Untersuchung des Einflusses intraoperativ applizierter Opioide auf das postoperative Schmerzempfinden mithilfe der Quantitativ Sensorischen Testung

Opioide stellen eine wichtige Säule der perioperativen Analgesie dar. Zunehmend wird das Vorhandensein pronozizeptiver Effekte diskutiert und untersucht. Die opioidinduzierte Hyperalgesie beschreibt die paradoxe Reaktion, bei der es nach einer zunächst vorliegenden Analgesie zu abgesenkten Schmerzschwellen und einem erhöhten postoperativen Schmerzmittelbedarf kommen kann. 16 Patientinnen wurden vor und 24 Stunden nach einer Segmentresektion der Mamma mittels Quantitativ Sensorischer Testung nach dem Protokoll des Deutschen Forschungsverbundes Neuropathischer Schmerz (DFNS) untersucht. Zwei verschiedene Anästhesieverfahren kamen zum Einsatz: Acht Patientinnen erhielten Sufentanil (0,25 µg × kg-1 initial, ggf. 0,15 µg × kg-1 Repetition nach 60 min), die andere Hälfte Remifentanil (0,4 µg × kg-1 × min-1). Die Aufrechterhaltung der Narkose erfolgte durch Propofol. Zur postoperativen Analgesie wurde bereits intraoperativ 1 g Paracetamol infundiert und anschließend die Gabe alle sechs Stunden wiederholt mit einer maximalen Tagesdosis von 3 g. Das untersuchte Areal der QST befand sich im Dermatom Th 5 auf der mittleren Axillarlinie beidseitig, auf der operierten sowie zum Vergleich auf der kontralateralen Seite. Im Vergleich zu gesunden Probanden traten pathologische QST-Werte weder präoperativ noch postoperativ signifikant häufiger in einer der beiden Gruppen auf. Mit Hilfe des Wilcoxon-Tests bzw. des Mann-Whitney-U-Tests konnten keine signifikanten Unterschiede zwischen den QST-Parametern im Intra- bzw. Intergruppenvergleich nachgewiesen werden. Lediglich in der Sufentanil-Gruppe zeigte sich ein Trend zur Entwicklung einer Hypästhesie in den thermischen und Vibrationsschwellen. Somit konnte 24 Stunden nach der durchgeführten Operation weder für die intraoperative Einnahme von Remifentanil noch von Sufentanil eine Veränderung des QST-Profils nachgewiesen werden. Insbesondere unter Remifentanil zeigte sich keine Entstehung einer opioidinduzierten Hyperalgesie

Does Executive Function Influence Walking in Acutely Hospitalized Patients With Advanced Parkinson's Disease: A Quantitative Analysis

IntroductionIt is well-known that, in Parkinson's disease (PD), executive function (EF) and motor deficits lead to reduced walking performance. As previous studies investigated mainly patients during the compensated phases of the disease, the aim of this study was to investigate the above associations in acutely hospitalized patients with PD.MethodsA total of seventy-four acutely hospitalized patients with PD were assessed with the delta Trail Making Test (ΔTMT, TMT-B minus TMT-A) and the Movement Disorder Society-revised version of the motor part of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS III). Walking performance was assessed with wearable sensors under single (ST; fast and normal pace) and dual-task (DT; walking and checking boxes as the motor secondary task and walking and subtracting seven consecutively from a given three-digit number as the cognitive secondary task) conditions over 20 m. Multiple linear regression and Bayes factor BF10 were performed for each walking parameter and their dual-task costs while walking (DTC) as dependent variables and also included ΔTMT, MDS-UPDRS III, age, and gender.ResultsUnder ST, significant negative effects of the use of a walking aid and MDS-UPDRS III on gait speed and at a fast pace on the number of steps were observed. Moreover, depending on the pace, the use of a walking aid, age, and gender affected step time variability. Under walking-cognitive DT, a resolved variance of 23% was observed in the overall model for step time variability DTC, driven mainly by age (β = 0.26, p = 0.09). Under DT, no other significant effects could be observed. ΔTMT showed no significant associations with any of the walking conditions.DiscussionThe results of this study suggest that, in acutely hospitalized patients with PD, reduced walking performance is mainly explained by the use of a walking aid, motor symptoms, age, and gender, and EF deficits surprisingly do not seem to play a significant role. However, these patients with PD should avoid walking-cognitive DT situations, as under this condition, especially step time variability, a parameter associated with the risk of falling in PD worsens

Motor, cognitive and mobility deficits in 1000 geriatric patients : protocol of a quantitative observational study before and after routine clinical geriatric treatment – the ComOn-study

© The Author(s). 2020 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Motor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany). Methods: This is a prospective, explorative observational multi-center study. In addition to the comprehensive geriatric assessment, quantitative measures of reduced mobility and motor and cognitive deficits are performed before and after a two week's inpatient stay. Components of the assessment are mobile technology-based assessments of gait, balance and transfer performance, neuropsychological tests, frailty, sarcopenia, autonomic dysfunction and sensation, and questionnaires to assess behavioral deficits, activities of daily living, quality of life, fear of falling and dysphagia. Structural MRI and an unsupervised 24/7 home assessment of mobility are performed in a subgroup of participants. The study will also investigate the minimal clinically relevant change of the investigated parameters. Discussion: This study will help form a better understanding of symptoms and their complex interactions and treatment effects in a large geriatric cohort.info:eu-repo/semantics/publishedVersio