Mario Iannotti

Is pre-emptive administration of ketamine a significant adjunction to intravenous morphine analgesia for controlling postoperative pain? A randomized, double-blind, placebo-controlled clinical trial

OBJECTIVES To evaluate if the pre-emptive administration of ketamine would potentiate the effect of intravenous morphine analgesia in the management of post-thoracotomy pain. METHODS This was a unicentre, double-blind, placebo-controlled, parallel-group, prospective study. Patients were randomly assigned to receive 1 mg/kg ketamine (ketamine group) or an equivalent dose of normal saline (placebo group) before thoracotomy in 1:1 ratio. All patients received postoperatively intravenous morphine administration as additional analgesic regimen. Primary end-point was the pain relief measured with Visual Analogue Scale at rest. The secondary end-points were the reduction of inflammatory response expressed by plasma C-reactive protein levels, the morphine consumption and the rate of side effects. The measurements were carried out 6, 12, 24, 36 and 48 hours postoperatively. RESULTS A total of 75 patients were randomized of whom 38 were allocated to ketamine group and 37 to placebo group. Baseline characteristics were comparable. Ketamine compared with placebo group showed a significant reduction of pain scores (P = 0.01), C-reactive protein (P < 0.001) and morphine consumption (P < 0.001). No acute psychological side effects related to the use of ketamine were registered. CONCLUSIONS The administration of ketamine before surgery may be an effective adjunct to intravenous morphine analgesia in acute post-thoracotomy pain management. In ketamine group, satisfaction of pain relief was significantly higher with a significant reduction of inflammatory response and morphine consumption compared with placebo group. Our results, if confirmed by larger studies, may be of clinical relevance in situations where epidural analgesia or other analgesic procedures different from systemic opioid analgesia are unavailable or contraindicated.

Treatment of ischemic pain in patients suffering from peripheral vasculopathy with transdermal buprenorphine plus epidural morphine with ropivacaine vs. epidural morphine with ropivacaine.

Aim:  This study compared the efficacy and safety of buprenorphine transdermal delivery system with peridural infusion of morphine and ropivacaine to peridural infusion alone for the control of ischemic pain in patients suffering from peripheral vasculopathy.

191 ASSOCIATION OF BUPRENORPHINE TDS AND PREGABALIN IN THE TREATMENT OF LOW BACK PAIN

Aim. Pharmacoepidemiologic investigation regarding the frequency of associate diseases and the management of neuropathic pain. Neuropathic pain, caused by a primary lesion or dysfunction in the nervous system, is associated with many diseases, including diabetic peripheral neuropathy, posttherapeutic neuralgia, chronic radiculopathy and cancer-related pain. Major pathophysiological mechanisms include peripheral sensitization, sympathetic activation, disinhibition, and central sensitization. Method. This exploratory study was performed on 123 patients with neuropathic pain, with ages between 29 and 67, from a privat medical center in Romania, using a questionnaire consisting of some questions about intensity of pain, measured with the visual analogue scale (range = 0–10), associated diseases, and the treatment of neuropathic pain. Results. Analysis and statistical processing of data shows that neuropathic pain is most frecquent in male subjects (63.4%). In more than 84% of patients, the pain was reported to be intense to severe (range 6–10 to visual analogue scale). Of the patients, 48 presented with nociceptive chronic radiculopathy pain, 39 with diabetic pain, 19 with neoplastic pain and 12 with post-therapeutic neuralgia. Non-opioid analgesics (acetaminophen, ketoprofen, and indometacin) were administered to all patients, antidepressants (amitriptyline) to 4% and anticonvulsants (carbamazepine) to 1% of them. Opioid analgesics (tramadol) were used only in neoplastic patients, due to legal restrictions in use in Romania until the end of 2006. Conclusions. The study shows that neuropathic pain is often undertreated also due to economical and legal conditions in our country.

CGRP and Visceral Pain: The Role of Sex Hormones in In-Vitro Experiment.

A large number of studies have showed that women reported feeling pain more acutely than men. In support of this hypothesis, many research groups proved that in different animals model of pain the sex hormones regulate the somatic and visceral sensitivity to different noxious stimuli. Therefore, in this study, we went to evaluate if estrogen hormones by regulating the CGRP levels are implicated during the visceral pain transmission. Toward this aim, we have investigated the effect of 17β‐estradiol in regulating the synthesis and release of CGRP, as well as the expression levels of the opioid receptor of type K. In order to gain information about the potential effects of 17β‐estradiol on K‐opioid receptor expression and activity, we have cultured F11 cells. Our results revealed that, when F11 cells were short‐term exposed (30 min) to 17β‐estradiol, the expression of the opioid K receptor was not significantly modified. We carried out enzyme immunoassay analysis to evaluate the potential effects of short‐term exposure to 17‐estradiol (30 min) on the release of CGRP in F11 cells. The results obtained showed that 17β‐estradiol at the dose of 100 nM is able to induce the release of CGRP from F11 cells; whereas, a higher dose of 17β‐estradiol (200 nM) did not produce significant effects when compared to control. In conclusion, all these findings suggest that the 17β‐estradiol‐regulated release of CGRP could at least in part provide a rational explanation for the difference of gender in the visceral pain sensitivity. J. Cell. Biochem. 118: 510–517, 2017.

The Analgesic Effect of Betamethasone Administered to Outpatients before Conscious Sedation in Gynecologic and Obstetric Surgery

Conscious sedation, used with or without peripheral or central blocks, is an elective anesthetic technique used for many outpatient procedures. The aim of this study was to evaluate the effects of a single pre‐anesthetic dose of betamethasone (4 mg) on intraoperative and postoperative pain in 380 women, 18 to 75 years old, undergoing gynecologic and obstetric surgery (diagnostic curettage, operative and diagnostic hysteroscopy, conization, minilaparoscopy, cone biopsy, endometrial ablation, assisted reproduction techniques, and induced and therapeutic abortion) in a outpatient service. In this randomized, double‐blind, placebo‐controlled study, the patients were divided into two equal groups according to a computer‐generated randomized list. One group received 4 mg of betamethasone i.v. as a premedication (group B), whereas the placebo group (group P) received only saline. All patients underwent the same sedation, associated with a peripheral block. Pain was evaluated using a 5‐point verbal rating scale during surgery, after 2 h, and on discharge. In group B, intraoperative and postoperative pain was significantly less frequent than in group P (P < 0.001). Consequently, fewer women belonging to group B requested additional analgesic drugs during and after surgery (P < 0.01). Patients in group B also experienced a greater degree of satisfaction (P < 0.01). Briefly, a single dose of betamethasone seemed to reduce the incidence and severity of perioperative pain after gynecologic outpatient surgery.

644 PARACETAMOL + TRAMADOL TABLETS AFTER QUADRANTECTOMY FOR BREAST CANCER

641 PRELIMINARY STUDY OF COGNITIVE AND EMOTIONAL PREDICTORS OF POST-SURGERY PAIN IN PATIENTS SUBMITTED TO GYNECOLOGIC AND ORTHOPEDIC SURGERY P. Pinto *, A. Almeida, C. Correia, T. McIntyre. School of Psychology, Minho University, Braga, Portugal; School of Health Sciences, Minho University, Braga, Portugal; Alto Ave Hospital Center, Guimarães, Portugal; Department of Psychology, University of Houston, Houston, United States

Comparison of two rocuronium bromide doses in adult and elderly patients who underwent laparoscopic surgery.

ABSTRACT Background The aim of our study was to evaluate the effects of two different doses of rocuronium bromide (0.5 mg/kg and 0.9 mg/kg) on the length of neuromuscular block, on the haemodynamic stability and on the side effects in patients of different ages. Methods We recruited 80 patients who underwent laparoscopic surgery (cholecystectomy, appendicectomy, varicocelectomy) belonging to ASA I—II classes and divided them into four groups: • 20 adults (A0.5) who received rocuronium bromide 0.5 mg/kg • 20 elderly patients (E0.5) who received rocuronium bromide 0.5 mg/kg • 20 adults (A0.9) who received rocuronium bromide 0.9 mg/kg • 20 elderly patients (E0.9) who received rocuronium bromide 0.9 mg/kg Intubation conditions, continuous monitoring of HR, NIBP, SpO2, EtCO2 were recorded. Onset time, REC 25%, TOF-ratio 0.70 were analysed by TOF-WATCH. Nerve-evoked muscle tension and neuromuscular paralysis extension were expressed by strength of contraction of adductor pollicis, in response to a direct stimulation of the ulnar nerve (TOF). Results The results showed that in elderly patients the effect of rocuronium bromide, at two different doses, was similar. Significant differences regarding the onset time was found among the groups showing that with the same dose of rocuronium bromide, the onset time was prolonged in elderly patients compared to adult patients. Moreover, increasing the dose, the onset time was reduced in both groups (p < 0.05). Forty per cent of adult group A0.5 showed excellent intubation conditions versus 60% of A0.9 (p < 0.05); elderly patients did not show any significant difference in the intubation procedure after different doses of rocuronium bromide. Conclusions The results from the four groups showed that in elderly patients 0.5 mg/kg of rocuronium bromide resulted in a good recovery, while 0.9 mg/kg increased the recovery time. Moreover, in adults the high dose was more effective because it reduced the number of injections and post-operative recovery time.

627 BUPRENORPHINE TDS IN CRITICAL CARE PATIENTS: NEW APPROACH ON PAIN

0.9 [0.0; 2.0]/0.5 [0.0; 1.7], decrease of the current spinal pain intensity (DVAS) 0.6 [0.0; 2.5]/0.0 [−1.0, 1.0] (p = 0.006), decrease of the average headache intensity within the last 4 weeks. In the medication switch period, the number of study participants who favoured nabilone was more than 4 times higher than those who favoured placebo. Conclusion: In summary, the study results allow the conclusion that a majority of patients with chronic pain classify nabilone intake in addition to the standard treatment as a measure with a positive individual benefitrisk-ratio. Thus, this kind of treatment may be an interesting and attractive enrichment of analgetic therapy concepts.