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British Journal of Anaesthesia Jan 1999
Topics: Analgesics, Opioid; Humans; Pain, Postoperative; Pirinitramide
PubMed: 10325826
DOI: 10.1093/bja/82.1.3 -
The Journal of Pharmacy and Pharmacology Sep 1961
Topics: Analgesics; Analgesics, Non-Narcotic; Antipyretics; Pirinitramide
PubMed: 13789502
DOI: 10.1111/j.2042-7158.1961.tb11864.x -
Nordisk Medicin Sep 1965
Topics: Analgesics; Analgesics, Non-Narcotic; Antipyretics; Biomedical Research; Drug Therapy; Morphine; Pirinitramide; Respiration
PubMed: 14345706
DOI: No ID Found -
Schmerz (Berlin, Germany) Aug 2017In many European countries and particularly in Germany, piritramide is the first choice opioid analgesic for the management of postoperative and posttraumatic pain. (Comparative Study)
Comparative Study Review
BACKGROUND
In many European countries and particularly in Germany, piritramide is the first choice opioid analgesic for the management of postoperative and posttraumatic pain.
OBJECTIVE
The aim of this study was to review the pharmacological properties of piritramide and to evaluate whether these result in any clinical advantages with respect to effectiveness, safety and side effect profile compared to other strong opioids.
MATERIAL AND METHODS
A systematic literature search was conducted in PubMed and Google Scholar and 27 articles published between 1961 and 2015 were retrieved and included in this review.
RESULTS
Piritramide is a strong opioid that can only be administered parenterally. After intravenous injection it is effective after 17 min with pain relief lasting for up to 6 h. It is metabolized in the liver to inactive compounds, which is advantageous compared to morphine where active metabolites can accumulate in patients with renal failure. Piritramide is highly lipophilic resulting in a long context-sensitive half-life, making it unsuitable for continuous infusions. Studies further suggest that the side effect profile of piritramide is comparable to morphine.
CONCLUSION
So far there is little evidence to support the widespread use of piritramide as first-line opioid analgesic for postoperative pain management in Germany. Especially lacking are in-depth studies about its mechanisms of action, receptor pharmacology, dose-response relationships and clinical dosing regimens. It is therefore questionable why piritramide is given priority.
Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Germany; Half-Life; Humans; Infusions, Intravenous; Metabolic Clearance Rate; Morphine; Pain, Postoperative; Pirinitramide
PubMed: 28265754
DOI: 10.1007/s00482-017-0197-y -
BMC Emergency Medicine Sep 2023BACKGROUND: Treatment of acute pain is an essential element of pre-hospital care for injured and critically ill patients. Clinical studies indicate the need for...
ABSTRAC
BACKGROUND: Treatment of acute pain is an essential element of pre-hospital care for injured and critically ill patients. Clinical studies indicate the need for improvement in the prehospital analgesia.
OBJECTIVE
The aim of this study is to assess the current situation in out of hospital pain management in Germany regarding the substances, indications, dosage and the delegation of the use of analgesics to emergency medical service (EMS) staff.
MATERIAL AND METHODS
A standardized survey of the medical directors of the emergency services (MDES) in Germany was carried out using an online questionnaire. The anonymous results were evaluated using the statistical software SPSS (Chi-squared test, Mann-Whitney-U test).
RESULTS
Seventy-seven MDES responsible for 989 rescue stations and 397 EMS- physician bases in 15 federal states took part in this survey. Morphine (98.7%), Fentanyl (85.7%), Piritramide (61%), Sufentanil (18.2%) and Nalbuphine (14,3%) are provided as opioid analgesics. The non-opioid analgesics (NOA) including Ketamine/Esketamine (98,7%), Metamizole (88.3%), Paracetamol (66,2%), Ibuprofen (24,7%) and COX-2-inhibitors (7,8%) are most commonly available. The antispasmodic Butylscopolamine is available (81,8%) to most rescue stations. Fentanyl is the most commonly provided opioid analgesic for treatment of a traumatic pain (70.1%) and back pain (46.8%), Morphine for visceral colic-like (33.8%) and non-colic pain (53.2%). In cases of acute coronary syndrome is Morphine (85.7%) the leading analgesic substance. Among the non-opioid analgesics is Ketamine/Esketamine (90.9%) most frequently provided to treat traumatic pain, Metamizole for visceral colic-like (70.1%) and non-colic (68.6%) as well as back pain (41.6%). Butylscopolamine is the second most frequently provided medication after Metamizole for "visceral colic-like pain" (55.8%). EMS staff (with or without a request for presence of the EMS physician on site) are permitted to use the following: Morphine (16.9%), Piritramide (13.0%) and Nalbuphine (10.4%), and of NOAs for (Es)Ketamine (74.1%), Paracetamol (53.3%) and Metamizole (35.1%). The dosages of the most important and commonly provided analgesic substances permitted to independent treatment by the paramedics are often below the recommended range for adults (RDE). The majority of medical directors (78.4%) of the emergency services consider the independent application of analgesics by paramedics sensible. The reason for the relatively rare authorization of opioids for use by paramedics is mainly due to legal (in)certainty (53.2%).
CONCLUSION
Effective analgesics are available for EMS staff in Germany, the approach to improvement lies in the area of application. For this purpose, the adaptations of the legal framework as well as the creation of a guideline for prehospital analgesia are useful.
Topics: Adult; Humans; Ketamine; Analgesics, Non-Narcotic; Dipyrone; Acetaminophen; Nalbuphine; Pirinitramide; Butylscopolammonium Bromide; Physician Executives; Analgesics; Analgesics, Opioid; Fentanyl; Germany; Acute Pain; Morphine Derivatives
PubMed: 37710177
DOI: 10.1186/s12873-023-00878-8 -
Klinische Anasthesiologie Und... 1981
Topics: Analgesics; Buprenorphine; Butorphanol; Chemical Phenomena; Chemistry; Endorphins; Fentanyl; Humans; Morphine; Pentazocine; Pirinitramide
PubMed: 7339167
DOI: No ID Found -
Anaesthesiologie Und Reanimation 1991The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only... (Review)
Review
The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. Considerations which lead to opioid underdosage include: the development of addiction and possible side-effects such as respiratory depression, heavy sedation, possible constipation and urinary retention. The aim in postoperative pain therapy is a time-contingent dosing after careful intravenous titration of the compound in the lower dose range during continuous supervision. Thus, the individual need in the recovery room can be estimated. Only such a procedure helps to keep the patient pain-free over a long period of time, reduces the workload of nurses during the night, results in the reduction of complications and finally may even reduce the hospital stay. Piritramide is a compound which has a number of potential advantages with regard to efficacy and side-effects in postoperative pain therapy. It has the highest analgesic potency among those compounds suitable for postoperative pain therapy; when compared with pethidine, pentazocine or nalbuphine it shows remarkable cardiovascular stability. In comparison to morphine, pethidine and pentazocine, piritramide has a lower incidence of nausea and vomiting. With a mean duration of action of up to six hours, piritramide has an advantage over pentazocine (3 hours), pethidine (2-3 hours) and morphine (5-6 hours). Compared to other mixed narcotic analgesics, piritramide does not induce dysphoric side-effects when given in the higher dose range and does not lead to addiction. It is derived from the same group of agents such as fentanyl or alfentanil which are used in neuroleptanaesthesia so that there is an increase in analgesia one to the interaction with the same receptor site. Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.
Topics: Analgesics, Opioid; Humans; Pain, Postoperative; Pirinitramide
PubMed: 1686169
DOI: No ID Found -
Acta Pharmacologica Et Toxicologica 1965
Topics: Analgesics; Analgesics, Non-Narcotic; Antipyretics; Carbon Dioxide; Meperidine; Pharmacology; Pirinitramide; Respiration; Respiratory Function Tests
PubMed: 14284193
DOI: 10.1111/j.1600-0773.1965.tb03508.x -
Journal of Clinical Pharmacy and... Jun 2017In our university hospital (UZBrussel), one of the options to control post-operative pain after a Caesarean section under general anaesthesia is to administer...
WHAT IS KNOWN AND OBJECTIVE
In our university hospital (UZBrussel), one of the options to control post-operative pain after a Caesarean section under general anaesthesia is to administer piritramide by patient-controlled intravenous analgesia (PCIA). As no information is available about the possible transfer of this synthetic narcotic analgesic into breastmilk, women are frequently advised not to breastfeed their newborn. A sensitive liquid chromatographic (LC) method coupled with UV detection will therefore be developed and validated for the quantification of piritramide in colostrum samples to evaluate the presence of the analgesic in the first milk.
METHODS
The method included the isolation and concentration of piritramide from colostrum using protein precipitation and solid-phase extraction (SPE) using a mixed-mode cation exchange sorbent. Subsequently, the extracted samples were analysed on a microbore C column (1 mm id) and a mobile phase consisting of 15 mm ammonium hydroxide in methanol/tetrahydrofuran/water 50 : 10 : 40 V/V/V.
RESULTS AND DISCUSSION
As colostrum contains a high amount of proteins, mixed-mode cation exchange SPE was preceded by a 1 : 2 dilution and protein precipitation with phosphoric acid followed by double centrifugation of the samples. The reversed-phase LC-UV method used a mobile phase at alkaline pH to obtain a selective method for piritramide and the internal standard pipamperone. After investigating the validation characteristics (linearity, accuracy, precision and stability), samples from ten patients who had received piritramide via PCIA during the first 48 h post-partum were analysed.
WHAT IS NEW AND CONCLUSION
To the best of our knowledge, this is the first method described for the quantification of the synthetic narcotic analgesic piritramide in colostrum samples. The obtained results suggest that after the administration of this opioid by PCIA to nursing mothers low concentrations of piritramide can be found in the first milk, but are mostly below the limit of quantification of 30 ng/mL.
Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Chromatography, Liquid; Chromatography, Reverse-Phase; Colostrum; Female; Humans; Pirinitramide; Reproducibility of Results; Spectrophotometry, Ultraviolet
PubMed: 28295465
DOI: 10.1111/jcpt.12515