Maternal and neonatal effects of adding morphine to low‑dose bupivacaine for epidural labor analgesia

Aim: Labor is one of the most painful experiences a woman may face during her lifetime. One of the most effective methods used for eliminating this pain is epidural analgesia. The aim of this study to determine the impact of adding morphine to low‑dose bupivacaine epidural anesthesia on labor and neonatal outcomes, and maternal side effects.Materials and Methods: This is a prospective randomized double‑blind study comparing two regimens of anesthetic agents used for epidural anesthesia in labor. A total of 120 pregnant women were randomized into two groups with 60 subjects in each study arm. A catheter was inserted, and 0.1% bupivacaine + 2 μg/mL fentanyl in 15 mL saline were given to Group bupivacaine‑fentanyl (Group BF), while 0.0625% bupivacaine + 2 μg/ml fentanyl + 2 mg morphine in 15 mL saline were given to Group bupivacaine‑fentanyl‑morphine (Group BFM) with no test dosing from the needle. No morphine was added to the subsequent epidural injections in Group BFM.Results: The total dose of bupivacaine was significantly lower in Group BFM relative to Group BF (P = 0.0001). The visual analogu scalescores at 15, 30, and 45 min were significantly lower in Group BF compared to thosein Group BFM (P = 0.0001, P = 0.001, and P = 0.006, respectively). The second stage of labor was significantly shorter in Group BFM relative to Group BF (P = 0.027 and P = 0.003, respectively). The satisfaction with analgesia following the first dose was higher in the nonmorphine group (P = 0.0001). However, maternal postpartum satisfaction was similar in both groups. Either nausea or vomiting was recorded in eight patients in Group BFM.Conclusion: We believe that epidural analgesia comprised of a low‑dose local anaesthetic and 2 mg morphine provides a painless labor that significantly reducesthe use of local anesthetic without changing the efficiency of the analgesic, ensuring the mother’s satisfaction without leading to an adverse effect on the mother or foetus, while mildly (but significantly) shortening the second stage of labor.Key words: Bupivacaine, epidural analgesia, fentanyl, morphine, painless labo

Is 18F-FDG-PET/CT prognostic factor for survival in patients with small cell lung cancer? Single center experience

Background: Although a number of studies in patients with a variety of malignant tumors have shown that metabolic activity on fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) is correlated with survival, there are few studies about the impact of 18F-FDG-PET/CT for survival in small cell lung cancer (SCLC) patients. There is still some ambiguity as to whether FDG PET in patients with SCLC will ensure prognostic knowledge for survival. We performed a retrospective analysis of prognostic implication of 18F-FDG-PET/CT in patients with SCLC. Methods: We retrospectively reviewed 54 patients with histologically or cytologically proven SCLC who had undergone pre-treatment 18F-FDG-PET/CT scanning between September 2007 and November 2011 in the Dicle University, School of Medicine, Department of Medical Oncology. SUVmax and other potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival. Result: Among the eleven variables of univariate analysis, three variables were identified as having prognostic significance: Performance status (p < 0.001), stage (p = 0.02) and diabetes mellitus (p = 0.05).Multivariate analysis showed that performance status and stage were considered independent prognostic factors for survival (p < 0.001 and p = 0.002 respectively). Conclusion: In conclusion, performance status and stage were identified as important prognostic factors, while 18F-FDG-PET/CT uptake of the primary lesions was not associated with prognostic importance for survival in patients with SCLC. Resumo: Antecedentes: Embora uma série de estudos em pacientes com uma diversidade de tumores malignos tenham demonstrado que a atividade metabólica na tomografia computorizada por emissão de positrões de deoxiglucose marcada com flúor-18 (18F-FDG-PET/CT) está correlacionada com a sobrevivência, existem poucos estudos sobre o impacto do 18F-FDG-PET/CT para a sobrevivência em pacientes com cancro pulmonar de células pequenas (SCLC). Ainda existe alguma ambiguidade de que, em pacientes com SCLC, o FDG PET forneça informações importantes relativamente de prognóstico para a sobrevivência. Realizámos uma análise retrospetiva da implicação no prognóstico de 18F-FDG-PET/CT em pacientes com SCLC. Métodos: Analisámos retrospetivamente 54 pacientes com SCLC comprovado histologicamente ou citologicamente, que tinham realizado 18F-FDG-PET/CT entre setembro de 2007 e novembro de 2011, na Universidade de Dicle, Faculdade de Medicina, Departamento de Oncologia Médica. Foram escolhidas a SUVmax e outras potenciais variáveis de prognóstico para a análise neste estudo. Foram realizadas análises univariadas e multivariadas para identificar os fatores de prognóstico associados à sobrevivência. Resultado: Entre as 11 variáveis da análise univariada, 3 variáveis foram identificadas como tendo significância para o prognóstico. Estado Geral (p < 0,001), estádio (p = 0,02) e diabetes mellitus (p = 0,05).A análise multivariada mostrou que o Estado Geral e o estádio foram considerados fatores de prognóstico independentes para a sobrevivência (p < 0,001, p = 0,002 respetivamente). Conclusão: Em conclusão, o Estado Geral e o estádio foram identificados como importantes fatores de prognóstico, enquanto a absorção de 18F-FDG-PET/CT das lesões primárias não se associou ao prognóstico para a sobrevivência em pacientes com SCLC. Keywords: Small cell lung cancer, Prognostic factors, 18F-FDG-PET/CT, Palavras-chave: Cancro pulmonar de pequenas células, Fatores de prognóstico, 18F-FDG-PET/C

The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery

Background: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. Methods: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen group (Group 2). Patients were followed for 48 hours to compare both groups for; post-operative pain scores, effectiveness of postoperative analgesia, duration of analgesia, and analgesia consumption. Duration of postoperative sensory block of the shoulder joint was defined as time to onset of pain at the incision site. Duration of postoperative motor block of the shoulder joint was defined as time to onset of first shoulder movement. Results: While no significant difference was determined for motor block time, sensory block time was significantly longer in the dexketoprofen group (p < 0.05).VAS scores were significantly lower at all times in the dexketoprofen group (p < 0.05).Total PCA fentanyl consumption was 274.16 ± 314.89 (μg) in the dexketoprofen group, and 490.00 ± 408.98 (μg) in the control group, the difference was statistically significant (p < 0.05). No significant difference was observed between the groups’ demographic and hemodynamic data. Conclusion: Pre-emptive IV dexketoprofen may be a good option for arthroscopic shoulder surgery and provides effective analgesia

Comparative Investigation of Protective Effects of Metyrosine and Metoprolol Against Ketamine Cardiotoxicity in Rats

Ahiskalioglu, Ali/0000-0002-8467-8171; ALP, Hamit Hakan/0000-0002-9202-4944; Ahiskalioglu, Ali/0000-0002-8467-8171; AKSOY, Mehmet/0000-0003-0867-8660WOS: 000361605900005PubMed: 25503950This study investigated the effect of metyrosine against ketamine-induced cardiotoxicity in rats and compared the results with the effect of metoprolol. in this study, rats were divided into groups A, B and C. in group A, we investigated the effects of a single dose of metyrosine (150 mg/kg) and metoprolol (20 mg/kg) on single dose ketamine (60 mg/kg)-induced cardiotoxicity. in group B, we investigated the effect of metyrosine and metoprolol, which were given together with ketamine for 30 days. in group C, we investigated the effect of metyrosine and metoprolol given 15 days before ketamine and 30 days together with ketamine on ketamine cardiotoxicity. By the end of this process, we evaluated the effects of the levels of oxidant-antioxidant parameters such as MDA, MPO, 8-OHGua, tGSH, and SOD in addition to CK-MB and TP I on cardiotoxicity in rat heart tissue. the experimental results show that metyrosine prevented ketamine cardiotoxicity in groups A, B and C and metoprolol prevented it in only group C