Emiliano Petrucci

Low Back Pain in a Natural Disaster

Low back pain is usually self‐limited. The transition from acute to chronic LBP is influenced by physical and psychological factors. Identification of all contributing factors, in a mass emergency setting, differentiating primary and secondary life‐threatening forms of LBP, is the best approach for success. Aims of the present report were to estimate the prevalence of LBP in population afferent to four advanced medical presidiums (AMPs) during postseismic emergency period and to evaluate frequency of use, types of pain killers administered to patients and short‐term efficacy of them.

High dose of buprenorphine in terminally ill patient with liver failure: Efficacy and tolerability

Pain in terminally ill patients with cancer can be often hard to manage, due to the unpredictable kinetics of drugs caused by progressive kidney and liver dysfunction. Plasma concentrations of active metabolites-also a cause of dangerous side effects--could be difficult to estimate. This case report holds the idea that buprenorphine, a partial agonist of m-receptors, even at high dosage, may be effective and safe to use in terminally ill patients with significant liver and kidney impairment.

Unilateral paravertebral block compared with subarachnoid anesthesia for the management of postoperative pain syndrome after inguinal herniorrhaphy: a randomized controlled clinical trial.

Abstract Inguinal herniorrhaphy is a common surgical procedure. The aim of this investigation was to determine whether unilateral paravertebral block could provide better control of postoperative pain syndrome compared with unilateral subarachnoid block (SAB). A randomized controlled study was conducted using 50 patients with unilateral inguinal hernias. The patients were randomized to receive either paravertebral block (S group) or SAB (C group). Paravertebral block was performed by injecting a total of 20 mL of 0.5% levobupivacaine from T9 to T12 under ultrasound guidance, whereas SAB was performed by injecting 13 mg of 0.5% levobupivacaine at the L3 to L4 level. Data regarding anesthesia, hemodynamic changes, side effects, time spent in the postanesthesia care unit, the Karnofsky Performance Status, acute pain and neuropathic disturbances were recorded. Paravertebral block provided good anesthesia of the inguinal region without patient or surgeon discomfort, with better hemodynamic stability and safety and with a reduced time to discharge from the postanesthesia care unit compared with SAB. During the postsurgical and posthospital discharge follow-ups, rest and incident pain and neuropathic positive phenomena were better controlled in the S group than in the C group. The consumption of painkillers was higher in the C group than in the S group throughout the follow-up period. Paravertebral block can be considered a viable alternative to common anesthetic procedures performed for inguinal hernia repair surgery. Paravertebral block provided good management of acute postoperative pain and limited neuropathic postoperative disturbances.

Anaesthesia management in patients with multiple chemical sensitivity syndrome.

Multiple Chemical Sensitivity (MCS) is characterised by the appearance of numerous and sometimes severe symptoms, when subjects are in contact with various chemicals and medicinal substances. Currently there are no useful guidelines for managing clinical issues and, specifically, anaesthesia for patients with MCS. This case report describes anaesthesia management in a patient affected by clinically documented MCS and a latex allergy, a candidate for a laparoscopic cholecystectomy operation.

The addition of continuous wound infusion of local anaesthetics to local infiltration in the management of postoperative pain and rehabilitation after total hip arthroplasty: a double-blind randomized controlled trial

BACKGROUND Total hip arthroplasty is one of the most common procedures in orthopedic surgery. We hypothesized that local infiltration of analgesia and continuous wound infusion of anesthetics in the first 72 hours after surgery could provide more effective postoperative analgesia with better rehabilitation. METHODS A double-blind, randomized, controlled study was conducted with 96 patients who underwent total hip arthroplasty. The patients were randomized to receive either a local infiltration analgesia and continuous wound infusion of anesthetics or a local infiltration analgesia and continuous wound infusion of saline solution. The patients in both groups received subarachnoid anesthesia and a local infiltration analgesia. A multihole catheter was placed next to the implant and connected to an electronic pump containing a 300-mL solution of 0.2% levobupivacaine (experimental group) or saline (control group). RESULTS A total of 96 consecutive patients were enrolled and randomized. Of these, 48 patients received local infiltration analgesia and continuous wound infusion of local anesthetics, and the remainder received local infiltration analgesia and continuous wound infusion of saline solution. The analysis showed a significant main effect of treatment on the postoperative incident of pain (Ftreat(1,93)=22.62, P=0.000) and on resting pain during the post-surgery follow-up (Ftreat(1,93)=15.62, P=0.0002). The pain scores during the rehabilitation period were significantly less in the experimental group. Analgesic consumption was less in the experimental group. CONCLUSIONS The addition of continuous wound infusion of anesthetics to local infiltration analgesia provided an extended analgesic effect associated with good rehabilitation performance.

Wireless and Low-Weight Technologies: Advanced Medical Assistance During a Cave Rescue: A Case Report

Trauma care in cave rescue is a unique situation that requires an advanced and organized approach with medical and technical assistance because of the extreme environmental conditions and logistical factors. In caving accidents, the most common injuries involve lower limbs. We describe an advanced medical rescue performed by the Italian Corpo Nazionale del Soccorso Alpino e Speleologico, in which extended focused assessment with sonography for trauma and an ultrasound-guided adductor canal block were performed on a patient with a knee distortion directly in the cave. The rescue team inside the cave shared data on patient monitoring and the ultrasound scanning in real time with rescuers at the entrance, using a video conference powered by the new Ermes system. The use of handheld, battery-powered, low-weight, multiparametric monitors, ultrasound machines, and digital data transmission systems could ensure complete medical assistance in harsh environmental conditions such as those found in a cave.

Ultrasound-guided Dry Needling Treatment of Myofascial Trigger Points for Piriformis Syndrome Management: A Case Series

Objective The purpose of this case series was to describe the outcomes of diagnostic ultrasound‐assisted dry needling in the management of piriformis syndrome. Clinical Features Case 1: a 45‐year‐old woman reported gluteal pain occasionally radiating in the sciatic region. Her magnetic resonance imaging showing sciatic nerve edema in the underlying portion of the piriformis muscle. Case 2: a 55‐year‐old man had gluteal pain after deep palpation or being in a prolonged sitting position. A previous magnetic resonance imaging showed a disk herniation at L2‐L3. Case 3: a 65‐year‐old woman reported pain in the sciatic area when she was walking and at nighttime rest. All patients had been treated with oral drugs, with poor results. Interventions and Outcome Patients had the same quality and duration of symptoms. The treatments of piriformis muscle and gluteus minimus, medius, and maximus muscles were performed using a convex probe and a 0.30 × 60 mm needle, which was inserted out of plane, maintaining a constant view of its tip. All patients were treated over 10 days and followed up for 6 months. Their symptoms resolved during this time and no adverse reactions were reported. Conclusion For these 3 patients with piriformis syndrome who were treated with ultrasound‐guided dry‐needling treatment, their symptoms resolved and their quality of life improved.

748 GENERAL MEDICINE AND PAIN IN ITALY, THERE IS STILL MUCH TO DO: THE RESULTS OF PROMETEO STUDY

management outcome, including pain reassessments and therapy reevaluation. Sometimes, GPs refuse to conduct the proposed pain therapy. Pitfalls schould be explained by low education in pain medicine (e.g. GPs suspicion on pts complains, opiophobia) and absence of regulatory issuses on pain management in health care system. Conclusion: Pain education and formation of pain units in all settings of medical practices should be addressed to health care authorities.

578 A STRONG OPIOID IN NEUROPATHIC PAIN: HYDROMORPHONE

Results: At the last follow-up control (t45) both groups reported a good pain relief (VAS≤3). More specific: in group A at t30 VAS 4±0.98 at t45 VAS 2±1.17; while in group B at t30 VAS 4 ±0.75 at t45 VAS 2±1.21. Our study failed to show a statistic significative difference (p < 0.05). 3 subjects of group A with DN related sleep difficulties reported the greatest pain relief with improved sleep quality. 2 subjects of group B reported urinary retention and decrease of libido after the treatment. Discussion: According to our data Duloxetin may be considered an effective treatment for neuropatic pain with better tolerability than usual antidepressants.