Influence of Physostigmine on Patient-Controlled Analgesia (PCA) in Postoperative Intensive Care Patients

Klinikum Ludwigshafen60 enrolled

Overview

The study is to evaluate the influence of physostigmine in the postoperative period in intensive care patients considering pain quality, opioid consumption, hemodynamics and mobilisation.

Pain management is of major concern in the postoperative period, mostly based on opioids. In numerous experimental and clinical trials cholinergic mechanisms have been demonstrated to play an important antinociceptive role. Physostigmine, a central cholineresterase inhibitor, has been shown to produce analgesia and enhance opiate analgesia after systemic injection. This action is not based on µ-receptor (opioid) activity, but can be mostly explained by stimulation of serotonine (5-HT-3) receptors. The major withdrawal of utilizating physostigmine in postoperative care, is due to its short duration of action. In the present study, we examined the effect of a continuous intavenous physostigmine application during a patient-controlled analgesia with piritramide for 48 hours compared to a placebo infusion with NaCl. Major concern was set for consumption of analgesics, VAS-pain scale, hemodynamics, mobilisation and side effects.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Pain

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18-80 years * Indication for postoperative pain therapy and admission to ICU * ASA I-III * Weight 50-125 kg * Patients that are willing to participate in the present study Exclusion Criteria: * Peridural anesthesia for pain management * Severe left ventricular function (EF \<30%) * Severe/exacerbated COPD; Asthma * ASA IV-V * Chronic renal insufficiency(Creatinine \> 1,5 mg/dl) * Ulcera ventriculi * Known allergy to any of the study agents * Hb preoperative \<9,5 g/dl * Alcohol,drug and/or tablet abuse (Opioids, NSAR) * Emergency operation * Pregnancy * Women of childbearing age and without a negative pregnancy test * Severe liver disease (GOT oder GPT \> 45 U/L) * Severe neurologica derangements (e.g. M. Parkinson, Multiple Sklerosis) * History of apoplexia \<6 Monate or residua * Perioperative myocardial infarction * Patients that are not able to agree to the present study * Patients that refuse to participate in the present study * Patients that are part of any other study

Locations (1)

Klinkum Ludwigshafen, Department of Anesthesiology

Ludwigshafen, Germany

Outcomes

Primary Outcomes

opioid consumption

Time frame: 48 hours

Secondary Outcomes

pain quality (VAS) mobilisation hemodynamics side effects

Time frame: operation to discharge from hospital

Data from ClinicalTrials.gov

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