Neben einer zuverlässigen Wirkung bei hoher Patientenzufriedenheit gewinnt die Wirtschaftlichkeit der in der postoperativen Schmerztherapie eingesetzten Verfahren zunehmend an Bedeutung.

Besides reliable efficacy and patient satisfaction, economic efficiency is becoming increasingly more important in postoperative pain management. The present study investigated the effectiveness of two pain pump systems and compared the running costs in treatment. In this study 40 patients received an interscalene catheter prior to shoulder surgery. Postoperative pain management was provided via an electronic pump with patient-controlled analgesia (PCA) or a mechanical pump without PCA. Patients kept a pain log. After treatment they were interviewed about their satisfaction with the pump. In addition drug consumption, nursing material, staff time for handling and maintenance of the pumps and preparation of medications pro re nata were assessed. Postoperative pain levels and patient satisfaction were comparable in both groups. Economically, the electronic pump was more cost-effective than the electronic model for a duration of treatment of 1 and 2 days. With treatment duration of 2 days the costs of both pumps were equivalent; however, the PCA feature of the electronic pump allowed a reduced intake of systemic analgesics on demand. Both pain pump systems provide equally effective pain management, while the electronic model caused less costs. Both pumps offer advantages and disadvantages that should be considered based on local circumstantial demands.

Interventional pain therapy aims to treat pain which is refractory to pharmacologic and noninterventional treatment. Due to the partly lacking evidence and recommendations it remains unclear when interventional methods should be applied within the treatment pathway. This study assesses the current state of interventional methods in Germany and their leading indications comparing with the recommendations found in the literature. An online survey was conducted among German physicians specialized in pain therapy concerning the number of interventions they perform per quarter, which supporting measures they use, and their indications for sympathetic blocks, sensory blocks, intrathecal administration, and spinal cord stimulation. A total of 109 physicians (23.5 %) participated in the survey. Blocks are most often performed on the stellate ganglion (94 %) and on the superior cervical ganglion (82 %). They are supported by anatomical landmarks and less often by imaging control. Both classic neuropathic pain diagnoses (e.g., complex regional pain syndrome) and diagnoses with a neuropathic pain component (e.g., peripheral arterial disease, tumor pain, and back pain) were considered as indications to perform interventional procedures. Although there is no clear evidence on interventional procedures in the current literature, these methods are often performed by the respondents. Anatomic landmarks are most frequently used for orientation. The German pain physicians who responded consider especially neuropathic pain as an indication to perform interventional procedures for pain therapy.

Die interventionelle Schmerztherapie stellt eine Komponente der multimodalen Schmerztherapie dar. In Anbetracht teils fehlender Evidenz und Empfehlungen ist jedoch unklar, wann interventionelle Verfahren in der Praxis eingesetzt werden sollen. Diese Arbeit erhebt den Istzustand der derzeit in Deutschland durchgeführten interventionellen Schmerztherapie und setzt ihn in Relation zu den in der Literatur angegebenen Indikationen für interventionelle Verfahren.

INTRODUCTION:Sepsis still has a high mortality in critically-ill patients. Here, analysis of early alterations in cerebral proteome may lead to a better understanding of the molecular basis of cerebral dysfunction. The aim of the present study was therefore to analyze cerebral protein dynamics during emerging sepsis in an established rat model.MATERIAL AND METHODS:To induce sepsis, an established coecal ligature and double puncture (coecal ligature and puncture, CLP) model was used on Wistar rats. After 12 hours, surviving rats (sepsis: n=6 and sham: n=6) were decapitated and their brains prepared for gel electrophoresis (2DE) and subsequent mass spectrometry. Biological function of differentially regulated proteins (t-test, p<0.01) was then analyzed using bioinformatic network analysis (ingenuity pathways analysis, IPA).RESULTS:Mortality was 40 % in the sepsis-group and no rat of the sham-group died. Altogether, nine significantly regulated proteins were identified (4 up-regulated, 5 down-regulated). IPA then detected eight network proteins and interpreted them in the context of established protein alterations for sepsis.CONCLUSION:The combination of proteomics and IPA could identify proteins in rat brain, whose expression was significantly regulated during sepsis. The methodological approach applied in the present study may facilitate the quest for novel sepsis-induced protein alterations in the future.

Spatial learning is known to depend on protein synthesis in the hippocampus. Whereas the role of the hippocampus in spatial memory is established, the biochemical and molecular mechanisms underlying this process are poorly understood. To comprehend the complex pattern of protein expression induced by spatial learning, we analyzed alterations in the rat hippocampus proteome after 7 days of spatial learning in the Morris water maze. Forty Wistar rats were randomized into two groups. Animals of group A learned to localize a hidden platform in the water maze. Animals of group B served as controls and spent exactly the same time in the water maze as animals of group A. However, no platform was used in this test and the rats could not learn to localize the target. After the last trial, hydrophilic proteins from the hippocampus were isolated. A proteome‐wide study was performed, based on two‐dimensional gel electrophoresis and mass spectrometry. Compared with non‐learning animals, 53 (70%) proteins were downregulated and 23 (30%) proteins were upregulated after 7 days in rats with spatial learning. The overall changes in protein expression, as quantified by the induction factor, ranged from −1.62 (downregulation to 62%) to 2.10 (upregulation by 110%) compared with controls (100%). Most identified proteins exhibit known functions in vesicle transport, cytoskeletal architecture, and metabolism as well as neurogenesis. These findings indicate that learning in the Morris water maze has a morphological correlate on the proteome level in the hippocampus.