title: [Anesthesiologic aspects of chemonucleolysis in local anesthesia].
abstract: After treatment of herniation of a lumbar disc by injection of the enzyme chymopapain, i. e. after chemonucleolysis, anaphylactic reactions can occur in about one per cent of the cases. In order to recognise the pattern of signs associated with such reactions, well in advance, while avoiding the additional risk of general anaesthesia, some authors propagate local anaesthesia. We report on our perioperative procedure in 102 cases of chemonucleolysis under local anaesthesia. Prick's tests were carried out before surgery to exclude sensitization to the substances to be injected. In two cases only due to a positive prick test to chymopapain chemonucleolysis had to be effected with collagenase; as a matter of fact, collagenase is not known to have caused any anaphylactic reactions, but it may be responsible for local side effects, such as destruction of adjacent tissues. The patients were kept under observation by an anaesthetist during and after surgery. No anaphylactic reaction was seen. Chemonucleolysis appears to be a suitable treatment method provided it is carried out under local anaesthesia with the same precautions as applied under regional anaesthesia by the anaesthetist.
authors.forename: J
authors.initials: J
authors.lastname: Schäffer
authors.forename: S
authors.initials: S
authors.lastname: Piepenbrock
authors.forename: H M
authors.initials: HM
authors.lastname: Mayer
authors.forename: M
authors.initials: M
authors.lastname: Brock
mesh_terms: D000328:Adult; D000772:Anesthesia, Local; D002917:Chymopapain / Q000009:adverse effects / Q000627:therapeutic use*; D004342:Drug Hypersensitivity / Q000209:etiology; D010450:Endopeptidases / Q000627:therapeutic use*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000188:drug therapy*; D007428:Intradermal Tests; D008159:Lumbar Vertebrae / Q000187:drug effects; D003012:Microbial Collagenase / Q000627:therapeutic use; D012306:Risk
chemical_list: D010450:Endopeptidases; D002917:Chymopapain; D003012:Microbial Collagenase
vernacular_title: Anästhesiologische Aspekte bei der Chemonukleolyse in Lokalanästhesie.