Introduction For endoprosthetic knee surgery, intensive postoperative pain therapy is necessary. We therefore evaluated whether the combination of continuous psoas compartment and sciatic analgesia (PSC) is as effective as epidural analgesia (EPI) and whether it provides better analgesia than patient-controlled intravenous analgesia with piritramide (PCA).Methods We studied 63 patients who underwent total knee arthroplasty (TKA). The PSC group received a combination of continuous psoas and sciatic nerve block, the EPI group an epidural analgesia, and the PCA group an intravenous patient-controlled piritramide pump. Pain scores, satisfaction, flexion and side effects were recorded.Results Pain scores (0-10) were higher in the PCA group (on movement, day 1/day 2: 7.0/6.5) than in the EPI group (5.0/5.0) and the PSC group (4.0/3.5). Postoperative opioid consumption over 48 h was higher in the PCA group (51 mg) than in the EPI group (0 mg) and the PSC group (0 mg). There were no differences in functional recovery. Pruritus occurred more frequently in the PCA and EPI groups than in the PSC group. Patients receiving a PSC and EPI were more satisfied than those treated with PCA.Interpretation Analgesia with PSC catheters or EPI catheter is superior to PCA regarding pain levels, analgesic requirements, and patient satisfaction. There
Survival of Staphylococci in Lysa~es~ummary. 1. Twelve pathogenetie strains of staphylococci survived in 0.9% IqaC1 according to the density of their suspensions, i.e. the greater the number of germs, the longer the time of survival.2. Lysates of these 12 strains were mixed with staphylococci. Whereas standard doses of germs in NaC1 solution survived 2--3 days only, the same quantity of staphylococci added to these lysates survived up to 4 months. The survival time was found to be directly related to the dilution of lysates.3. It is possible to keep these bacteria alive in lysates for a long time, if they are transferred in regular intervals to new lysates. The biological properties of the strains did not ohange.4. By means of the Warburg apparatus it could be demonstrated that the respiration of the germs suspended in lysat~s was significantly augmented in comparison to the controls suspended in NaC1 solution.5. All investigations concerning lysates have been performed with isologous and homologous lysates. No differences in the behavior of respiration between isologons and homologous strains in different lysat~s could be observed.6. Staphylococci are able to survive over longer periods in a substrate prepared from killed germs of their own. Zusammen]assung. 1. Die ~berlebenszeiten (Tage-Monato) yon 12 pathogenen in NaC1-L6sung aufgesehwemmten Staphylokokken-StEmmen waren abh/~ngig yon der Menge der jeweils verwendeten Keime. Je gr61]er die Keimzakl, desto 1/~nger die ~.~berlebenszeiten.2. In Staphylokokken-Lysaten ergaben sieh gegenfiber den KontroIlen in NaCIL6sung (2--3 Tage) ~berlebenszeiten bis zu 4 Monaten. Diese t)berlebenszeiten sind unmittelbar abhEngig yon den vorgegebenen Lysat-Konzentrationen.3. Es gelingt, Staphylokokken in Lysatans~tzen bei regelm~Bigem Oberimpfen in frisehes Lysat fiber sehr lange Zeitr~ume lebensf~hig zu erhalten, ohne dab sieh ihre biologisehen Eigensehaften ~ndern.4. Im Warburg-Apparat war eine deutliehe Steigerung der Zellatmtmg festzustellen.5. Alle Versuehe mit Lysaten sind im isologen und homologen Ansatz geprfift worden. Untersehiedlicho Ergebnisse waren dabei nicht zu beobaehten.6. Staphylokokken sind in der Lage, sieh anssehlieBlieh mit ihren eigenen Lysaten fiber 1/~ngere Zeitabsehnitte am Leben zu erhalton.
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