An Updated Review of Neuropathic Pain Treatm ent: State of Art and Future Prospects

El dolor neuropático es un tipo de dolor de difícil manejo con una prevalencia próxima al 10% de la población. Actualmente, existen varios fármacos aprobados para su tratamiento agrupados en distintas líneas. Sin embargo, la eficacia farmacológica es limitada en un número significativo de pacientes, por lo que es necesario desarrollar nuevas estrategias terapéuticas. Varias moléculas se encuentran en fases iniciales de ensayos clínicos en humanos, muchas de las cuales están demostrando resultados esperanzadores. Por otra parte, el conocimiento cada vez más preciso de las distintas vías moleculares implicadas en el dolor neuropático está promoviendo el desarrollo de nuevas moléculas con acción sobre potenciales dianas terapéuticas. Algunos de estos agentes se están ensayando en modelos animales y muestran una significativa potencia analgésica. Por último, el papel del tratamiento no farmacológico en el dolor neuropático, mediante alternativas como la radiofrecuencia, la estimulación o los bloqueos nerviosos, está cobrando una relevancia cada vez mayor en la práctica clínica. El objetivo de este trabajo es revisar el statu quo del tratamiento del dolor neuropático en la actualidad, repasando los fármacos aprobados a día de hoy y sus mecanismos de acción principales, y poniendo especial interés en algunas de las moléculas más novedosas que se encuentran en ensayo clínico en humanos y en desarrollo en modelos animales. Además, se recogen algunas de las estrategias no farmacológicas más relevantes en el manejo del dolor neuropático en la actualidad.Neuropathic pain (NP) is a difficult-to-manage kind of pain that affects 10% of the population. Nowadays, there are some agents that can be used for its treatment, and they are grouped according to different lines. However, their pharmacological effectiveness is only proved on a reduced number of patients. For this reason, new therapeutic strategies need to be developed. Certain molecules currently are on the initial stages of human clinical trials, and many of them are showing encouraging results. Furthermore, there is an increasingly accurate knowledge about the different molecular pathways related to NP. This advance is promoting the development of new molecules with potential therapeutic targets. Some of these agents are being tested with animal models, and they are showing a significant analgesic potency. Finally, non-pharmacological treatment in NP is becoming more important in clinical practice through alternatives such as radio frequency, stimulation, and nerve block therapy. The aim of this work is to review the state of art of NP treatment. For that purpose, the agents approved until today and their main action mechanisms should be considered, with a special emphasis on some of the latest molecules used on human clinical trials and those which are in development with animal models. Moreover, some of the main non-pharmacological strategies used to manage pain nowadays are also reviewed

A comparative study of hydroxyl- and carboxylate-functionalized imidazolium and benzimidazolium salts as precursors for N-heterocyclic carbene ligands

The preparation of imidazolium and benzimidazolium salts with hydroxyl or carboxylate functions has been achieved using straightforward synthetic pathways. These salts in combination with palladium(II) acetate give active catalytic systems for Suzuki reaction. A comparative study has been performed, which has revealed that both the heterocycle and the functional group are important for the catalytic activity and stability of the catalyst.Financial support from the University of Alicante (VIGROB-285) and the Spanish Ministerio de Economía y Competitividad (CTQ2011-24165) is acknowledged

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P &lt; 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion