[Patient-controlled analgesia with clonidine and piritramide]. / Patienten-kontrollierte Analgesie mit Clonidin und Piritramid.

UNLABELLED: Following parenteral administration, clonidine has analgesic effects at both cerebral and spinal levels. Patient-controlled analgesia (PCA) makes it possible to determine equipotent dosages of analgesics by relating analgesic consumption per time to the levels of analgesia obtained in comparable patient populations. Therefore, we studied the equipotency ratios of clonidine and piritramide and the incidence of undesired side effects in the treatment of postoperative pain in patients undergoing maxillo-facial surgery. METHODS: After approval of the local ethics committee and informed consent 40 patients (age > 18 year, ASA I-III) were studied. Following randomization, the patients each received a PCA device containing either clonidine (bolus 30 micrograms), or piritramide (bolus 1.5 mg) for treatment of postoperative pain (lockout interval 5 min in both groups). During the postoperative period, pain was determined using a visual analogue scale, while analgesic consumption, sedation, haemodynamic parameters, respiration rate, and the occurrence of undesired side effects were documented additionally. RESULTS: The groups had comparable distributions of biometric data, duration of anaesthesia, and ASA classification. Pain level decreased significantly (P < 0.0001) in both groups during the first 2 h of PCA. Mean arterial pressure and heart rate were lower (P < 0.05) in the clonidine group 4 and 6 h after PCA onset, while the degree of sedation after 2 (P < 0.01) and 6 (P < 0.05) h was higher than in the piritramide group. Nausea and vomiting were more frequent (P < 0.05) in the piritramide group. Both groups showed a wide interpatient variation in analgesic requirement. The equipotency ratio clonidine/piritramid was 1:63.7. CONCLUSION: Intravenous clonidine is a potent analgesic and is suitable or the treatment of postoperative pain following maxillo-facial surgery. The analgesic potency of 150 micrograms clonidine i.v. was equivalent to that of 9.56 mg piritramide i.v. Nausea and vomiting occurred more rarely in the clonidine group, while deeper sedation was observed more frequently than in the piritramide group. Owing to the wide interindividual variation of analgesic consumption, clonidine dosages have to be adjusted to the actual requirements.

[Clinical and roentgenologic outcome evaluation after apicoectomy with zirconium oxide ceramic pins--a prospective study of 112 apicoectomy teeth]. / Klinische und röntgenologische Erfolgsbeurteilung nach Wurzelspitzenresektionen mit Zirkonoxidkeramikstiften--eine prospektive Studie an 112 wurzelspitzenresezierten Zähnen.

We post-examined 112 apicectomies in 93 patients after an average placement period of 4.8 months (3-15.3 months) both clinically and radiologically in a prospective study to evaluate the security of success using zirconoxide ceramic pins. Clinical functioning was examined by means of the clinical mobility test, the periotest method, the sulcusfluidflowrate (periotrontest), measurements of the depths of parodontal pockets at 6 points and the papillary bleeding index in comparison to the contralateral comparative tooth. To assess the osseous regeneration of the resection defect, we carried out planimetric evaluations of standardized X-ray tooth film exposures during surgery as well as at the post-examination. The resected teeth revealed an average loosening of 10.2 in periotest. The sulcusfluidflowrate came to an average of 26.1 (control group: 22.7); the parodontal pockets were an average of 0.2 mm deeper than those of the control teeth. After 4.8 months, 63.54% of the resection defect showed complete osseous regeneration. Considering the clinical and the radiological criteria, the rate of success was 85%. Clinical use of zirconoxide ceramic pins is recommended. The high radiolucency of zirconoxide ceramics permits a safe assessment of the osseous regeneration and therefore a safe assessment of resection success.