than 50% of patients. Cardiovascular stability of the patients was good and, with one exception, there was no respiratory depression.

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Section: Discussionmentioning

confidence: 96%