SERUM TOTAL CPK ALTERATION AND ITS ISOENZYMES UNDER THE INFLUENCE OF ANAESTHESIA, DURING NORMAL DELIVERY AND CAESARIAN SECTION

IT WAS DISCOVERED FROM THE CONCLUSIONS THAT THERE IS A STATISTICALLY SIGNIFICANT DIFFERENCE IN THE MEAN RATE OF SERUM CPK BEFORE THE ANAESTHESIA ALLOWANCE, FROM THE MEAN RATE OF CPK AFTER THE ANAESTHESIA ALLOWANCE, IN BOTH KINDS OF CHILD BIRTH. IT WAS ALSO PROVED THAT THE MEAN QUANTITY OF TOTAL SERUM CPK IN THENATURAL CHILD BIRTH, IS BIGGER THAN THAT IN THE CAESARIAN SECTION REGARDLESS OF HAVING TAKEN THE BLOOD SAMPLE BEFORE OR AFTER THE ANAESTHESIA ALLOWANCE. ATLAST IT SEEMED FROM THE STUDY OF CPK ISOENZYMES THAT THE ISOENZYME WHICH WAS PREDOMINANT IN BOTH GROUPS OF WOMEN WAS THE SKELETAL MUSCLE TYPE (MM) OF 93-100%. WE PROPOSE THE MEASUREMENT OF TOTAL CPK AND ITS ISOENZYMES AS A ROUTINE METHOD FOR ALL PREGNANT WOMEN, WHO ARE GOING TO RECEIVE ANAESTHESIA, IN ORDER TO PROTECT INDIVIDUALS POSSIBLY SUCCEPTIBLE FOR MALIGNANT HYPERPUREXIA (M.H).ΜΕΛΕΤΗΘΗΚΑΝ ΔΥΟ ΟΜΑΔΕΣ ΕΓΚΥΩΝ ΓΥΝΑΙΚΩΝ. ΣΤΗ ΠΡΩΤΗ ΟΜΑΔΑ ΟΙ ΓΥΝΑΙΚΕΣ ΓΕΝΝΗΣΑΝ ΜΕ ΦΥΣΙΟΛΟΓΙΚΟ ΤΟΚΕΤΟ, ΕΝΩ ΣΤΗ ΔΕΥΤΕΡΗ ΟΜΑΔΑ, Ο ΤΟΚΕΤΟΣ ΕΓΙΝΕ ΜΕ ΚΑΙΣΑΡΙΚΗ ΤΟΜΗ. ΚΑΙ ΣΤΙΣ ΔΥΟ ΟΜΑΔΕΣ ΜΕΤΡΗΘΗΚΕΕ Η ΟΛΙΚΗ CPK ΑΙΜΑΤΟΣ ΚΑΙ ΤΑ ΙΣΟΕΝΖΥΜΑ ΤΗΣ ΠΡΙΝΤΗ ΧΟΡΗΓΗΣΗ ΑΝΑΙΣΘΗΣΙΑΣ ΣΤΗ ΑΡΧΗ ΤΟΥ ΤΟΚΕΤΟΥ ΚΑΘΩΣ ΚΑΙ ΜΕΤΑ ΤΗ ΧΟΡΗΓΗΣΗ ΑΝΑΙΣΘΗΣΙΑΣ ΟΤΑΝ ΤΕΛΕΙΩΝΕ Ο ΤΟΚΕΤΟΣ. Η ΜΕΤΡΗΣΗ ΤΗΣ CPK ΕΓΙΝΕ ΜΕ ΚΙΝΗΤΙΚΗ ΜΕΘΟΔΟ ΜΕ ΤΟ ΑΝΤΙΔΡΑΣΤΗΡΙΟ ΤΗΣ S.KI ΕΝΩ ΓΙΑ ΤΟΝ ΠΡΟΣΔΙΟΡΙΣΜΟ ΤΩΝ ΙΣΟΕΝΖΥΜΩΝ ΧΡΗΣΙΜΟΠΟΙΗΘΗΚΕ Η ΗΛΕΚΤΡΟΦΟΡΗΤΙΚΗ ΜΕΘΟΔΟΣ ΤΗΣ HELENA. ΑΠΟ ΤΗ ΜΕΛΕΤΗ ΤΩΝ ΑΠΟΤΕΛΕΣΜΑΤΩΝ ΒΡΕΘΗΚΕ ΟΤΙ ΥΠΑΡΧΕΙ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΗ ΔΙΑΦΟΡΑ ΣΤΗ ΜΕΣΗ ΤΙΜΗ CPK ΟΡΟΥ ΠΡΙΝ ΤΗ ΧΟΡΗΓΗΣΗ ΑΝΑΙΣΘΗΣΙΑΣ, ΑΠΟ ΤΗ ΜΕΣΗ ΤΙΜΗ CPK ΜΕΤΑ ΤΗ ΧΟΡΗΓΗΣΗ ΑΝΑΙΣΘΗΣΙΑΣ ΚΑΙ ΣΤΑΔΥΟ ΕΙΔΗ ΤΟΥ ΤΟΚΕΤΟΥ. ΕΠΙΣΗΣ ΑΠΟΔΕΙΧΘΗΚΕ ΟΤΙ Η ΜΕΣΗ ΠΟΣΟΤΗΤΑ ΟΛΙΚΗΣ CPK ΟΡΟΥ ΣΤΟΝ ΦΥΣΙΟΛΟΓΙΚΟ ΑΥΤΟΜΑΤΟ ΤΟΚΕΤΟ ΕΙΝΑΙ ΜΕΓΑΛΥΤΕΡΗ ΑΠΟ ΕΚΕΙΝΗ ΣΤΗ ΚΑΙΣΑΡΙΚΗ ΤΟΜΗ, ΑΝΕΞΑΡΤΗΤΑ ΤΟΥ ΕΑΝ ΕΙΧΑΜΕ ΠΑΡΕΙ ΤΟ ΔΕΙΓΜΑ ΑΙΜΑΤΟΣ ΠΡΙΝ 'Η ΜΕΤΑ ΤΗ ΧΟΡΗΓΗΣΗΑΝΑΙΣΘΗΣΙΑΣ. ΤΕΛΟΣ ΑΠΟ ΤΗ ΜΕΛΕΤΗ ΤΩΝ ΙΣΟΕΝΖΥΜΩΝ ΤΗΣ CPK ΦΑΝΗΚΕ ΟΤΙ ΤΟ ΙΣΟΕΝΖΥΜΟ ΠΟΥ ΕΠΙΚΡΑΤΟΥΣΕ ΚΑΙ ΣΤΙΣ ΔΥΟ ΟΜΑΔΕΣ ΤΩΝ ΓΥΝΑΙΚΩΝ ΗΤΑΝ ΤΟ ΙΣΟΕΝΖΥΜΟ ΣΚΕΛΕΤΙΚΟΥ ΜΥΙΚΟΥ ΤΥΠΟΥ (ΜΜ) ΣΕ ΠΟΣΟΣΤΟ 93- 100%. ΤΗ ΜΕΤΡΗΣΗ ΟΛΙΚΗΣ CPK ΚΑΙ ΤΩΝ ΙΣΟΕΝΖΥΜΩΝ ΤΗΣ ΠΡΟΤΕΙΝΟΥΜΕ ΣΑΝ ΜΕΘΟΔΟ ΡΟΥΤΙΝΑΣ Σ'ΟΛΕΣ ΤΙΣ ΕΓΚΥΕΣ ΓΥΝΑΙΚΕΣ ΠΟΥ ΠΡΟΚΕΙΤΑΙ ΝΑ ΤΟΥΣ ΧΟΡΗΓΗΘΕΙ ΑΝΑΙΣΘΗΣΙΑ, ΜΕ ΣΚΟΠΟ ΝΑ ΠΡΟΦΥΛΑΞΟΥΜΕ ΑΤΟΜΑ ΠΙΘΑΝΩΣ ΕΥΑΙΣΘΗΤΑ ΓΙΑ ΚΑΚΟΗΘΗ ΥΠΕΡΠΥΡΕΞΙΑ (Μ.Η)

The Diagnostic Odyssey of Patients with Chronic Neuropathic Pain—Expert Opinion of Greek Pain Specialists

The diagnosis of chronic neuropathic pain requires a laborious process and can be a very long journey for the patients, one that can be characterized as an “odyssey.” Our aim was to describe the “diagnostic odyssey” associated with chronic neuropathic pain in the Greek context. Specialized clinicians working at dedicated chronic pain and palliative care centers were asked to participate in a survey regarding the diagnostic process in Greece. In total, 44 respondents provided information on the organization of their centers, the diagnostic process, and the perceived obstacles involved in the diagnosis of chronic neuropathic pain. Most respondents reported that their centers were not fully or efficiently organized and believed that additional specialized healthcare personnel should be employed. Raising public awareness about the existence of such centers was also considered key. The two main obstacles in reaching a diagnosis were the difficulty non-experts had in recognizing chronic neuropathic pain and the lack of acknowledgement that chronic neuropathic pain is a condition that needs to be addressed. When considering these responses in light of the extended socioeconomic burden associated with chronic neuropathic pain, efforts should be made to limit the “diagnostic odyssey” of chronic neuropathic pain in Greece. The aim of this study is to explore the experience of patients with chronic neuropathic pain in Greece from the viewpoint of pain specialists. A better organization of pain and palliative care centers, facilitation of communication with previously treating clinicians, increased personnel, utilization of a chronic pain registry, and guidelines development can aid in this venture. Keypoints: The diagnosis of chronic neuropathic pain in Greece is a laborious and time-consuming process that needs to be refined; Greek clinicians believe that their centers were not fully or efficiently organized and think that additional specialized healthcare personnel should be employed; Patient comorbidities and retards in visiting a clinic at the onset of symptoms delay the diagnosis of neuropathic pain and may complicate subsequent care; The diagnostic delay has been reported as three years between the onset of symptoms and seeking general medical help and another nine years before a referral to a pain specialist; Neuropathic pain is associated with patient distress and socioeconomic burdens, and diagnostic delays prolong the condition, may allow it to worsen, and utilize valuable healthcare resources without providing effective solutions

The Diagnostic Odyssey of Patients with Chronic Neuropathic Pain—Expert Opinion of Greek Pain Specialists

The diagnosis of chronic neuropathic pain requires a laborious process and can be a very long journey for the patients, one that can be characterized as an “odyssey.” Our aim was to describe the “diagnostic odyssey” associated with chronic neuropathic pain in the Greek context. Specialized clinicians working at dedicated chronic pain and palliative care centers were asked to participate in a survey regarding the diagnostic process in Greece. In total, 44 respondents provided information on the organization of their centers, the diagnostic process, and the perceived obstacles involved in the diagnosis of chronic neuropathic pain. Most respondents reported that their centers were not fully or efficiently organized and believed that additional specialized healthcare personnel should be employed. Raising public awareness about the existence of such centers was also considered key. The two main obstacles in reaching a diagnosis were the difficulty non-experts had in recognizing chronic neuropathic pain and the lack of acknowledgement that chronic neuropathic pain is a condition that needs to be addressed. When considering these responses in light of the extended socioeconomic burden associated with chronic neuropathic pain, efforts should be made to limit the “diagnostic odyssey” of chronic neuropathic pain in Greece. The aim of this study is to explore the experience of patients with chronic neuropathic pain in Greece from the viewpoint of pain specialists. A better organization of pain and palliative care centers, facilitation of communication with previously treating clinicians, increased personnel, utilization of a chronic pain registry, and guidelines development can aid in this venture. Keypoints: The diagnosis of chronic neuropathic pain in Greece is a laborious and time-consuming process that needs to be refined; Greek clinicians believe that their centers were not fully or efficiently organized and think that additional specialized healthcare personnel should be employed; Patient comorbidities and retards in visiting a clinic at the onset of symptoms delay the diagnosis of neuropathic pain and may complicate subsequent care; The diagnostic delay has been reported as three years between the onset of symptoms and seeking general medical help and another nine years before a referral to a pain specialist; Neuropathic pain is associated with patient distress and socioeconomic burdens, and diagnostic delays prolong the condition, may allow it to worsen, and utilize valuable healthcare resources without providing effective solutions

Postoperative pain and analgesic requirements after anesthesia with sevoflurane, desflurane or propofol

General anesthetics may have nociceptive actions that affect postoperative pain. In studies evaluating postoperative pain, the effect of general anesthetics on analgesic requirements has not been considered except for one recent study suggesting that propofol anesthesia provides better analgesia after surgery than isoflurane. In this prospective, blind, randomized trial we recorded postoperative analgesic requirements (mg of morphine) and pain scores (visual analog scale in mm) 2, 4, 8, and 24 h postoperatively in patients undergoing abdominal hysterectomy or myomectomy under sevoflurane, desflurane or propofol anesthesia, titrated to maintain Bispectral Index values between 35 and 45. Pain scores were also recorded immediately after transfer to the postanesthesia care unit. Cumulative morphine consumption did not differ among the three groups 2, 4, 8, or 24 h postoperatively (P = 0.50). The morphine consumed within 24 h postoperatively was 28 +/- 13.8 mg in the sevoflurane group, 25 +/- 11.7 mg in the desflurane group and 27 +/- 16.1 mg in the propofol group. The visual analog scale values at rest or after cough immediately after patient transport to the postanesthesia care unit and 2, 4, 8, and 24 h after surgery did not differ among the three groups (P = 0.40, 0.39, 0.50, 0.47, 0.06 at rest and P = 0.67, 0.45, 0.22, 0.26, 0.29 after cough respectively). Morphine consumption and pain 24 h postoperatively did not differ among the sevoflurane, desflurane, and propofol groups

Analgesic Effect of the Topical Use of Dexamethasone in Ultrasound-Guided Axillary Brachial Plexus Blockade: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Introduction Increasing the duration of regional anesthesia in orthopedic surgery is of vital importance, as it prolongs postoperative analgesia, allowing faster rehabilitation of patients. Dexamethasone has been found to extend the block duration in animal and human studies. The aim of this study is the assessment of the effect of the addition of dexamethasone to ropivacaine on the onset and duration of axillary brachial plexus block, along with the intensity of postoperative pain. Methods Forty patients undergoing below-elbow surgery under ultrasound-guided axillary brachial plexus block were randomly allocated to receive either 30 mL ropivacaine 0.75% with 2 mL of saline (Group A, n = 20) or 30 mL ropivacaine 0.75% with 2 mL of dexamethasone (4 mg) (Group B, n = 20). Sensory and motor blockade were assessed, with the use of the pinprick test and the modified Bromage scale, at five, 10, 15, and 20 min after the block. The duration of analgesia, intensity of postoperative pain, postoperative opioid consumption, overall satisfaction, and perioperative complications were compared between the two groups. Results We found no difference at the mean onset time of the sensory and motor block between the two groups. The mean duration of postoperative analgesia was three hours higher in the dexamethasone group (15.85 +/- 4.82 versus 11.75 +/- 6.81, p-value = 0.035). Pain intensity was lower in the dexamethasone group, at six and 12 hours after surgery (3.45 +/- 1.79 versus 4.65 +/- 1.79, p-value = 0.040). Postoperative opioid consumption, patient overall satisfaction, and perioperative complications were not significantly different between groups. Conclusions Dexamethasone prolongs the duration of ropivacaine in an axillary brachial plexus block and decreases postoperative pain in patients subjected to below-elbow surgery

Validation of the Patient Neurotoxicity Questionnaire for Patients Suffering From Chemotherapy-Induced Peripheral Neuropathy in Greek

Purpose: The Patient Neurotoxicity Questionnaire (PNQ) represents a diagnostic tool concerning patients with chemotherapy-induced peripheral neuropathy (CIPN). The application of such a tool in the Greek clinical praxis requires validation. Methods: Validation consists of three stages - translation, reverse translation, and patient application. Hundred oncologic patients were assessed by comparing the PNQ to the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) at the chemotherapy onset and second, fourth, and sixth sessions. The diagnostic tool’s specific requirements (compliance, validity, concordance, sensitivity, specificity, reliability) were statistically evaluated. Results: Differences between translated texts and between the reverse translation and the original were considered negligible. At the second, fourth, and sixth session compliance was 98%, 95%, and 93% while Cronbach’s a was 0,57 0,69, and 0,81, respectively. Cohen’s weighted. was 0,67 and 0,58, Spearman’s. was 0,7 and 0,98, while the area under the curve (AUC) of the receiver operating characteristic (ROC) was 1 and 0,9 for the sensory and the motor part, respectively. The variance’s linear regression analysis confirmed CIPN worsening over time (P<0.0001). Discussion: The Greek version remains close to the original English version. Compliance rates reflect easy PNQ applications. Cohen’s. values highlight the physicians’ tension to underestimate the patients’ condition. Spearman’s., Cronbach’s a, and AUC values reflect good validity, reliability, and specificity of the PNQ respectively. Finally, the linear analysis confirmed the PNQ sensitivity over time. Conclusions: The PNQ validation in Greek adds a crucial tool to the physicians’ armamentarium. It can now delineate the necessary information to modify the chemotherapy and analgesic treatment regimens at both preventive and acute levels

Regional anesthesia practice in Greece: A census report

Background and Aims: Regional anesthesia (RA) techniques (central neuraxial and peripheral nerve blocks [CNBs and PNBs]) are well-established anesthesia/analgesia modalities. However, information on their nationwide use is sparse. The aim of the survey was to assess the utility of RA techniques in Greece, during 2011. Materials and Methods: A nationwide, cross-sectional descriptive survey was conducted (March to June, 2012), using a structured questionnaire that was sent to 128 Greek Anesthesia Departments. Results: Sixty-six completed questionnaires (response rate 51.56%) were analyzed. The data corresponded to 187,703 operations and represented all hospital categories and geographical regions of Greece. On the whole, RA was used in 45.5% of performed surgical procedures (85,386/187,703). Spinal anesthesia was the technique of choice (51.9% of all RA techniques), mostly preferred in orthopedics (44.8%). Epidural anesthesia/analgesia (application rate of 23.2%), was mostly used in obstetrics and gynecology (50.4%). Combined spinal-epidural and PNBs were less commonly instituted (11.24% and 13.64% of all RA techniques, respectively). Most PNBs (78.5%) were performed with a neurostimulator, while elicitation of paresthesia was used in 16% of the cases. Conversely, ultrasound guidance was quite limited (5%). The vast majority of consultant anesthesologists (94.49%) were familiar with CNBs, whereas only 46.4% were familiar with PNBs. The main reported limitations to RA application were lack of equipment (58.23%) and inadequate education/training (49.29%). Conclusion: Regional modalities were routinely used by Greek anesthesiologists during 2011. Neuraxial blocks, especially spinal anesthesia, were preferred over PNBs. The underutilization of certain RA techniques was attributed to lack of equipment and inadequate training

Pharmacological Management of Neuropathic Pain after Radiotherapy in Head and Neck Cancer Patients: A Systematic Review

Background: Neuropathic pain (NP) in head and neck cancer (HNC) patients represents a treatment challenge. Most studies investigating drugs against NP are conducted in patients suffering with diabetic neuropathy or postherpetic neuralgia, while data are limited in cancer pain management. Additionally, regarding cancer therapy-related NP, most of the studies do not focus on HNC patients. The aim of this review is to identify the studies on systematically administered medication for NP management that included HNC patients under radiotherapy. Methods: A systematic literature search was performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in PubMed, Cochrane Library, Web of Science and ClinicalTrials.gov on 30 October 2021. The medical subject heading (MeSH) terms were (“head and neck cancer” OR “tumor”) AND “neuropathic pain” AND “medication” AND “radiotherapy.” The Cochrane Collaboration tool was used for quality assessment. Results: The search identified 432 articles. Three more articles were identified after searching the reference lists of the retrieved articles. A total of 10 articles met the eligibility inclusion criteria and were included in this review; 6 on gabapentin, 1 on pregabalin, 1 on nortriptyline, 1 on methadone, and 1 on ketamine. Statistically significant results in pain reduction compared to placebo or standard pain medication were found in the studies on pregabalin (p = 0.003), methadone (p = 0.03), ketamine (p = 0.012), and in two out of six gabapentin studies (p < 0.004). Two of the studies (both concerning gabapentin) had no comparison arm. Conclusions: Treatments including pregabalin, methadone, ketamine, and gabapentin were found to provide pain relief against HNC NP. While there is a plethora of pharmacological treatments available for the management of NP, only a few studies have been conducted regarding the pharmacological management of therapy-related NP in HNC patients. More studies should be conducted regarding the pharmacological approaches in HNC therapy-related NP so that specific treatment algorithms can be developed