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Intraoperative peridurale Opiatanalgesie

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Book cover Neue Aspekte in der Regionalanaesthesie 3

Zusammenfassung

Die Existenz von Opiatrezeptoren in der Substantia gelatinosa des Rüekenmarks ermöglieht eine regionale Sehmerzreduktion durch ruckenmarksnahe Opiatgabe [1]. Mikroiontophore- tische [31] und tierexperimentelle Untersuchungen [33] haben gezeigt, daß niedrige Opiatdosen zwar die späte nozizeptive Entladung in den Rückenmarkshinterhörnern blockieren (dumpfer Schmerz: = C-Fasern), eine Hemmung der frühen Entladung (heller Schmerz: Aδ-Fasern) aber nur durch hohe lokale Opiatkonzentrationen möglich ist. So werden chirurgische Eingriffe mit den bei anderen Indikationen (chronischer und postoperativer Schmerz) verwandten Opiatdosen nicht toleriert. Eine weitere Dosissteigerung ist jedoch beim spontan- atmenden Patienten durch unvorhersehbare Umverteilungsvorgänge über Liquor und Blut mit konsekutiven zentralen Begleiteffekten nicht vertretbar [18]. Im Rahmen einer intra- operativen Anwendung muß weiterhin beachtet werden, daß die synaptische Transmission dicker Afferenzen (Aα, Aβ) und damit das Tastgefühl unbeeinträchtigt bleiben. Auch ist eine Beeinflussung vegetativer Reaktionen umstritten, obwohl eine Reihe von Untersuchungen Hinweise für Effekte an der vegetativen Afferenz erbracht haben [7,14,22]. Die rückenmarksnahe Opiatgabe kann im Rahmen einer Allgemeinanaesthesie den Bedarf an Narkotika senken [7,17,30]. Zweckmäßig erscheint auch die Kombination von periduralen Opiaten und Lokalanaesthetika (2,11,12,15,19,20,26,30,31). Die dabei zu beobachtende gegenseitige Wirkungsverstärkung kann als Ausdruck der allgemeinen Fähigkeit der intrinsischen spinalen Modulationssysteme zur synergistischen Interaktion angesehen werden [32].

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Literatur

  1. Atweh SF, Kuhar MJ (1977) Autoradiographic localization of opiate receptors in rat brain, spinal cord and lower medulla. Brain Res 124: 53

    Article  PubMed  CAS  Google Scholar 

  2. Birkhan HJ, Rosenberg B, Simon K, Moskowitz B (1982) Epidural morphine. A new approach to postoperative analgesia in urologic surgery. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 37

    Google Scholar 

  3. Bonica JJ, Kennedy WF, Akamatsu TJ (1972) Circulatory effects of peridural block: III. Effects of acute blood loss. Anesthesiology 36: 219

    Article  PubMed  CAS  Google Scholar 

  4. von Bormann B, Weidler B, Dennhardt R, Frings N, Lennhartz H, Hempelmann G (im Druck) Plasma- ADH-Spiegel unter kombinierter Neuroleptanalgesie-peridurale Opiatanalgesie. Anaesthesist

    Google Scholar 

  5. Bromage PR, Shibita HR, Willoughby HW (1971) Influence of prolonged epidural blockade on blood sugar and Cortisol responses to operations upon the upper part of the abdomen and the thorax. Surg Gynecol Obstet 132: 1051

    PubMed  CAS  Google Scholar 

  6. Cosgrove DO, Jenkins JS (1974) The effects of epidural anaesthesia on the pituitary-adrenal response to surgery. Clin Sci Mol Med 46: 403

    PubMed  CAS  Google Scholar 

  7. Cousins MJ, Glynn CJ, Wilson PR, Mather LE, Graham JR (1979) Aspects of epidural morphine. Lancet 11: 584

    Google Scholar 

  8. De Castro J, D’Inverno E, Lecron L, Levy D, Toppet-Belatoni E (1980) Perspectives d’utilisation des morphinoides en anesthésie locorégionale. Anesth Analg Reanim 37: 17

    Google Scholar 

  9. Dirksen R, Nijhuis GMM (1980) Epidural opiate and perioperative analgesia. Acta Anaesth Scand 24: 367

    Article  PubMed  CAS  Google Scholar 

  10. Engquist A, Brandt MR, Fernandes A, Kehlet H (1977) The blocking effect of epidural analgesia on the adrenocortical and hyperglycaemic responses to surgery. Acta Anaesth Scand 21: 330

    Article  PubMed  CAS  Google Scholar 

  11. Handjis GP, Liolios A, Anagnostakos A, Vailas G, Tsantakis CE (1982) Epidural morphine for 24 hours of postoperative analgesia. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 47

    Google Scholar 

  12. Kawashima Y, Uchida N, Kawahira S, Meguro K, Nampo T, Fujita Y (1982) A step to complete pain relief after surgery. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 53

    Google Scholar 

  13. Krebs R (1978) Pharmakologie und Toxikologie der Lokalanästhetika. In: Ahnefeld FW, Bergmann H. Burri C, Dick W, Halmágyi M, Hossli G, Rügheimer E (Hrsg) Lokalanästhesie, Bd. 18, Klinische Anästhesiologie und Intensivtherapie. Springer, Berlin Heidelberg New York, p 32

    Google Scholar 

  14. Leslie J, Camporesi E, Urban B, Bromage P (1979) Selective epidural analgesia. Lancet II: 151

    Google Scholar 

  15. Manolescu R, Elian I, Lehmann JM (1982) Peridural bupivacain and morphine for residual pain after peripheral vascular surgery. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 58

    Google Scholar 

  16. Michiels M, Hendriks R, Heykants J (1977) A sensitive radioimmunoassay for fentanyl. Plasma levels in dogs and man. Eur J Clin Pharmacol 12: 153

    Article  PubMed  CAS  Google Scholar 

  17. Müller H, Börner U, Stoyanov M, Hempelmann G (1980) Intraoperative peridurale Opiatanalgesie. Anaesthesist 12: 656

    Google Scholar 

  18. Müller H, Börner U, Stoyanov M, Hempelmann G (1982) Theoretical aspects and practical considerations concerning selective opiate-analgesia. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 9

    Google Scholar 

  19. Müller H, Börner U, Stoyanov M, Hempelmann G (1982) The perioperative use of epidural opiates. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 67

    Google Scholar 

  20. Müller H, Stoyanov M, Börner U, Hempelmann G (1982) Epidural opiates for relief of cancer pain. In: Yaksh TL, Miiller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 125

    Google Scholar 

  21. Oyama T (1980) Influence of anaesthesia on the endocrine system. In: Stöckel H, Oyama T (eds) Endocrinology in anaesthesia and surgery. Springer, Berlin Heidelberg New York

    Google Scholar 

  22. Rieder W, Müller H, Klug N, Kling D, Lüben V, Stoyanov M, Hempelmann G (1981) Neurologische Untersuchungsbefunde bei periduraler Opiatgabe. In: Hempelmann G, Müller H (Hrsg) Peridurale Opiatanalgesie. Bibliomed, Köln S. 61

    Google Scholar 

  23. Schleimer R, Benjamini E, Eisele J, Henderson G (1978) Pharmacokinetics of fentanyl as determined by radioimmunoassay. Clin Pharmacol Ther 23: 188

    PubMed  CAS  Google Scholar 

  24. Thoren L (1974) General metabolic response to trauma including pain influence. Acta Anaesthesiol Scand 55: 9

    Article  CAS  Google Scholar 

  25. Traynor C, Hall GM (1981) Endocrine and metabolic changes during surgery: Anaesthetic implications. Br J Anaesth 53: 153

    Article  PubMed  CAS  Google Scholar 

  26. Varga L (1982) Continuous epidural analgesia in the perioperative period. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 99

    Google Scholar 

  27. Ward RJ, Bonica JJ, Frennd FG, Akamatsu T, Danzinger F, Englesson S (1965) Epidural and subarachnoid anesthesia: Cardiovascular and respiratory effects. JAMA 191: 275

    Article  PubMed  CAS  Google Scholar 

  28. Weidler B, von Bormann B, Dennhardt R, Hempelmann G (im Druck) Plasma-ADH-Spiegel als peri-operativer Streßparameter. Anaesthesist

    Google Scholar 

  29. Welchew EA, Thornton JA (1982) The control of postoperative pain by thoracic epidural fentanyl and its effect upon the stress response. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 103

    Google Scholar 

  30. Yakashita Y, Fukuda K, Morioka T, Kano T, Araki Y (1979) Intrathecal application of morphine. I. As a supplement of anesthesia and a prolonged relief of postoperative pain. Jpn J Anesth 12: 1584

    Google Scholar 

  31. Yaksh TL (1978) Inhibition by etorphine of the discharge of dorsal horn neurons: Effects upon the neuronal response to both high- and low-threshold sensory input in the decerebrate spinal cat. Exp Neurol 60: 23

    Article  PubMed  CAS  Google Scholar 

  32. Yaksh TL (1981) Analgesia and the spinal action of opiates. In: Hempelmann G, Müller H (Hrsg) Peridurale Opiatanalgesie. Bibliomed, Köln S. 43

    Google Scholar 

  33. Yaksh TL (1982) Animal studies on the spinal action of opiates in analgesia. In: Yaksh TL, Müller H (eds) Spinal opiate Analgesia, vol 144, Anaesthesiology and intensive care medicine. Springer, Berlin Heidelberg New York, p 1

    Google Scholar 

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Authors
  1. H. Müller
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  2. U. Börner
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  3. H. Gips
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  4. M. Stoyanov
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  5. G. Hempelmann
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Editor information

Editors and Affiliations

  1. Inst. f. Anaesthesiologie, Med. Einrichtungen d. Univ, Moorenstr. 5, 4000, Düsseldorf, Germany

    H. J. Wüst  & M. Zindler  & 

  2. Dept. of Anesthesia, University Hospital, Denver, Colorado, USA

    M. d’Arcy Stanton-Hicks

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© 1984 Springer-Verlag Berlin Heidelberg

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Müller, H., Börner, U., Gips, H., Stoyanov, M., Hempelmann, G. (1984). Intraoperative peridurale Opiatanalgesie. In: Wüst, H.J., Zindler, M., d’Arcy Stanton-Hicks, M. (eds) Neue Aspekte in der Regionalanaesthesie 3. Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine, vol 158. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-69453-0_18

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  • DOI: https://doi.org/10.1007/978-3-642-69453-0_18

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-13023-9

  • Online ISBN: 978-3-642-69453-0

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