piperidines and Shoulder-Pain

In the postoperative period, α2-adrenergic agonists have an opioid sparing effect. In a previous, experimental study, it was also shown that clonidine attenuates remifentanil-induced hyperalgesia. In this study, we examined under clinical conditions whether early administration of a single dose of clonidine can inhibit remifentanil-induced hyperalgesia in patients undergoing elective surgery of the shoulder and with continuous intraoperative use of remifentanil.. In this study 40 patients received double-blind and randomized either 150 µg clonidine or placebo intravenously before skin incision. Anaesthesia was maintained with propofol and remifentanil (0.23 ± 0.09 µg/kg body weight/min) and morphine (0.1 mg/kg body weight) was administered 20 min before incision closure. Postoperatively, the patients were given a patient-controlled analgesia pump (PCA) with morphine.. Overall morphine consumption as well as overall assessment of pain with the visual analogue scale in the first 24 h postoperatively did not differ significantly between the groups. Isolated pain scores at 12 h and 24 h were significantly enhanced in the clonidine group (p<0.05).. An early single dose of 150 µg of clonidine did not reduce the postoperative morphine consumption and pain scores in patients undergoing elective surgery of the shoulder with remifentanil/propofol-based anaesthesia. After the effect of clonidine has presumably subsided the pain can even increase, therefore further studies with repetitive doses of clonidine should be carried out.

Topics: Adult; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Anesthetics, Intravenous; Arthroscopy; Austria; Clonidine; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Hyperalgesia; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Piperidines; Preanesthetic Medication; Remifentanil; Shoulder; Shoulder Injuries; Shoulder Pain

A case report of a successful treatment of neuropathic pain after a plexus brachialis injury is presented. On basis of experience from nerve-injured rat models 5 mg donepezil was added to an already instituted gabapentin therapy of 800 mg x 3 daily. This allowed halving the gapentin dose with fully contained pain alleviation but with a drastic reduction of gabapentin's side effects: ataxia and somnolence. Thus, without adding any new side effects life quality was improved and an increased working capacity was observed together with a weight loss of 9 kg over six months.

Topics: Aged; Analgesics; Donepezil; Drug Therapy, Combination; Female; Humans; Indans; Neuralgia; Piperidines; Shoulder Pain; Treatment Outcome

In this case a woman underwent a cervical laminectomy with a total i.v. anaesthesia technique and during her care two problems occurred with propofol delivery. In both cases, bispectral index increases alerted caregivers to the decreased propofol delivery and allowed them to make corrections in a manner timely enough to prevent the occurrence of awareness during anaesthesia. The case illustrates how intraoperative processed electroencephalographic monitoring may decrease the incidence of recall of awareness following surgery.

Topics: Adult; Anesthesia, General; Anesthetics; Awareness; Cervical Vertebrae; Desflurane; Electroencephalography; Equipment Failure; Female; Fentanyl; Humans; Intraoperative Complications; Isoflurane; Laminectomy; Mental Recall; Monitoring, Intraoperative; Nerve Compression Syndromes; Piperidines; Propofol; Psychological Tests; Remifentanil; Shoulder Pain; Signal Processing, Computer-Assisted