[Neuromodulation of spasticity in children by intrathecal baclofen]. / Neuromodulation der Spastik bei Kindern durch intrathekal verabreichtes Baclofen.

INTRODUCTION: Treatment with intrathecal baclofen (ITB) is an important part of the complex therapy of patients with cerebral spasticity aiming to improve the motoric functions and to reduce pain intensity. MATERIAL AND METHODS: ITB was started in the Orthopaedic Hospital in Speising in 1999. From 1999 to 2006 a total of 15 children aged 3 to 16 years old were selected for this special treatment. RESULTS: The average degree of spasticity according to Ashworth (scale 1-5) could be reduced by ITB from 4.38 to 3.0, the time spent sitting could be increased from 3.3 to 5.8h per day and the pain intensity (VAS 1-10) could be reduced from 4.2 to 0.6. The time necessary for nursing treatment was shortened from 7.5 to 3.4 (VAS 1-10). Also improved was the emotional situation, the ability to swallow, the posture of the head and the concentration ability. CONCLUSION: ITB provides neuromodulation even in pediatric patients with complex neuromotoric spasticity.

[Pain therapy using stimulating catheters after total knee arthroplasty]. / Schmerztherapie mit Stimulationskathetern bei Kniegelenkersatz.

BACKGROUND: Epidural analgesia and continuous femoral nerve blocks are often used for pain therapy after total knee arthroplasty. The additional use of a continuous sciatic nerve block is controversially discussed. To avoid the problem of inaccurate placement a stimulating catheter may be useful. The aim of this study was to compare the effectiveness of a continuous femoral nerve block with an additional continuous sciatic nerve block for improved functional recovery and pain relief. MATERIAL AND METHODS: An open randomized prospective controlled study was carried out with 54 patients to receive either a stimulating catheter placed in the femoral nerve sheath or two stimulating catheters placed in the femoral and in the sciatic nerve sheath or an epidural analgesia. Pain was recorded with the visual analogue scale at rest and with passive motion of the knee during the first 3 postoperative days. The angle of nearly pain-free bending of the knee, side effects and opioid consumption were recorded. RESULTS: The reported pain scores and opioid consumption did not differ significantly between the groups. However, functional recovery up to the third postoperative day was significantly worse in the femoral catheter group. CONCLUSION: Using stimulating catheters for pain therapy the three methods are largely comparable and other parameters should be used for individual selection.

[Do baseline haemoglobin-rates point to the efficacy of blood saving techniques?]. / Geben Ausgangs-Hämoglobinwerte einen Hinweis auf die Effektivität Fremdblut sparender Verfahren?*

OBJECTIVE: We tested the hypothesis that blood saving techniques are more effective in patients with a low baseline haemoglobin. METHODS: We analysed retrospectively 1665 total hip replacements and 848 total knee replacements. Patients were divided in three groups according to the baseline haemoglobin (Hb): Group A were patients with a Hb of more than 15 g/dl, group B between 15 g/dl and 13 g/dl and group C with a Hb of less than 13 g/dl. The blood saving techniques applied (Preoperative blood donation, isovolemic haemodilution, and mechanical autotransfusion) aimed to a high patient population which underwent surgery without transfusion of homologous blood. RESULTS: The higher the baseline value of haemoglobin the higher was the patient population without homologous blood transfusion. The lower the Hb the higher was the effectiveness of blood saving techniques. In case of total hip replacement preoperative blood donation increased the patient population without homologous blood transfusion in all three groups significantly. However, in case of total knee replacement preoperative blood donation increased the patient population without homologous blood transfusion only in group B and C significantly. In both surgical procedures the combination of preoperative blood donation with other blood saving techniques did not further increase the patient population without homologous blood transfusion. In total hip replacement mechanical autotransfusion as well as isovolemic haemodilution reduced homologous transfusion in patients with low baseline haemoglobin. However, the increase was more pronounced when both techniques were combined. CONCLUSION: From our data is derived that the likelihood of homologous blood transfusion is greater in patients with a low baseline haemoglobin. However, in case of hip arthroplasty patients with a high baseline haemoglobin also profit from blood saving techniques while in case of knee arthroplasty the efficiency of blood saving techniques in a patient population with a high baseline haemoglobin is negligible. It seems to make sense to evaluate for the different kinds of surgery those patients who profit most from the different blood saving techniques.

[Analysis of a blood use list for orthopedic operations]. / Analyse einer Blutverbrauchsliste für orthopädische Operationen.

OBJECTIVE: Is the documentation of blood utilisation, as demanded in the guidelines of serology and transfusion medicine, a proper instrument of quality control for the use of homologous blood saving techniques? PATIENTS AND METHODS: We analysed retrospectively a list of blood utilisation based on 12,482 surgical procedures in orthopaedic surgery. This list included the type of operation, the number of transfused packed red cell units and, if applicable, the type of homologous blood saving technique (preoperative blood donation, mechanical autotransfusion and isovolaemic haemodilution). Total hip and knee replacement patients were divided in two groups according to base line haemoglobin (A: Hb > 13 mg%, B: hB < or = 13 mg%). RESULTS: The increase of the percentage of patients not receiving homologous blood achieved by blood saving techniques is more pronounced in group B. Preoperative blood donation seems to be the most effective technique with a percentage of patients not receiving homologous blood of 93% in group A and 80% in group B of total hip replacement. This high percentage cannot be improved when preoperative blood donation is combined with mechanical autotransfusion or isovolaemic haemodilution. The efficiency of mechanical autotransfusion and isovolaemic haemodilution can be improved by combination of the two techniques. CONCLUSIONS: A list of blood utilisation as presented can serve as a basis for guidelines regarding the use of homologous blood saving techniques. Moreover such a simple statistic provides a means of quality control and provides information about the likelihood of transfusion.