Serratus anterior plane blok za analgeziju kod mastektomije

The incidence of breast cancer in women is on the rise, but the survival rate has increased due to the progress of medicine, especially if the disease is detected early. One of the imperatives is the patient’s quality of life after treatment. Inadequately treated acute postoperative pain leads to a worse treatment outcome and the development of chronic pain. The incidence of chronic pain after surgical treatment of breast cancer is high and negatively affects the quality of life of patients in the long term. Serratus anterior plane block (SAPB) is a relatively new ultrasound-guided regional analgesia technique. SAPB represents an alternative to an epidural, and to paravertebral and intercostal blocks. This review aims to describe serratus anterior plane block for breast surgery and emphasize their short- and long-term benefit. For this review, we searched MEDLINE in November 2022 to identify metanalyses, randomized controlled trial systemic reviews, and reviews published in the last five years. The search for metanalyses yielded 4 results; 12 results were found for randomized controlled trials; 5 results for reviews; and 4 results for systematic reviews. When employing SAPB in patients after mastectomy, good analgesia is achieved in the early postoperative period and the incidence of chronic pain is reduced, thus improving quality of life.Incidencija karcinoma dojke kod žena je u porastu ali napretkom liječenja povećana je stopa preživljena naročito ako se bolest otkrije u ranom stadiju. Jedan od imperativa je kvaliteta života bolesnice nakon liječenja. Neadekvatno liječena akutna poslijeoperacijska bol dovodi do lošijeg ishoda liječenja i razvoja kronične boli. Incidencija kronične boli nakon operativnog liječenja karcinoma dojke je visoka i dugoročno negativno utječe na kvalitetu života bolesnica. Serratus anterior plane block (SAPB) je relativno nova ultrazvukom vođena tehnika regionalne analgezije a predstavlja alternativu epiduralnim, paravertebralnim i interkostalnim blokovima.Cilj ovog pregleda je opisati serratus anterior plane block za mastektomiju i naglasiti njegovu kratkoročnu i dugoročnu korist. Za potrebe ovog rada proveli smo pretragu MEDLINE baze do studenog 2022. kako bismo identificirali meta-analize, sistemske preglede, randomizirana kontrolirana ispitivanja i preglede objavljene u posljednjih pet godina. Pretraživanjem meta-analiza dobili smo 4 rezultata, za randomizirano kontrolirano ispitivanje 12 rezultata, za preglede 5 rezultata i za sustavni pregled 4 rezultata. Primjenom SAPB kod bolesnica nakon mastektomije postiže se dobra analgezija u ranom poslijeoperacijskom periodu te se smanjuje pojavnost kronične boli i na taj način poboljšava se kvaliteta života

Utjecaj različitih minimalno invazivnih metoda na ishod liječenja lumbalne radikularne boli

Lumbar radicular pain is a major public health, social and economic problem and is often the cause of professional disability. The aim of this study was to compare pain intensity, disability and neuropatic pain depending on the method of treatment (epidural steroid injection or percutaneous laser disc decompression) in the treatment of lumbar radicular pain caused by intervertebral disc herniation with or without discoradicular contact. Data were collected from 28 patients at 3 measurement points (before the procedure and at examinations on the 15th and 30th day after the procedure) using the Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) and Pain Detect. The reduction of the pain after the procedure was statistically significant only in the group of patients with discoradicular contact in whom PLDD was performed (P=0.04). From the obtained results, it can be concluded that percutaneous laser disc decompression (PLDD) led to a greater reduction in disability (P=0.009) in patients with discorradicular contact, whereas lumbar transforaminal epidural steroid injection (ESI TF) led to greater reduction in patients without discorradicular contact (P=0.02). The results indicate that there was a significant (P=0.01) reduction in neuropathic pain in patients without discorradicular contact who were treated with ESI TF and in patients with discoradicular contact who were treated with PLDD (P=0.04).Lumbalna radikularna bol je veliki javnozdravstveni, društveni i ekonomski problem i često je uzrok profesionalne nesposobnosti. Cilj ovog istraživanja bio je usporediti intenzitet boli, onesposobljenost i neuropatsku bol ovisno o načinu liječenja (epiduralna injekcija steroida ili perkutana laserska dekompresija diska) u liječenju lumbalne radikularne boli uzrokovane hernijom intervertebralnog diska sa ili bez diskoradikularnog kontakta. Podaci su prikupljeni od 28 pacijenata u 3 točke mjerenja (prije zahvata i na pregledima 15. i 30. dana nakon zahvata) pomoću Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) i Pain Detect. Smanjenje boli nakon zahvata bilo je statistički značajno samo u skupini bolesnika s diskoradikularnim kontaktom kod kojih je učinjen PLDD (p = 0,04). Iz dobivenih rezultata može se zaključiti da je PLDD doveo do većeg smanjenja onesposobljenosti (p = 0,009 ) u bolesnika s diskoradikularnim kontaktom a ESI u bolesnika bez diskoradikularnog kontakta (p = 0,02 ). Rezultati pokazuju da je došlo do značajnog (p = 0,01) smanjenja neuropatske boli u bolesnika bez diskoradikularnog kontakta koji su liječeni ESI i u bolesnika s diskoradikularnim kontaktom koji su liječeni PLDD (p = 0,04)

Suggestive Preparation of Patients using Intravenous Ketoprofen as a Part of Postoperative Pain Management in Elective Abdominal Surgery

Suggestive preparation before surgery may have a placebo effect and can reduce perioperative consumption of analgesics. A total of 77 adult patients undergoing elective cholecystectomy and hernioplasty were included in this prospective study. All patients were given 100 mg of ketoprofen intravenously and were assigned to two groups. The first group was not informed about analgesia (no preparation, NP group), and the second group were told that they will receive a strong painkiller (suggestive preparation, SP group). Pulse rate, blood pressure and VAS scores were registered in all patients immediately before anesthesia induction in the operating room (T1), after waking up in the recovery room (T2), 6 hours after surgery at the surgical ward (T3) and on the morning after surgery in the surgical ward (T4), at rest and during movement. Rescue nonsteroidals were offered to patients with VAS 3-4, and opioids for VAS ≥5. The patients in the SP group had lower VAS scores in all measurements and lower opioid consumption. A statistically significant difference was observed in VAS2 measurement during movement (3 [2-5] vs. 2 [0-3.75] in the NP and SP group, P=0.008). SP had a placebo effect and reduced VAS scores as well as opioid consumption

Serratus anterior plane blok za analgeziju kod mastektomije

The incidence of breast cancer in women is on the rise, but the survival rate has increased due to the progress of medicine, especially if the disease is detected early. One of the imperatives is the patient’s quality of life after treatment. Inadequately treated acute postoperative pain leads to a worse treatment outcome and the development of chronic pain. The incidence of chronic pain after surgical treatment of breast cancer is high and negatively affects the quality of life of patients in the long term. Serratus anterior plane block (SAPB) is a relatively new ultrasound-guided regional analgesia technique. SAPB represents an alternative to an epidural, and to paravertebral and intercostal blocks. This review aims to describe serratus anterior plane block for breast surgery and emphasize their short- and long-term benefit. For this review, we searched MEDLINE in November 2022 to identify metanalyses, randomized controlled trial systemic reviews, and reviews published in the last five years. The search for metanalyses yielded 4 results; 12 results were found for randomized controlled trials; 5 results for reviews; and 4 results for systematic reviews. When employing SAPB in patients after mastectomy, good analgesia is achieved in the early postoperative period and the incidence of chronic pain is reduced, thus improving quality of life.Incidencija karcinoma dojke kod žena je u porastu ali napretkom liječenja povećana je stopa preživljena naročito ako se bolest otkrije u ranom stadiju. Jedan od imperativa je kvaliteta života bolesnice nakon liječenja. Neadekvatno liječena akutna poslijeoperacijska bol dovodi do lošijeg ishoda liječenja i razvoja kronične boli. Incidencija kronične boli nakon operativnog liječenja karcinoma dojke je visoka i dugoročno negativno utječe na kvalitetu života bolesnica. Serratus anterior plane block (SAPB) je relativno nova ultrazvukom vođena tehnika regionalne analgezije a predstavlja alternativu epiduralnim, paravertebralnim i interkostalnim blokovima.Cilj ovog pregleda je opisati serratus anterior plane block za mastektomiju i naglasiti njegovu kratkoročnu i dugoročnu korist. Za potrebe ovog rada proveli smo pretragu MEDLINE baze do studenog 2022. kako bismo identificirali meta-analize, sistemske preglede, randomizirana kontrolirana ispitivanja i preglede objavljene u posljednjih pet godina. Pretraživanjem meta-analiza dobili smo 4 rezultata, za randomizirano kontrolirano ispitivanje 12 rezultata, za preglede 5 rezultata i za sustavni pregled 4 rezultata. Primjenom SAPB kod bolesnica nakon mastektomije postiže se dobra analgezija u ranom poslijeoperacijskom periodu te se smanjuje pojavnost kronične boli i na taj način poboljšava se kvaliteta života

Lipopolysaccharide induces tumor necrosis factor receptor-1 independent relocation of lymphocytes from the red pulp of the mouse spleen

It is well known that bacterial lipopolysaccharide (LPS) induces migration of several cellular populations within the spleen. However, there are no data about the impact of LPS on B and T lymphocytes present in the red pulp. Therefore, we used an experimental model in which we tested the effects of intravenously injected LPS on the molecular, cellular and structural changes of the spleen, with special reference to the red pulp lymphocytes. We discovered that LPS induced a massive relocation of B and T lymphocytes from the splenic red pulp, which was independent of the tumor necrosis factor receptor-1 signaling axis. Early after LPS treatment, quantitative real-time PCR analysis revealed the elevated levels of mRNA encoding numerous chemokines and proinflammatory cytokines (XCL1, CXCL9, CXCL10, CCL3, CCL4, CCL5, CCL17, CCL20, CCL22, TNFα and LTα) which affect the navigation and activities of B and T lymphocytes in the lymphoid tissues. An extreme increase in mRNA levels for CCL20 was detected in the white pulp of the LPS-treated mice. The CCL20-expressing cells were localized in the PALS. Some smaller CCL20-expressing cells were evenly dispersed in the B cell zone. Thus, our study provides new knowledge of how microbial products could be involved in shaping the structure of lymphatic organs