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Chrysanthi Batistaki - One of the best experts on this subject based on the ideXlab platform.
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Bilateral Thoracic Splanchnic Nerve Radiofrequency Thermocoagulation for the Management of End-Stage Pancreatic Abdominal Cancer Pain
Pain Physician, 2013Co-Authors: Chrysanthi BatistakiAbstract: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
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Bilateral thoracic splanchnic nerve radiofrequency thermocoagulation for the management of end-stage pancreatic Abdominal Cancer pain.
Pain physician, 2013Co-Authors: Dimitrios Papadopoulos, Georgia Kostopanagiotou, Chrysanthi BatistakiAbstract: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.
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impact of body mass index on perioperative outcomes in patients undergoing major intra Abdominal Cancer surgery
Annals of Surgical Oncology, 2008Co-Authors: John T Mullen, Daniel L Davenport, Matthew M Hutter, Patrick Hosokawa, William G Henderson, Shukri F Khuri, Donald W MoormanAbstract: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.
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Impact of body mass index on perioperative outcomes in patients undergoing major intra-Abdominal Cancer surgery
Annals of surgical oncology, 2008Co-Authors: John T Mullen, Daniel L Davenport, Matthew M Hutter, Patrick Hosokawa, William G Henderson, Shukri F Khuri, Donald W MoormanAbstract: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.
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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.), 2017Co-Authors: Ahmad Ma El-rahman, Sahar Abdel-baky Mohamed, Ashraf Amin Mohamed, Mohamed Ahmed Mohamed MostafaAbstract: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.
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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, 2017Co-Authors: Fatma A. El Sherif, Sahar Abdel-baky Mohamed, Shereen Mamdouh KamalAbstract: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.
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Combined Intrathecal Morphine and Dexmedetomidine for Postoperative Analgesia in Patients Undergoing Major Abdominal Cancer Surgery
Pain medicine (Malden Mass.), 2016Co-Authors: Hala Saad Abdel-ghaffar, Sahar Abdel-baky Mohamed, Khaled Mohamed FaresAbstract: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.
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Intrathecal Dexmedetomidine, Ketamine, and their Combination Added to Bupivacaine for Postoperative Analgesia in Major Abdominal Cancer Surgery.
Pain physician, 2016Co-Authors: Sahar Abdel-baky Mohamed, Ahmad Ma El-rahman, Khaled Mohamed FaresAbstract:Background Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major Abdominal Cancer surgery. Design Double-blinded, randomized, controlled trial. Setting Academic medical center. Methods Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P Limitations This study is limited by its relatively small sample size. Conclusion In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone.
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High dose intrathecal morphine for major Abdominal Cancer surgery: a prospective double-blind, dose-finding clinical study.
Pain physician, 2014Co-Authors: Khaled Mohamed Fares, Sahar Abdel-baky Mohamed, Hala Saad Abdel-ghaffarAbstract:BACKGROUND Despite 30 years of clinical research, we still do not know the optimal dose of intrathecal morphine (ITM) when used alone. OBJECTIVES A safety investigation and comparison of the analgesic efficacy of ITM 0.2 mg, 0.5 mg, and 1 mg in patients undergoing major Abdominal Cancer surgery. STUDY DESIGN A randomized, double-blind trial. SETTING Academic medical center. METHODS Ninety patients were randomly assigned to receive morphine intrathecally either 0.2 mg (Group I, ITM 0.2 mg, n = 30), 0.5 mg (Group II, ITM 0.5 mg, n = 30), or 1 mg (Group III, ITM 1 mg, n = 30) dissolved in 5 mL physiological saline before general anesthesia. Assessment parameters included hemodynamics, respiratory rate, peripheral arterial oxygenation, sedation score, pain severity, time of first analgesic request, total analgesic consumption, and side effects in the first 72 hours. RESULTS The mean time to first request for rescue analgesia was significantly prolonged in Group II (22.13 ± 5.21 hours, P < 0.001) and Group III (30.83 ± 4.89 h, P < 0.001), compared with Group I (0.50 ± 0.66 hours). The mean tramadol consumption dose was significantly reduced in Group II (383.33 ± 91.28 mg, P < 0.001) and Group III (300 ± 69.48 mg, P < 0.001) compared with Group I (770 ± 114.92 mg). Patients received 1 mg ITM showed lower VAS scores in the first 48 h postoperative (P < 0.04) compared with Group I and Group II. No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate, and peripheral arterial oxygen saturation between groups. Lower mean heart rate values were observed in Group III patients at 6 hours (P < 0.01) and 12 hours (P < 0.03) postoperative compared with Group I and Group II patients. Six patients (20%) in Group II and 8 (26.7%) in Group III exhibited pruritus compared with 2 patients (6.66%) in Group I (P < 0.01). No intergroup statistical differences were observed for other studied side effects. LIMITATIONS This study is limited by its small sample size. CONCLUSION One mg ITM provided superior analgesia for 48 hours postoperative compared with 0.2 mg and 0.5 mg ITM with a nonsignificant difference in the incidence of side effects. Further studies of larger sample size are recommended to confirm these findings.
Khaled Mohamed Fares - One of the best experts on this subject based on the ideXlab platform.
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Epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing Abdominal Cancer surgery: randomized trial.
Journal of pain research, 2018Co-Authors: Diab Fuad Hetta, Khaled Mohamed Fares, Abualauon Mohamed Abedalmohsen, Amani Hassan Abdel-wahab, Ghada Mohammed Abo Elfadl, Wesam Nashat AliAbstract:To assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major Abdominal Cancer surgery. Patients scheduled for major upper Abdominal Cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine (n=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/h of bupivacaine 0.1% + dexmedetomidine, 0.5 µg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS pain score were evaluated. The cumulative morphine consumption was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs 23.23±8.37 mg with an estimated difference (95% CI) of -12.83 (-16.43, -9.24), (P<0.001). The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, (P<0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine : mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of -0.8 (-1, -0.86), (P<0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference (95% CI) of -1.1 (-1.27, - 0.89), (P<0.001), respectively. Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major Abdominal Cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.
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Combined Intrathecal Morphine and Dexmedetomidine for Postoperative Analgesia in Patients Undergoing Major Abdominal Cancer Surgery
Pain medicine (Malden Mass.), 2016Co-Authors: Hala Saad Abdel-ghaffar, Sahar Abdel-baky Mohamed, Khaled Mohamed FaresAbstract: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.
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Intrathecal Dexmedetomidine, Ketamine, and their Combination Added to Bupivacaine for Postoperative Analgesia in Major Abdominal Cancer Surgery.
Pain physician, 2016Co-Authors: Sahar Abdel-baky Mohamed, Ahmad Ma El-rahman, Khaled Mohamed FaresAbstract:Background Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major Abdominal Cancer surgery. Design Double-blinded, randomized, controlled trial. Setting Academic medical center. Methods Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P Limitations This study is limited by its relatively small sample size. Conclusion In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone.
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Efficacy and safety of dexmedetomidine added to caudal bupivacaine in pediatric major Abdominal Cancer surgery.
Pain physician, 2014Co-Authors: Khaled Mohamed Fares, Ahmed H. Othman, Nelly H AlieldinAbstract:Background Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective alpha-2 agonist with sedative and analgesic properties. Objective To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for caudal analgesia in children undergoing major Abdominal Cancer surgery. Study design A randomized double-blind trial. Setting Academic medical center. Methods Forty pediatric patients, aged 3 - 12 years, weighting 10 - 40 kg, and of American Society of Anesthesiologists (ASA) physical status I and II scheduled for major Abdominal Cancer surgeries under general anesthesia combined with caudal analgesia were enrolled. They were randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with dexmedetomidine 1 μg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes. Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia and total analgesic consumption in the first 24 hours were recorded. The level of sedation was recorded using Ramsay's sedation scale [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)]. Adverse effects were recorded and treated. Results There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no significant difference. Time of the first rescue analgesic requirement was significantly prolonged in group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when compared with group B (810.35 ± 200.93) mg. Limitations This study is limited by its small sample size. Conclusion Addition of dexmedetomidine (1 μg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major Abdominal Cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance.
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High dose intrathecal morphine for major Abdominal Cancer surgery: a prospective double-blind, dose-finding clinical study.
Pain physician, 2014Co-Authors: Khaled Mohamed Fares, Sahar Abdel-baky Mohamed, Hala Saad Abdel-ghaffarAbstract:BACKGROUND Despite 30 years of clinical research, we still do not know the optimal dose of intrathecal morphine (ITM) when used alone. OBJECTIVES A safety investigation and comparison of the analgesic efficacy of ITM 0.2 mg, 0.5 mg, and 1 mg in patients undergoing major Abdominal Cancer surgery. STUDY DESIGN A randomized, double-blind trial. SETTING Academic medical center. METHODS Ninety patients were randomly assigned to receive morphine intrathecally either 0.2 mg (Group I, ITM 0.2 mg, n = 30), 0.5 mg (Group II, ITM 0.5 mg, n = 30), or 1 mg (Group III, ITM 1 mg, n = 30) dissolved in 5 mL physiological saline before general anesthesia. Assessment parameters included hemodynamics, respiratory rate, peripheral arterial oxygenation, sedation score, pain severity, time of first analgesic request, total analgesic consumption, and side effects in the first 72 hours. RESULTS The mean time to first request for rescue analgesia was significantly prolonged in Group II (22.13 ± 5.21 hours, P < 0.001) and Group III (30.83 ± 4.89 h, P < 0.001), compared with Group I (0.50 ± 0.66 hours). The mean tramadol consumption dose was significantly reduced in Group II (383.33 ± 91.28 mg, P < 0.001) and Group III (300 ± 69.48 mg, P < 0.001) compared with Group I (770 ± 114.92 mg). Patients received 1 mg ITM showed lower VAS scores in the first 48 h postoperative (P < 0.04) compared with Group I and Group II. No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate, and peripheral arterial oxygen saturation between groups. Lower mean heart rate values were observed in Group III patients at 6 hours (P < 0.01) and 12 hours (P < 0.03) postoperative compared with Group I and Group II patients. Six patients (20%) in Group II and 8 (26.7%) in Group III exhibited pruritus compared with 2 patients (6.66%) in Group I (P < 0.01). No intergroup statistical differences were observed for other studied side effects. LIMITATIONS This study is limited by its small sample size. CONCLUSION One mg ITM provided superior analgesia for 48 hours postoperative compared with 0.2 mg and 0.5 mg ITM with a nonsignificant difference in the incidence of side effects. Further studies of larger sample size are recommended to confirm these findings.
George Macrinici - One of the best experts on this subject based on the ideXlab platform.
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Low Volume Neurolytic Retrocrural Celiac Plexus Block for Visceral Cancer Pain: Retrospective Review of 507 Patients with Severe Malignancy Related Pain Due to Primary Abdominal Cancer or Metastatic Disease.
Pain physician, 2018Co-Authors: Abed Rahman, Raed Rahman, George MacriniciAbstract:Background Abdominal pain from primary Cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant to conventional analgesics. The need for timely pain relief in order to facilitate further care in the Cancer treatment plan should be a priority. Objectives The aim of this retrospective observational review was to assess the relief given with a low volume neurolytic retrocrural celiac plexus nerve block, the duration of the procedure, the duration of relief, the reduction in daily opioid consumption, and the improvement of quality of life in a patient suffering from incapacitating Abdominal pain due to primary Abdominal malignancy or Abdominal metastatic disease. Patients were given a neurolytic celiac plexus block without previous diagnostic block due to multiple comorbidities. Study design This is a retrospective, observational study. Methods Five hundred and seven patients were studied and data at 5 months for 455 patients were retained at the end of the review. They were evaluated in the pain center prior to and after the neurolytic retrocrural celiac plexus nerve block under fluoroscopic guidance. They were assessed on duration of procedure, pain scores (numeric rating scale 0-10), daily opioid consumption, quality of life improvement (simple yes or no question at 3 months) and routine follow-up during treatment for the Cancer for 6 months or end of life. All data was gathered by extensive chart review and placed on a spreadsheet for analysis. Results Follow-up was completed 6 months after the procedure. Pain scores, daily opioid consumption, and quality of life showed improvement for the duration of the study. There was some return in pain during the fourth to sixth month due to disease progression and the anticipated duration of the neurolytic agent. Some short duration known side effects did occur. An initial vascular contrast uptake of 6.7% was noted during the procedure while utilizing digital subtraction angiography with fluoroscopy. Limitations A larger sample size would be ideal, as well as, a prospective trial with a control group, but this is unrealistic in our patient population. A proven quality of life questionnaire would be beneficial. Comparing alcohol, phenol and radiofrequency thermocoagulation would be interesting to equate duration, effect, and side effects. Conclusion Low volume neurolytic retrocrural celiac plexus nerve block with phenol is a safe procedure providing up to 6 months of pain relief and is an effective, well-established, minimally time-consuming procedure for Abdominal pain due to primary malignancy or metastatic spread. Key words Celiac plexus, neurolytic, Abdominal Cancer pain, pain, retrocrural, Cancer pain.
