Epidurale und intrathekale Anwendung von alpha2-Adrenozeptor-Agonisten zur postoperativen Analgesie

Rockemann, M.; Seeling, W.

doi:10.1007/s004820050022

Cited by 10 publications

(5 citation statements)

References 59 publications

(15 reference statements)

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“…The elimination half-life from the CSF is 80 min, from plasma 12 B 7 h. Clonidine is eliminated via the renal pathway. Therefore, in the event of renal insufficiency, a possible accumulation might be expected [4]. However, considering the low intrathecal doses necessary in our patient group, this would surely not be of any importance.…”

Section: Discussionmentioning

confidence: 96%

“…The dose must be adjusted individually. For an epidural administration, a bolus dose of 5-10 Ìg/kg is recommended followed by continuous infusion of 20-50 Ìg/h [4].…”

Section: Discussionmentioning

confidence: 99%

“…In those cases, it is administered orally, intravenously [1,12,13], intramuscularly, epidurally [1,[14][15][16] or intrathecally [17]. When applied epidurally and intrathecally, clonidine is also used in combination with opiates, a method which leads to dose reductions due to the synergistic antinociceptive effect of both [4,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…In 1904, Weber demonstrated in an animal experiment that the spinal transfer of pain is influenced via ·-receptors. Following the intrathecal administration of adrenaline he observed a segmental analgesia [2,4]. The first spinal anesthesia with adrenaline in human beings was performed in 1950 [5].…”

Section: Introductionmentioning

confidence: 99%

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Continuous Intrathecal Clonidine Administration for the Treatment of Neuropathic Pain

Uhle

Becker

Gatscher

et al. 2000

Stereotact Funct Neurosurg

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In many cases, the treatment of neuropathic pain by intrathecal opioids fails to meet expectations. In a trial involving 10 patients, the intrathecal administration of clonidine combined with opioids in the treatment of chronic pain was introduced in our department for the first time. Eight patients with neuropathic pain syndromes were subjected to a continuous intrathecal clonidine application in addition to intrathecal morphine. At an average dose of 44 µg clonidine/day, a 70–100% reduction in pain was achieved. Residual non-neuropathic pain in 4 of 8 patients was successfully treated with clonidine and low doses of opioids. On the basis of the results achieved so far, we recommend that clonidine should be routinely tested for intrathecal drug administration, especially in patients with a prominent neuropathic pain component.

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Section: Discussionmentioning

confidence: 96%

“…The dose must be adjusted individually. For an epidural administration, a bolus dose of 5-10 Ìg/kg is recommended followed by continuous infusion of 20-50 Ìg/h [4].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Continuous Intrathecal Clonidine Administration for the Treatment of Neuropathic Pain

Uhle

Becker

Gatscher

et al. 2000

Stereotact Funct Neurosurg

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“…[48]) nachweisen. Im direkten Vergleich zur PCA lassen sich Vorteile der epiduralen Analgesie bezüglich der Analgesiequalität (z.B.…”

Section: Vorteile: Bessere Analgesie Weniger Nebenwirkungenunclassified

Epidurale Analgesie in der Behandlung postoperativer Schmerzen

Wulf

1998

Der Anaesthesist

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This review highlights the advantages of regional anaesthesia techniques, especially of epidural analgesia, for the management of postoperative and posttraumatic pain: excellent pain relief and a high degree of patient satisfaction, even compared to the gold standard of acute pain therapy, i.v. PCA with opioids. Further advantages of epidural analgesia (EA) are discussed, such as early recovery of gastrointestinal function, reduction of postoperative respiratory complications, lower incidence of myocardial ischema, better mobilisation, reduced risk of thromboembolism, lower incidence of chronic pain problems (such as phantom limb pain) etc. Nevertheless, many studies failed to show significant effects on outcome (e.g. mortality). Weighing the risks, costs and benefits of EA, this technique is indicated in case of significant postoperative pain, especially in case of painful mobilisation, in patients with significant pulmonary risk factors (ASA 3 or IV), in patients where an improved perfusion or gastrointestinal motility is deemed essential, and if chronic pain syndromes are common problems that should be prevented (e.g., amputation). For the praxis of epidural analgesia it is emphasised to place the catheter in an appropriate segment to obtain sufficient analgesia without side effects. Organisational structures (such as an acute pain service) and appropriate monitoring allow to continue EA with local anaesthetics and/or opioids on surgical wards. Recommendations are given for the monitoring of EA on surgical wards. Clear cut agreements should define the role of anaesthesiologists, surgeons and nurses in the management of patients treated with postoperative EA on surgical wards.

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References

2004

Regional Nerve Blocks and Infiltration Therapy

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Epidurale und intrathekale Anwendung von alpha2-Adrenozeptor-Agonisten zur postoperativen Analgesie

Cited by 10 publications

References 59 publications

Continuous Intrathecal Clonidine Administration for the Treatment of Neuropathic Pain

Continuous Intrathecal Clonidine Administration for the Treatment of Neuropathic Pain

Epidurale Analgesie in der Behandlung postoperativer Schmerzen

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