[Chili for therapy of trigeminus neuralgia: a case report]. / Chili zur Therapie der Trigeminusneuralgie : Ein Fallbericht.

We report the case of a 39-year-old female patient who suffered from trigeminal neuralgia of the left lingual nerve for 6 years. The previous therapy according to the guidelines including a Jannetta operation was unsuccessful. Only after beginning with daily mastication and consumption of very hot chilli peppers has the patient become reliably pain-free.

[Anesthesiological management of Caesarean sections : nationwide survey in Germany]. / Anästhesiologisches Management der Sectio caesarea : Deutschlandweite Umfrage.

BACKGROUND: The rate of Caesarean sections in Germany continues to rise. The change in anesthetic technique of choice from general to spinal anesthesia began later than in other countries and at the last survey in 2002 was not widely established. The literature on the anesthetic management of Caesarean sections contains many controversies, for example fluid preload before performing spinal anesthesia and the vasopressor of choice. Other issues have received relatively little attention, such as the level of experience of anesthesiologists working autonomously on the labour ward or the timing of antibiotic prophylaxis. The aim of the current survey was to provide an updated overview of anesthetic management of Caesarean sections in Germany. MATERIAL AND METHODS: A questionnaire was sent out to 709 departments of anesthesiology serving obstetric units in Germany. The questionnaire concerned various aspects of anesthetic management of Caesarean sections. RESULTS: A total of 360 questionnaires (50.8%) were returned of which 346 were complete and could be analyzed, accounting for 330,000 births and 90,000 Caesarean sections per year. The predominant anesthetic method used for Caesarean sections was spinal anesthesia (90.8%) using hyperbaric bupivacaine and in approximately one third of the hospitals surveyed without administering intrathecal opioids. Approximately 12% of the departments surveyed used traumatic Quincke needles. In 86.2% the vasopressor of choice was caffedrine/theodrenaline. Nitrous oxide was used in only 19.2% of departments surveyed when general anesthesia is performed. An antibiotic drug was administered in only 11% of hospitals before cord clamping. In 43.1% no neonatologist was available to treat unexpected critically ill newborns. In 32.1% of departments surveyed residents with less than 2 years experience worked autonomously on the labour ward. CONCLUSIONS: Currently the predominant anesthetic technique of choice in Germany is spinal anaesthesia and at a much higher rate than in 2002. In addition 12% of departments use traumatic Quincke needles which are associated with a higher incidence of postpuncture headache. Nitrous oxide is no longer frequently used in Germany. Finally, the administration of an antibiotic before cord clamping has been shown to lead to lower rates of endometritis and postoperative wound infection without detrimental effects on the newborn. This is practiced in only a small minority of departments across Germany.

[Impact of preoperative pain on postoperative pain chronification. Six-month follow-up after urologic surgery]. / Einfluss präoperativer Schmerzen auf die postoperative Schmerzchronifizierung. Sechs Monate Nachbeobachtung nach urologischen Operationen.

BACKGROUND: We examined the influence of preoperative pain on postoperative pain chronification in urological patients. METHODS: Pain was determined before operation, immediately afterwards and 3 or 6 months post-surgically. Acute and chronic pain was analysed in detail with regard to severity, grade of chronification and pain intensity. We also assessed patients with the Hospital Anxiety and Depression Scale. RESULTS: Patients with preoperative pain reported postoperatively higher pain scores compared to patients without preoperative pain. Patients with higher Hospital Anxiety and Depression Scale scores reported higher pain scores for the first 7 days after the operation. Three months after surgery 51.2% of all patients and 6 months after surgery 1.2% of all patients reported about pain. CONCLUSION: Our results give evidence to the fact that preexisting pain prior to surgery has an influence on the postoperative pain course. To avoid chronification adequate therapy of the preexisting pain should be carried out.

Pain, postdural puncture headache, nausea, and pruritus after cesarean delivery: a survey of prophylaxis and treatment.

BACKGROUND: The need for a cesarean delivery may interfere negatively with the overall experience of childbirth. Several factors related to anesthesiological management such as postoperative pain and discomfort, nausea and pruritus, and postdural puncture headache (PDPH), may lead to dissatisfaction and have a negative impact on early mobilization and a new mother's ability to care for her newborn baby. Optimal prophylaxis and treatment decrease these complications, increase satisfaction, and prevent chronic pain. This survey determined how prophylaxis and treatment of pain, PDPH, nausea, and pruritus after cesarean section (CS) is managed. METHODS: A questionnaire was sent to 709 departments of anesthesiology serving an obstetric unit in Germany. The questionnaire asked about different aspects of pain management, the management of accidental dural puncture (ADP), and treatment of PDPH. Further we asked about therapy and prophylaxis of nausea and pruritus in the peripartal setting. RESULTS: In all, 360 questionnaires (50.8%) were returned; 346 were complete and analyzed (accounting for 330000 births per year). Paracetamol (77.5%) and piritramide (85.6%) are the most common analgesics used. If epidural catheters were used for anesthesia for CS, 47.7% were used for postoperative pain therapy. However, 92.7% of the departments removed catheters in less than 24 hours after delivery. In case of an ADP most departments (69.9%) repeated puncture, 2.6% placed catheters intrathecally. Median blood volume for an epidural blood patch was 10ml. CONCLUSION: Apart from conservative treatment of PDPH, prophylaxis and treatment of pain after cesarean delivery, PDPH, nausea, and pruritus varied widely, indicating the need for the qualitative evaluation of overall management.

Lipid therapy for serotonin syndrome after intoxication with venlafaxine, lamotrigine and diazepam.

A 44-year-old woman developed coma and seizure activity after intentional ingestion of 200 mg diazepam, 20 g lamotrigine and 4.5 g venlafaxine. In our intensive care unit a distinct rigidity and hyperreflexia was observed. This status was not influenced by haemodialysis which was initiated directly after admission. Plasma concentrations of the ingested drugs were determined before hemodialysis was started (560 µg/L diazepam, 42.4 mg/L lamotrigine and 1254 µg/L venlafaxine). Eight hours after the start of haemodialysis a 150 mL (2.5 mL/kg) intravenous bolus of 20% lipid emulsion was given. Soon after administration of the lipid infusion the distinct rigidity and hyperreflexia disappeared. The further course was uneventful.

Survey on the use of oxytocin for cesarean section.

BACKGROUND: The administration of oxytocin at high doses during cesarean section may cause severe cardiovascular complications. However, a dosage as low as 1 IU has been proven to suffice. Bolus administration is not superior to infusion and causes more severe side effects. The purpose of this survey was therefore to determine dosages and routes of administration of oxytocin during cesarean section in Germany. METHODS: A questionnaire was sent to 709 departments of anesthesiology. The questionnaire asked about the standard dosage of oxytocin and route of administration (bolus and/or slow infusion) used for cesarean section. RESULTS: A total of 360 questionnaires (50.8%) were returned; 346 of these were filled out and therefore analyzed (accounting for approximately 329,000 births). It was found that 295 (85.3%) departments administer oxytocin as a bolus, and 48 (13.9%) give it only as a slow infusion. A bolus of 1-3 IU is administered at 176 departments (51.8%), 5-9 IU at 71 (20.9%), 10 IU at 39 (11.6%), and 12-40 IU at 6 (1.8%). Additionally, 3-9 IU were slowly infused at 56 departments (16.7%), 10 IU at 174 (50.3%), 12-20 IU at 51 (14.7%), and 23-40 IU at 22 (6.4%). The median cumulative oxytocin dose is 13 IU, ranging from 1 to 80 IU. CONCLUSION: Most of the responding departments give oxytocin as a bolus at a relatively low dose. However, despite the potentially fatal side effects, one out of eight departments administers 10 IU or more as a bolus.

[Postoperative pain therapy after radical prostatectomy with and without epidural analgesia]. / Postoperative Schmerztherapie nach radikaler Prostatektomie mit oder ohne epiduraler Analgesie.

Epidural analgesia for postoperative pain treatment is favored, for example, within the scope of so-called fast-track surgery, especially abdominal surgery. To improve pain care for our urological patients, we examined the quality of postoperative pain therapy with and without epidural analgesia after radical prostatectomy. After the investigation was approved by the local ethics committee, patients were questioned in detail about the pain they experienced for 7 days after radical prostatectomy. For all 7 postoperative observation days, significantly less pain was measured for patients receiving epidural analgesia compared with patients without epidural analgesia. This could be shown for the average and strongest pain intensity at rest as well as for pain during mobilization. Patients with epidural analgesia were discharged, on average, 1 day earlier. After radical prostatectomy, postoperative pain therapy with epidural analgesia seems to offer advantages with regard to the quality of analgesia and the average length of hospital stay.

Effects of thiopental on endothelium-dependent relaxation in porcine coronary arteries.

This study investigated the effects of thiopental on endothelium-dependent relaxation (EDR), and especially the effects on nitric oxide- and prostacyclin-independent EDR. Fresh porcine coronary artery rings (4 mm long), were consecutively tested with and without 20 microg/ml thiopental in Krebs-Henseleit solution. Indomethacin (10 micromol/l) was used in all experiments to eliminate prostacyclin effects. Prostaglandin F(2alpha) (10 micromol/l) was used to induce contractions and bradykinin (10(-10) - 10(-5) M) was used to induce EDR. Experiments were also carried out using 300 micromol/l N-nitro-L-arginine to block nitric oxide production and to assess the influence of thiopental on nitric oxide- and prostacyclin-independent EDR. Thiopental induced statistically significant increases in EDR at concentrations of 10(-6) - 10(-5) M bradykinin. Following nitric oxide production block, thiopental significantly reduced the relaxation response at concentrations of 10(-8) - 10(-5) M bradykinin. At a clinically relevant concentration of 20 microg/ml thiopental, a significant increase in EDR and a significant reduction in nitric oxide- and prostacyclin-independent relaxation was observed in porcine epicardial coronary arteries.

[Management of a ureteroarterial fistula]. / Diagnostik und Behandlung einer ureteroarteriellen Fistel.

Ureteroarterial fistulae are rare after vascular surgery with only 16 cases being reported in the literature. We report a 65-year-old woman who presented with massive gross hematuria following endostenting of an iliac aneurysm. Cystoscopy demonstrated ejaculation of blood from the left orifice and angiography revealed an ureteroiliac fistula between the left ureter and the common iliac artery. Following placement of a vascular endoprosthesis and a double J stent gross hematuria developed. This case highlights the diagnosis and therapeutic approach in patients with suspected ureteroarterial fistula.

[Preoperative pain in urological patients scheduled for surgical intervention : Incidence, severity and chronicity]. / Präoperative Schmerzen bei urologisch operativen Patienten : Häufigkeit, Intensität und Chronizität.

BACKGROUND: The genesis of chronic pain in urology has so far been insufficiently investigated. No investigations have focused on the occurrence of preoperative pain. We developed an epidemiological questionnaire to analyze preoperative pain. METHODS: In this questionnaire, preoperative pain in all patients scheduled for urologic surgery (n=165) was analyzed. Acute and chronic pain was analyzed as main or adjoint pain, with the registration of severity, chronification states, and duration. We registered depression and anxiety, well-being, and somatic and psychological efficiency. RESULTS: Eighty percent of the patients reported pain within the previous 12 months. Acute preoperative pain was reported by 17% of the patients and chronic pain by 64%. Significant differences in quality of life were detected between patients with or without preoperative pain. Well-being was also significantly affected in patients having pain. CONCLUSION: The pain severity and states of chronification not only explain a reduction in somatic and psychological well-being but also emphasize that preoperative pain should be identified thoroughly prior to surgery.

[Influence of changes to daily dose of opioids on aspects of cognitive and psychomotor performance involved in driving]. / Einfluss von Anderungen der Opioidtagesdosis auf fahrrelevante kognitive und psychomotorische Leistungen.

INTRODUCTION: It has been shown that long-term treatment with opioids does not necessarily impair driving ability in patients suffering from chronic pain. However, few studies are so far available on how increases in daily opioid dosage affect driving ability. METHODS: A prospective trial was conducted in patients suffering from chronic noncancer pain, to examine the effects of the daily dose of opioids on psychomotor and cognitive functions. A computerized test system was administered to patients before and 7 days after alteration of their opioid therapy, to determine performance affecting driving ability at each time point. The test design was based on both international and national recommendations for the examination of driving safety. RESULTS: Raising the daily dose of opioids and/or changing to an opioid at a higher WHO level had no effect on the functions relevant to driving ability in the group context. Pain intensity and serum concentrations of morphine influenced only few items in the test battery. CONCLUSION: Seven days after an increase in the daily dose of an opioid or after the initiation of opioid therapy there was no general deterioration in patients' driving ability at group level.

[Measuring pressure pain thresholds. Comparison of an electromechanically controlled algometer with established methods]. / Messung der Druckschmerzempfindlichkeit. Vergleich eines elektromechanisch gesteuerten Algometers mit etablierten Methoden.

BACKGROUND: Measurement of the pressure pain threshold and suprathreshold pressure pain sensitivity using a newly developed computer controlled algometer was compared to established methods in this pilot study. METHODS: The pressure pain threshold was measured in 64 chronic pain patients and 37 healthy volunteers with a manual electronic algometer (Somedic) and the computer controlled Algoforce PA3. Stimulus-response curves with painful stimuli were applied using the Algoforce PA3 and a hydraulic algometer. RESULTS: Overall means and variance of the pressure pain thresholds for both methods were similar. For low pain thresholds the Algoforce PA3 generally resulted in lower values and for high pain thresholds in higher values. No differences were seen for suprathreshold pain sensitivity. Gender and the presence of chronic pain had no relevant effect on the different methods in both comparisons. CONCLUSION: For clinical use, the algometers investigated deliver comparable results. For studies requiring high precision with low levels of stimulation the use of the Algoforce PA3 could be considered.