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Chrysanthi Batistaki – One of the best experts on this subject based on the ideXlab platform.

  • Bilateral Thoracic Splanchnic Nerve Radiofrequency Thermocoagulation for the Management of End-Stage Pancreatic Abdominal Cancer Pain
    Pain Physician, 2013
    Co-Authors: Chrysanthi Batistaki
    Abstract:

    Background: Pancreatic Cancer pain is often severe and refractory to conservative therapies. Several interventional techniques have been described for the management of end-stage pancreatic Cancer pain, with variable results and complications. Objectives: The aim of this study was to assess the efficacy of bilateral radiofrequency thermocoagulation of splanchnic nerves for pain relief, the consumption of opioids, and the quality of life in patients suffering from severe pain due to pancreatic malignancies. Study Design: A retrospective observational design. Setting: The study includes patients with end-stage pancreatic Abdominal Cancer pain, which is refractory to conservative treatment. Methods: Thirty-five patients were studied. They were evaluated prior to and after the radiofrequency thermocoagulation of both splanchnic nerves under fluoroscopic guidance. The assessment included the pain intensity (Numeric Rating Scale 0 – 10), quality of life (selfreported quality of life score 0 – 10), and 24-hour consumption of opioids with monthly follow-up visits until the end of life. Results: Follow-up was completed 6 months after the intervention. The pain scores, quality of life, and consumption of opioids were significantly improved during the entire follow-up period. A slight deterioration was noticed during the fifth month because of malignancy progression. No complications that could be attributed to the technique were observed. Limitations: The study was not prospective and does not have a control group with a different intervention for comparisons. Conclusion: Radiofrequency thermocoagulation of both splanchnic nerves may offer a safe and effective technique for pain management and quality of life improvement in patients with end-stage pancreatic Cancer towards the end of life. Key words: Splanchnic nerves, radiofrequency thermocoagulation, pancreatic Cancer, pain

  • Bilateral thoracic splanchnic nerve radiofrequency thermocoagulation for the management of end-stage pancreatic Abdominal Cancer pain.
    Pain physician, 2013
    Co-Authors: Dimitrios Papadopoulos, Georgia Kostopanagiotou, Chrysanthi Batistaki
    Abstract:

    BACKGROUND Pancreatic Cancer pain is often severe and refractory to conservative therapies. Several interventional techniques have been described for the management of end-stage pancreatic Cancer pain, with variable results and complications. OBJECTIVES The aim of this study was to assess the efficacy of bilateral radiofrequency thermocoagulation of splanchnic nerves for pain relief, the consumption of opioids, and the quality of life in patients suffering from severe pain due to pancreatic malignancies. STUDY DESIGN A retrospective observational design. SETTING The study includes patients with end-stage pancreatic Abdominal Cancer pain, which is refractory to conservative treatment. METHODS Thirty-five patients were studied. They were evaluated prior to and after the radiofrequency thermocoagulation of both splanchnic nerves under fluoroscopic guidance. The assessment included the pain intensity (Numeric Rating Scale 0 – 10), quality of life (self-reported quality of life score 0 – 10), and 24-hour consumption of opioids with monthly follow-up visits until the end of life. RESULTS Follow-up was completed 6 months after the intervention. The pain scores, quality of life, and consumption of opioids were significantly improved during the entire follow-up period. A slight deterioration was noticed during the fifth month because of malignancy progression. No complications that could be attributed to the technique were observed. LIMITATIONS The study was not prospective and does not have a control group with a different intervention for comparisons. CONCLUSION Radiofrequency thermocoagulation of both splanchnic nerves may offer a safe and effective technique for pain management and quality of life improvement in patients with end-stage pancreatic Cancer towards the end of life.

Donald W Moorman – One of the best experts on this subject based on the ideXlab platform.

  • impact of body mass index on perioperative outcomes in patients undergoing major intra Abdominal Cancer surgery
    Annals of Surgical Oncology, 2008
    Co-Authors: John T Mullen, Daniel L Davenport, Matthew M Hutter, Patrick Hosokawa, William G Henderson, Shukri F Khuri, Donald W Moorman
    Abstract:

    Background Obesity is an increasingly common serious chronic health condition. We sought to determine the impact of body mass index (BMI) on perioperative outcomes in patients undergoing major intra-Abdominal Cancer surgery.

  • Impact of body mass index on perioperative outcomes in patients undergoing major intra-Abdominal Cancer surgery
    Annals of surgical oncology, 2008
    Co-Authors: John T Mullen, Daniel L Davenport, Matthew M Hutter, Patrick Hosokawa, William G Henderson, Shukri F Khuri, Donald W Moorman
    Abstract:

    Obesity is an increasingly common serious chronic health condition. We sought to determine the impact of body mass index (BMI) on perioperative outcomes in patients undergoing major intra-Abdominal Cancer surgery. A prospective, multi-institutional, risk-adjusted cohort study of patients undergoing major intra-Abdominal Cancer surgery was performed from the 14 university hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program (NSQIP). Demographic, clinical, and intraoperative variables and 30-day morbidity and mortality were prospectively collected in standardized fashion. Analysis of variance, Bonferroni multiple comparisons of means tests, and multivariable logistic regression analysis were performed. We identified 2258 patients who underwent esophagectomy (n = 29), gastrectomy (n = 223), hepatectomy (n = 554), pancreatectomy (n = 699), or low anterior resection/proctectomy (n = 753). Patients were stratified by National Institutes of Health (NIH)-defined BMI obesity class, with 573 (25.4%) patients classified as obese (BMI > 30 kg/m(2)). There were no differences in mean work relative value units, total time of operation, or length of stay amongst the BMI classes. After adjusting for other risk factors, obesity was not a risk factor for death or major complications but was a risk factor for wound complications. The risk of postoperative death was greatest in underweight patients (odds ratio [OR] 5.24; 95% confidence interval [CI] 1.7-16.2). In patients undergoing major intra-Abdominal Cancer surgery, obesity is not a risk factor for postoperative mortality or major complications. Importantly, underweight patients have a fivefold increased risk of postoperative mortality, perhaps a consequence of their underlying nutritional status.

Sahar Abdel-baky Mohamed – One of the best experts on this subject based on the ideXlab platform.

  • Effect of Intrathecally Administered Ketamine, Morphine, and Their Combination Added to Bupivacaine in Patients Undergoing Major Abdominal Cancer Surgery a Randomized, Double-Blind Study.
    Pain medicine (Malden Mass.), 2017
    Co-Authors: Ahmad Ma El-rahman, Sahar Abdel-baky Mohamed, Ashraf Amin Mohamed, Mohamed Ahmed Mohamed Mostafa
    Abstract:

    Objective Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major Abdominal Cancer surgery. Study Design Prospective, randomized, double-blind. Setting Academic medical center. Patients and Methods Ninety ASA I-III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 mL volume and 0.3 mg morphine in 1 mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1 mL volume instead of morphine. The morphine + ketamine group (group K + M) received both 0.3 mg morphine and 0.1 mg/kg ketamine in 1 mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Results Total PCA morphine was significantly decreased in group M + K compared with groups M and K. Time to first request of analgesia was prolonged in groups M and M + K compared with group K (P < 0.001). VAS in group M + K was reduced from two to 24 hours, and in group M from 12 and 18 hours postoperation compared with group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M + K compared with group M until six hours postoperation. No other side effects were observed. Conclusions Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients who underwent major Abdominal Cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

  • The effect of morphine added to bupivacaine in ultrasound guided transversus abdominis plane (TAP) block for postoperative analgesia following lower Abdominal Cancer surgery, a randomized controlled study.
    Journal of clinical anesthesia, 2017
    Co-Authors: Fatma A. El Sherif, Sahar Abdel-baky Mohamed, Shereen Mamdouh Kamal
    Abstract:

    Abstract Objectives Transversus abdominis plane (TAP) block used for management of surgical Abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower Abdominal Cancer surgery. Study design Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096. Setting Academic medical center. Patients Sixty patients were enrolled in this study after ethical committee approval. Interventions Patients divided into 2 groups (30 each): Bupivacaine group (GB): given ultrasound guided TAP-block 20ml 0.5% bupivacaine diluted in 20ml saline; Morphine group (GM): given ultrasound guided TAP-block with 20ml 0.5% bupivacaine+10mg morphine sulphate diluted in 20ml saline. Measurements Patients were observed for total morphine consumption, time for first request of rescue analgesia, sedation scores, hemodynamics and side effects for 24h postoperatively. Results Morphine added to bupivacaine in TAP block compared to bupivacaine alone reduced total morphine consumption (5.33±1.28mg) (10.70±3.09mg) respectively (p 0.05). Conclusion Addition of morphine to bupivacaine in TAP block is effective method for pain management in patients undergoing major Abdominal Cancer surgery without serious side effects.

  • Combined Intrathecal Morphine and Dexmedetomidine for Postoperative Analgesia in Patients Undergoing Major Abdominal Cancer Surgery
    Pain medicine (Malden Mass.), 2016
    Co-Authors: Hala Saad Abdel-ghaffar, Sahar Abdel-baky Mohamed, Khaled Mohamed Fares
    Abstract:

    To compare the analgesic effect of combined intrathecal morphine and dexmedetomidine with either drug alone for postoperative analgesia in patients undergoing major Abdominal Cancer surgery. Ninety patients were allocated to receive intrathecal 10 mg bupivacaine 0.5% (bupivacaine group, n = 30), 10 mg bupivacaine 0.5% and 0.5 mg morphine (Morphine Group, n = 30), or 10 mg bupivacaine 0.5%, 0.5 mg morphine and 5 µg dexmedetomidine (morphine-Dex group, n = 30). The groups were compared with time to first postoperative analgesia, iv patient-controlled analgesia (PCA) morphine consumption, pain scores, hemodynamics, sedation, and adverse events in the first 48h postoperative. The time to first use of morphine PCA was longer in morphine (22.13 ± 5.21h, P = 0.000) and morphine-Dex (23.46 ± 4.69h, P = 0.000) groups compared with bupivacaine group (0.50 ± 0.09h). Dexmedetomidine addition increased the duration of intrathecal morphine (ITM) analgesia by 1.33 h (P = 0.485). Morphine consumption was less in morphine (10.83 ± 2.96 mg, P = 0.000) and morphine-Dex (11.00 ± 3.32 mg, P = 0.000) groups than in bupivacaine group (27.5 ± 4.30 mg), with a nonsignificant difference between morphine and morphine-Dex groups (P = 0.375). Morphine and morphine-Dex groups showed lower pain scores (P < 0.001). Intraoperative blood pressure and heart rate were lower in morphine and morphine-Dex groups (P < 0.05) with no significant difference between groups in postoperative hemodynamics. Patients in bupivacaine group showed a higher incidence of postoperative nausea (P < 0.03) and vomiting (P < 0.01), while patients in morphine and morphine-Dex groups had a higher incidence of pruritus (P < 0.02). Our results do not support improved analgesia with the combination of intrathecal morphine and dexmedetomidine, despite the absence of significant adverse effects. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.