morphinans and Intervertebral-Disc-Displacement

The aim of the study was a comparison of the side-effects and efficacy of nalbuphine, piritramide, and placebo in patients during recovery from halothane anesthesia.. Neurosurgical (vertebral surgery) and otolaryngological patients (surgery of face and neck) were operated under halothane anesthesia. Postoperatively 20 patients received 20 mg nalbuphine, 21 patients 15 mg piritramide, and 19 patients 0.9% NaCl for pain therapy in a randomized and double-blind manner. Respiratory function was monitored by blood gas analysis, hemodynamic function by noninvasive measurements. The analgetic and sedative effects were estimated by the patients (visual analog scale) and the investigator (4-point scale). If the treatment was ineffective, the study was interrupted and a known analgesic was prescribed.. The noninvasively measured hemodynamic parameters were unchanged. On the other hand, in the nalbuphine group mean arterial pCO2 increased significantly (max. 55.4 mmHg after 20 min), over the piritramide group (max. 51.2 mmHg before treatment) and the placebo group (max. 55.1 mmHg before treatment). Drowsiness, in 8 patients in each of the treatment groups and 3 patients in the placebo group, was the most frequent side-effect. After nalbuphine the pain threshold was significantly higher than after treatment with piritramide and placebo. The study was interrupted because of inefficacy in no patients from the nalbuphine group, 2 patients from the piritramide group, and 6 patients from the placebo group. There were no differences in the sedative effects.. Nalbuphine seems to have better analgesic effects then piritramide. Both cause no hemodynamic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anesthesia, Endotracheal; Blood Pressure; Cervical Vertebrae; Clinical Trials as Topic; Halothane; Humans; Intervertebral Disc Displacement; Isonipecotic Acids; Lumbar Vertebrae; Morphinans; Nalbuphine; Otorhinolaryngologic Diseases; Oxygen; Pain Measurement; Pain, Postoperative; Pirinitramide; Random Allocation

In order to demonstrate pharmacokinetic and pharmacodynamic interactions between fentanyl and buprenorphine, 3 groups of patients (n = 30) were compared, receiving either fentanyl (0.005 mg/kg b.w.) or buprenorphine (0.01 mg/kg b.w.) or both opioids as analgesic during surgery for disc protrusion. For a period of 4 h haemodynamic parameters were monitored and blood samples were taken for determination of the following concentrations: ADH, ACTH, cortisol, glucose, unbound glycerol, fentanyl and buprenorphine. Blood gas analyses were performed up to 2 h postoperatively. Although in all groups haemodynamic parameters were constant, there was an increase in factors related to operative stress (cortisol, glucose, unbound glycerol, postoperative acidosis) after the combination of both opioids, while postoperative ventilatory parameters in this group were not improved by the partial agonist buprenorphine. Plasma levels were not affected by combined application, except for a slight elevation of buprenorphine concentrations during additional use of fentanyl. Buprenorphine, at least in higher dosages, seems to antagonize analgesia induced by fentanyl, although respiratory depression is even more pronounced. It may be assumed, that with partial agonists the relation of agonistic and antagonistic activity may be different, depending on the dosage used and on the respective pharmacologic effect observed during investigation.

Topics: Acid-Base Equilibrium; Adrenocorticotropic Hormone; Anesthesia, General; Blood Pressure; Buprenorphine; Carbon Dioxide; Drug Interactions; Fentanyl; Heart Rate; Humans; Hydrocortisone; Intervertebral Disc Displacement; Kinetics; Lumbar Vertebrae; Morphinans; Oxygen; Random Allocation; Vasopressins

A modification of neuroleptanalgesia by substituting fentanyl with buprenorphine is presented. Both anaesthesia techniques could be applied alternatively. We did not recognize any significant difference between the two groups concerning haemodynamics, the secretion of the so called stress hormones (antidiuretic hormone, cortisol) as well as the postoperative respiratory depression. The long lasting analgesia, which could be achieved by buprenorphine, can be advantageous in certain surgical interventions. The lack of a potent antagonist for buprenorphine in addition to its longer half-life for--not being of advantage in any anaesthesia--is discussed.

Topics: Adult; Buprenorphine; Carbon Dioxide; Electrolytes; Female; Fentanyl; Heart Rate; Humans; Hydrocortisone; Intervertebral Disc Displacement; Male; Middle Aged; Morphinans; Neuroleptanalgesia; Oxygen; Prolactin; Respiration