Skip to main content
SpringerLink
Log in

Die peridurale Anwendung von Ropivacain und Clonidin zur Schmerztherapie nach Prostatektomie

Peridural application of ropivacaine and clonidine for pain therapy after prostatectomy

  • Originalien
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Wir wollten überprüfen, ob für die postoperative Analgesie nach radikaler retropubischer Prostatektomie Ropivacain mit Clonidin eine ausreichende Therapie darstellt.

Material und Methoden

Sechsundachtzig Patienten wurden in 2 Gruppen zu je 43 Patienten randomisiert. Gruppe 1 bekam peridural Bupivacain/Morphin/Clonidin, Gruppe 2 Ropivacain/Clonidin.

Nach Bedarf bekamen sie zusätzlich Analgetika, Antiemetika und Antihistaminika. Es wurden Schmerzen auf der visuellen Analogskala (VAS), motorische Störungen, Parästhesien, Sedierung, Juckreiz, Übelkeit, Hypotension, der Bedarf an Antihistaminikum, Naloxon, Antiemetikum, Efedrin und zusätzlichen Analgetika dokumentiert.

Ergebnisse

Unterschiede bei Sedierung, Juckreiz, Übelkeit, motorischen Störungen, Parästhesien, dem Bedarf an Antihistaminikum, Antiemetikum und Ketoprofen waren signifikant, bei anderen Parametern fanden sich keine signifikanten Unterschiede.

Schlussfolgerungen

Wir empfehlen die peridurale Gabe von Ropivacain für die postoperative Analgesie nach radikaler retropubischer Prostatektomie.

Abstract

Objective

The aim of this study was to find out if ropivacaine with clonidine can be successfully used after radical retropubic prostatectomy.

Material and methods

A total of 86 patients were randomized into two groups each consisting of 43 patients. Patients in group 1 received epidural bupivacaine/morphine/clonidine and those in group 2 ropivacaine and clonidine. If necessary analgesic, antiemetic or antihistamine drugs were administered. Pain on a visual analogue scale (VAS), motoric and sensoric disturbances, sedation, itching, nausea and vomiting, hypotension, need of antihistamines, naloxon, antiemetics, ephedrine, and analgesics were also documented.

Results

Differences in sedation, itching, nausea and vomiting, motoric and sensoric disturbances, need of antihistamines, antiemetics, and ketoprofen were significant, the other parameters did not show any significant differences.

Conclusions

We recommend the use of ropivacaine with clonidine in the postoperative pain management after radical retropubic prostatectomy

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Baker DM (2000) Selective block of late Na+ current by local anaesthetics in rat large sensory neurones. Br J Pharamacol 129: 1617–1626

    Article  CAS  Google Scholar 

  2. Bräu ME, Branitzki P, Olschewski A (2000) Block of neuronal tetrodotoxin – resistant Na+ currents by stereoisomers of piperidine local anesthetics. Anesth Analg 91: 1499–1505

    Article  PubMed  Google Scholar 

  3. Burmeister MA, Gottschalk A, Freitag M et al. (2003) Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery. Can J Anesth 50: 568–573

    Article  PubMed  Google Scholar 

  4. Donner B, Tryba M, Zenz M, Strumpf M (1994) Intrathekale und epidurale Applikation von Nichtopioidanalgetika zur Therapie akuter und chronischer Schmerzen. Schmerz 8: 71–81

    Article  PubMed  Google Scholar 

  5. Doss Nabil W, Ipe J, Crimi T (2001) Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy. Anesth Analg 92: 1552–1557

    Article  PubMed  CAS  Google Scholar 

  6. Erichsen CJ, Sjövall J, Kehlet H et al. (1996) Pharmacokinetics and analgesic effect of ropivacaine during continuous epidural infusion for postoperative pain relief. Anesthesiology 84: 834–842

    Article  PubMed  CAS  Google Scholar 

  7. Frank E, Sood OP, Torjman M (1998) Postoperative epidural analgesia following radical retropubic prostatectomy. J Surg Oncol 67: 117–120

    Article  PubMed  CAS  Google Scholar 

  8. Gang-Bao L, Zhuang-Xin L, Tong-Shi, Hui Xu-Gou (2000) The effect of ropivacaine on sodium currents in dorsal horn neurons of neonatal rats. Anesth Analg 90: 1034–1038

    Article  Google Scholar 

  9. Gedney JA, Liu EH (1998) Side-effect of epidural infusions of opioid bupivacaine mixtures. Anaesthesia 53: 1148–1155

    Article  PubMed  CAS  Google Scholar 

  10. Gianferrari P, Voltolina M, Clara ME et al. (2003) Postoperative pain management: epidural analgesia. Minerva Chir 58: 857–860

    PubMed  CAS  Google Scholar 

  11. Gottschalk A, Smith DS, Jobes DR (1998) Preemptive epidural analgesia and recovery from radical prostatectomy. JAMA 279: 1076–1082

    Article  PubMed  CAS  Google Scholar 

  12. Hall MC, Roehrborn CG (1998) Preemptive analgesia for prostatectomy. JAMA 280: 517–518

    Article  PubMed  CAS  Google Scholar 

  13. Hamitouche Y, Benhamou D (2004) Postoperative pain relief after gynecologic surgery. J Gynecol Obstet Biol Reprod (Paris) 33: 7–13

    Google Scholar 

  14. Heid F, Schmidt-Glintzer A, Piepho T, Jage J (2007) Epidural ropivacaine – where are the benefits? A prospective, randomized, double-blind trial in patients with retropubic prostatectomy. Acta Anaesthesiol Scand 51: 294–298

    Article  PubMed  CAS  Google Scholar 

  15. Heller AR, Litz RJ, Djonlagic I (2000) Kombinierte Anästhesie mit Epiduralkatheter. Anaesthesist 49: 949–959

    Article  PubMed  CAS  Google Scholar 

  16. Hergert M, Rosolski T, Lestin HG, Stranz G (2002) Postoperative epidural analgesia – current status, indications and management. Anaesthesiol Reanim 27: 152–159

    PubMed  CAS  Google Scholar 

  17. Himmelseher S, Ziegler-Pithamitsis D, Argiriadou H et al. (2001) Small-dose S(+) ketamine reduces postoperative pain when applied with ropivacaine in epidural anesthesia for total knee arthroplasty. Anesth Analg 92: 1290–1295

    Article  PubMed  CAS  Google Scholar 

  18. Ng JM, Goh MH (2002) Problems related to epidural analgesia for postoperative pain control. Ann Acad Med Singapore 31: 509–515

    PubMed  CAS  Google Scholar 

  19. Nakayama Y, Omote K, Kawamata T, Namiki A (2004) A Comparison of 0.2% ropivacaine/fentanyl and 0.375% ropivacaine for continuous epidural postthoracotomy analgesia. Anesthesiology 101: A904

    Google Scholar 

  20. Oda A, Ohashi H, Komori S (2000) Characteristics of ropivacaine block of Na+ channels in rat dorsal root ganglion neurons. Anesth Analg 91: 1213–1220

    Article  PubMed  CAS  Google Scholar 

  21. Olschewski A, Hempelmann G, Vogel W (1998). Blokade of Na+ and K+ currents by local anesthetics in the dorsal horn neurons of the spiral cord. Anesthesiology 88: 172–179

    Article  PubMed  CAS  Google Scholar 

  22. Owen MD, Dean LS (2000) Ropivacaine. Expert Opin Pharmacother 1: 325–336

    Article  PubMed  CAS  Google Scholar 

  23. Schug SA, Scott DA, Payne J et al. (1996) Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery. Br J Anaesth 76: 487–491

    PubMed  CAS  Google Scholar 

  24. Schuster M, Gottschalk A, Freitag M, Standl T (2004) Cost drivers in patient-controlled epidural analgesia for postoperative pain management after major surgery. Anesth Analg 98: 708–713

    Article  PubMed  Google Scholar 

  25. Scott DA, Chamley DM, Mooney PH et al. (1995) Epidural ropivacaine infusion of postoperative analgesia following major lower abdominal surgery – a dose finding study. Anesth Analg 81: 982–986

    Article  PubMed  CAS  Google Scholar 

  26. Scott D, Lee A, Fagan D et al. (1989) Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 69: 563–569

    PubMed  CAS  Google Scholar 

  27. Senard M, Kaba A, Jacquemin MJ et al. (2004) Epidural levobupivacaine 0.1% or ropivacaine 0.1% combined with morphine provides comparable analgesia after abdominal surgery. Anesth Analg 98: 389–394

    Article  PubMed  CAS  Google Scholar 

  28. Tobias JD (2004) A review of intrathecal and epidural analgesia after spinal surgery in children. Anesth Analg 98: 56–65

    Google Scholar 

  29. Whizar LV, Cisneros CR, Chombo SE (2001). Nuevos anestésicos locales isoméricos: ropivacaína y levobupivacaína. In: Whizar LV, Jaramillo MJ (eds) Anestesia regional y dolor postoperatorio. Parte I. PAC Anestesia, 2nd ed. Científica Médica Latinoamericana e Intersistemas, México DF, pp 45–56

  30. Yamauchi M, Asano M, Watanabe M et al. (2004) The effects of patient-controlled epidural analgesia with background infusion after abdominal surgery. Masui 53: 29–33

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Onkologisches Institut in Ljubljana, Zaloška 2, 1000, Ljubljana, Slowenien

    M. Voje

  2. Abteilung für Anästhesiologie und Intensivtherapie, Universitätsklinikum Ljubljana, Ljubljana, Slowenien

    A. Manohin

Authors
  1. M. Voje
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Manohin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Voje.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Voje, M., Manohin, A. Die peridurale Anwendung von Ropivacain und Clonidin zur Schmerztherapie nach Prostatektomie. Schmerz 22, 672–678 (2008). https://doi.org/10.1007/s00482-008-0704-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-008-0704-2

Schlüsselwörter

Keywords

Search

Navigation