Osteoarthritis (OA) represents one of the most important clinical situation characterized by chronic pain (CP), huge number of patients worldwide and large amount of burden for each national health systems. Moreover, OA is now considered as a syndrome in terms of each articular localization; on the other hands the cartilage remodelling is characterized by an imbalance between degradation and synthesis due to the impact of subchondral bone citokines production. OA presents mechanic CP, and inflammatory acute pain in the period of inflammatory flare. The American College of Rheumatology published the “2012 recommendations for the therapy of OA”: NSAIDs, acetaminophen, opioids, intra-articular steroids, as well as intra-articular viscosupplementation are the cornerstones of the pharmacological recommendations, while weight management and exercises are the most important suggestions for non-pharmacological treatments. The American Academy of Orthopeadic Surgeons published in the 2015 the surgery criteria for OA: both conservative and pharmacological treatments come first the surgical approaches. It is very important to consider that an early diagnosis of OA and an accurate stadiation of the disease can lead to the early start of a focused therapy, the reduction of evolution towards chronicity, progression, and disability, with a consequent reduction of pain and burden, and, finally, the increasing of quality of life.
{"title":"Recommendations for osteoarthritis","authors":"S. Coaccioli","doi":"10.22514/sv.2021.203","DOIUrl":"https://doi.org/10.22514/sv.2021.203","url":null,"abstract":"Osteoarthritis (OA) represents one of the most important clinical situation characterized by chronic pain (CP), huge number of patients worldwide and large amount of burden for each national health systems. Moreover, OA is now considered as a syndrome in terms of each articular localization; on the other hands the cartilage remodelling is characterized by an imbalance between degradation and synthesis due to the impact of subchondral bone citokines production. OA presents mechanic CP, and inflammatory acute pain in the period of inflammatory flare. The American College of Rheumatology published the “2012 recommendations for the therapy of OA”: NSAIDs, acetaminophen, opioids, intra-articular steroids, as well as intra-articular viscosupplementation are the cornerstones of the pharmacological recommendations, while weight management and exercises are the most important suggestions for non-pharmacological treatments. The American Academy of Orthopeadic Surgeons published in the 2015 the surgery criteria for OA: both conservative and pharmacological treatments come first the surgical approaches. It is very important to consider that an early diagnosis of OA and an accurate stadiation of the disease can lead to the early start of a focused therapy, the reduction of evolution towards chronicity, progression, and disability, with a consequent reduction of pain and burden, and, finally, the increasing of quality of life.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41747838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In line with the new definition of chronic pain [1] outcome measures of pain treatment have shifted from unidimensional scales (NRS, VRS) to multidimensional patient reported outcome measures. The Patient Reported Outcome Measurement Information System (PROMIS) rates across seven domains (pain interference, physical functioning, anxiety, depression, fatigue, sleep disturbance, and the ability to participate in social roles and activities) with four questions in each domain. PROMIS have been shown to be adequate and cross-walks may replace disease specific legacy PROMS [2, 3]. In Europe, data for the general population are available online [4]. Opioids are an integral part of many chronic pain patients but are not associated with improvement of PROMIS PI (pain interference) and PF (physical function) scores [5]. A consensus group advocated against Buprenorphin tapering before surgery [6] but opioid weaning improves PROMIS profiles for patients undergoing spine surgery [7] and liver transplants [8]. Methadone may be more effective than conventional perioperative short acting opioids [9, 10] and may also prevent against chronic pain after surgery [11]. Perioperative low dose Ketamine treatment has been advocated for chronic pain patients [12, 13]. A combination of Methadone and Ketamine showed impressive results in spinal surgery patients [14]. Gabapentinoid treatment should be continued but not initiated for surgery [15, 16]. i.v Lidocaine currently has no clear beneficial impact [17]. Regional anesthesia is generally advocated as its opioid sparing effects are well documented. Whether it provides protection against chronic pain after surgery is less clear [18, 19].
{"title":"PROMs (Patient Reported Outcome Measures) after surgery for patients with chronic pain","authors":"T. Volk","doi":"10.22514/sv.2021.202","DOIUrl":"https://doi.org/10.22514/sv.2021.202","url":null,"abstract":"In line with the new definition of chronic pain [1] outcome measures of pain treatment have shifted from unidimensional scales (NRS, VRS) to multidimensional patient reported outcome measures. The Patient Reported Outcome Measurement Information System (PROMIS) rates across seven domains (pain interference, physical functioning, anxiety, depression, fatigue, sleep disturbance, and the ability to participate in social roles and activities) with four questions in each domain. PROMIS have been shown to be adequate and cross-walks may replace disease specific legacy PROMS [2, 3]. In Europe, data for the general population are available online [4]. Opioids are an integral part of many chronic pain patients but are not associated with improvement of PROMIS PI (pain interference) and PF (physical function) scores [5]. A consensus group advocated against Buprenorphin tapering before surgery [6] but opioid weaning improves PROMIS profiles for patients undergoing spine surgery [7] and liver transplants [8]. Methadone may be more effective than conventional perioperative short acting opioids [9, 10] and may also prevent against chronic pain after surgery [11]. Perioperative low dose Ketamine treatment has been advocated for chronic pain patients [12, 13]. A combination of Methadone and Ketamine showed impressive results in spinal surgery patients [14]. Gabapentinoid treatment should be continued but not initiated for surgery [15, 16]. i.v Lidocaine currently has no clear beneficial impact [17]. Regional anesthesia is generally advocated as its opioid sparing effects are well documented. Whether it provides protection against chronic pain after surgery is less clear [18, 19].","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49029382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The number of nerve blocks performed in the pediatric population is constantly increasing nowadays, contributing to better post-op analgesia and outcomes. Multiple studies by the Pediatric Regional Anesthesia Network (PRAN) and the French-Language Society of Pediatric Anesthesiologists (ADARPEF), the use of ultrasound, the push for multimodal analgesia on the one hand, and the evolution of various innovative interfascial nerve blocks performed on the thoracic and the abdominal wall (i.e., Pecs blocks, Posterior TAP, Serratus Anterior Plane block, Rectus Sheath Block, Quadratus Laborum blocks, Erector Spinae block, super-inguinal fascia illiaca) on the other hand, have led to this trend. The ease of their performance, the steeper learning curve and the safer adverse effect profile compared to other “traditional” central regional techniques, still providing comparable analgesic results, accounts for this trend towards interfascial plane blocks performed for pediatric surgeries lately. This presentation focuses on the techniques of administration (using ultrasound), the anatomic considerations, the indications and limitations of these innovative interfascial nerve blocks performed on children. We are also going to talk about the appropriate for age doses and concentrations of local anesthetics and the adjuvant drugs used for blocks in the pediatric population, the more often and the most serious complications we can come across when performing these “high volume” blocks, what should alert us in the sleeping child and what is the best way to cope with an inadvertent complication, should this happen. After all is it really worth the trouble and why. Finally, we will talk about the reinvasion of subarachnoid anesthesia in the pediatric anesthesia practice and some issues of current debate in the pediatric regional anesthesia literature.
{"title":"The promising novelty nerve blocks in the paediatric population","authors":"L. Flouda","doi":"10.22514/sv.2021.187","DOIUrl":"https://doi.org/10.22514/sv.2021.187","url":null,"abstract":"The number of nerve blocks performed in the pediatric population is constantly increasing nowadays, contributing to better post-op analgesia and outcomes. Multiple studies by the Pediatric Regional Anesthesia Network (PRAN) and the French-Language Society of Pediatric Anesthesiologists (ADARPEF), the use of ultrasound, the push for multimodal analgesia on the one hand, and the evolution of various innovative interfascial nerve blocks performed on the thoracic and the abdominal wall (i.e., Pecs blocks, Posterior TAP, Serratus Anterior Plane block, Rectus Sheath Block, Quadratus Laborum blocks, Erector Spinae block, super-inguinal fascia illiaca) on the other hand, have led to this trend. The ease of their performance, the steeper learning curve and the safer adverse effect profile compared to other “traditional” central regional techniques, still providing comparable analgesic results, accounts for this trend towards interfascial plane blocks performed for pediatric surgeries lately. This presentation focuses on the techniques of administration (using ultrasound), the anatomic considerations, the indications and limitations of these innovative interfascial nerve blocks performed on children. We are also going to talk about the appropriate for age doses and concentrations of local anesthetics and the adjuvant drugs used for blocks in the pediatric population, the more often and the most serious complications we can come across when performing these “high volume” blocks, what should alert us in the sleeping child and what is the best way to cope with an inadvertent complication, should this happen. After all is it really worth the trouble and why. Finally, we will talk about the reinvasion of subarachnoid anesthesia in the pediatric anesthesia practice and some issues of current debate in the pediatric regional anesthesia literature.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43025267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Conduction of a systematic review and meta-analysis to determine the clinical efficacy, tolerability and safety of cannabinoids in adults patients with multiple sclerosis and intractable pain. Methods: Our review was performed according to the PRISMA guidelines. Pubmed, Scopus, Cochrane Library databases and ClinicalTrials.gov, EudraCT registries were searched for double-blind RCTs, involving adults with any form of multiple sclerosis and intractable pain. We included studies with cannabinoids of any type, dose or route of administration versus any control group. Risk of bias was assessed with Cochrane Risk of Bias 2 tool and certainty of evidence was rated according to GRADE approach. Review Manager 5.4 computer program was used to conduct our meta-analysis. Results: 6 trials, including 798 patients, were analyzed. Cannabinoids were superior to placebo for reducing pain intensity with statistical significance [MD = –0.48 (–0.88 to –0.08)]. Instead, overall withdrawals and frequency of adverse events showed a statistically significant increase in the cannabinoid groups [RR = 1.63, (1.05 to 2.52), ΝΝΤΗ = 19 (8 to 200) and RR = 1.32 (1.12 to 1.55), ΝΝΤΗ = 6 (3 to 16) respectively]. No statistical significant difference has been found on serious adverse events frequency. Short-term trials with small size and studies investigating THC/CBD spray (up to 120 mg/120 mg per day), showed a significant reduction in pain (0.90 and 0.86 points on NRS 0–10 scale respectively). Conclusions: Cannabinoids have never been administered as monotherapy and always administered by titration to treat intractable pain of various types in patients with multiple sclerosis. Our findings were based on a small number of trials and patients. Therefore certainty of evidence has been rated as moderate. Oromucosal spray THC/CBD (up to 120mg/120mg daily) is most likely to be used, in patients with multiple sclerosis and pain resistant to conventional analgesics, initially for short term treatment in future clinical practice.
{"title":"Efficacy, tolerability and safety of cannabinoids for management of pain in adult patients with multiple sclerosis: A systematic review and meta-analysis","authors":"L. Dimitrios, Fotakis Aris","doi":"10.22514/sv.2021.157","DOIUrl":"https://doi.org/10.22514/sv.2021.157","url":null,"abstract":"Objective: Conduction of a systematic review and meta-analysis to determine the clinical efficacy, tolerability and safety of cannabinoids in adults patients with multiple sclerosis and intractable pain. Methods: Our review was performed according to the PRISMA guidelines. Pubmed, Scopus, Cochrane Library databases and ClinicalTrials.gov, EudraCT registries were searched for double-blind RCTs, involving adults with any form of multiple sclerosis and intractable pain. We included studies with cannabinoids of any type, dose or route of administration versus any control group. Risk of bias was assessed with Cochrane Risk of Bias 2 tool and certainty of evidence was rated according to GRADE approach. Review Manager 5.4 computer program was used to conduct our meta-analysis. Results: 6 trials, including 798 patients, were analyzed. Cannabinoids were superior to placebo for reducing pain intensity with statistical significance [MD = –0.48 (–0.88 to –0.08)]. Instead, overall withdrawals and frequency of adverse events showed a statistically significant increase in the cannabinoid groups [RR = 1.63, (1.05 to 2.52), ΝΝΤΗ = 19 (8 to 200) and RR = 1.32 (1.12 to 1.55), ΝΝΤΗ = 6 (3 to 16) respectively]. No statistical significant difference has been found on serious adverse events frequency. Short-term trials with small size and studies investigating THC/CBD spray (up to 120 mg/120 mg per day), showed a significant reduction in pain (0.90 and 0.86 points on NRS 0–10 scale respectively). Conclusions: Cannabinoids have never been administered as monotherapy and always administered by titration to treat intractable pain of various types in patients with multiple sclerosis. Our findings were based on a small number of trials and patients. Therefore certainty of evidence has been rated as moderate. Oromucosal spray THC/CBD (up to 120mg/120mg daily) is most likely to be used, in patients with multiple sclerosis and pain resistant to conventional analgesics, initially for short term treatment in future clinical practice.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46545591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexis Triantopoulos, P. Dedopoulou, Aggeliki Athanasopoulou, Christiana Gkeka, Theodora Mpouzi, Christine Arachoviti
Introduction: Achieving correct hydrodissection in fascia plane blocks increases their success rate. With the use of ultrasound, it exceeds 80%, which is still far from 100%. This experimental study addresses the causes that lead to an approximate 20% failure probably due to the injection of the local anaesthetic between epimysium and fascia and not between fascia and fascia, as it should be. This leads to the corresponding ultrasound images: double-edge (correct sign) and single-edge (wrong sign). Method: The experiments were conducted with abdominal aponeurosis of dead pigs with the use of ultrasound and ejection with the use of epidural needles. First, the analogue sonographic images were generated and then, the surgical exposure of the tip of the needles and the distribution of the local anaesthetic was performed. Results: When the Fig. 1a,b were captured showing the right placement of the needle and the correct hydrodissection (double-edge) that was obtained, the Fig. 1c was acquired by carrying out the surgical exposure of the tip of the needle between the fascia.
{"title":"Double and single edge sign hydrodissection: An experimental study","authors":"Alexis Triantopoulos, P. Dedopoulou, Aggeliki Athanasopoulou, Christiana Gkeka, Theodora Mpouzi, Christine Arachoviti","doi":"10.22514/sv.2021.161","DOIUrl":"https://doi.org/10.22514/sv.2021.161","url":null,"abstract":"Introduction: Achieving correct hydrodissection in fascia plane blocks increases their success rate. With the use of ultrasound, it exceeds 80%, which is still far from 100%. This experimental study addresses the causes that lead to an approximate 20% failure probably due to the injection of the local anaesthetic between epimysium and fascia and not between fascia and fascia, as it should be. This leads to the corresponding ultrasound images: double-edge (correct sign) and single-edge (wrong sign). Method: The experiments were conducted with abdominal aponeurosis of dead pigs with the use of ultrasound and ejection with the use of epidural needles. First, the analogue sonographic images were generated and then, the surgical exposure of the tip of the needles and the distribution of the local anaesthetic was performed. Results: When the Fig. 1a,b were captured showing the right placement of the needle and the correct hydrodissection (double-edge) that was obtained, the Fig. 1c was acquired by carrying out the surgical exposure of the tip of the needle between the fascia.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49443459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Raptopoulou, M. Kouri, A. Vadalouka, A. Tsaroucha
Aim: This study is to investigate the effect of Reflexology as an add-on treatment in patients with Fibromyalgia, receiving pregabalin as treatment. Method: The study was conducted from September 2017 to February 2020. 79 patients (74 women and 5 men) with a mean age of 54.6 years were included. Inclusion criteria: - Diagnosis of Fibromyalgia >1 year - Duration of pain >1 year - Pain intensity >6 on VAS scale - Not using Reflexology in the pastResults: - Primary endpoint: Reduction of pain scores more than 30% in 3 months. - Secondary endpoints: Functionality (in terms of rigidity and workability) in 3 months.In all patients, the diagnosis of Fibromyalgia was made by completing the FIRST (Fibromyalgia Rapid Screening Tool) questionnaire (Greek version). The evaluation of the results was done with the pain intensity questionnaire in scale VAS as well as with observation, interviews, diaries.All patients received Pregabalin medication at a recommended dose of 75–600 mg daily.44 patients (56%) received normal medication. A mean reduction in pain of >50% was recorded.35 patients (44%) did not reach the maximum dose due to side effects and the drug was stopped at 450 mg daily. These patients received 14, 20-min Reflexology sessions, in 12 weeks, in order to achieve the desired analgesic effect.There was a reduction of pain >65% and a significant improvement in the secondary endpoints of functionality (significantly reduced morning stiffness, increased ability to work).Conclusions: Reflexology may be beneficial as add-on treatment in patients with Fibromyalgia who are unable to receive the recommended dosages of their medication.
{"title":"The effect of Reflexology in patients with Fibromyalgia","authors":"S. Raptopoulou, M. Kouri, A. Vadalouka, A. Tsaroucha","doi":"10.22514/sv.2021.175","DOIUrl":"https://doi.org/10.22514/sv.2021.175","url":null,"abstract":"Aim: This study is to investigate the effect of Reflexology as an add-on treatment in patients with Fibromyalgia, receiving pregabalin as treatment. Method: The study was conducted from September 2017 to February 2020. 79 patients (74 women and 5 men) with a mean age of 54.6 years were included. Inclusion criteria: - Diagnosis of Fibromyalgia >1 year\u0000- Duration of pain >1 year\u0000- Pain intensity >6 on VAS scale\u0000- Not using Reflexology in the pastResults:\u0000- Primary endpoint: Reduction of pain scores more than 30% in 3 months.\u0000- Secondary endpoints: Functionality (in terms of rigidity and workability) in 3 months.In all patients, the diagnosis of Fibromyalgia was made by completing the FIRST (Fibromyalgia Rapid Screening Tool) questionnaire (Greek version). The evaluation of the results was done with the pain intensity questionnaire in scale VAS as well as with observation, interviews, diaries.All patients received Pregabalin medication at a recommended dose of 75–600 mg daily.44 patients (56%) received normal medication. A mean reduction in pain of >50% was recorded.35 patients (44%) did not reach the maximum dose due to side effects and the drug was stopped at 450 mg daily. These patients received 14, 20-min Reflexology sessions, in 12 weeks, in order to achieve the desired analgesic effect.There was a reduction of pain >65% and a significant improvement in the secondary endpoints of functionality (significantly reduced morning stiffness, increased ability to work).Conclusions: Reflexology may be beneficial as add-on treatment in patients with Fibromyalgia who are unable to receive the recommended dosages of their medication.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46976371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The term peripheral neuropathy refers to disorders of the peripheral nervous system (PNS) including single and multiple (asymmetric) mononeuropathies, and symmetrical involvement of many nerves (polyneuropathy). Further classification depends on a mixture of phenomenological, neurophysiological, pathological and aetiological parameters. The temporal evolution of symptoms divides polyneuropathy (PN) into acute or chronic. Acute PN e.g. Guillain-Barre syndrome (GBS) is rare but an important entity to recognise because whilst at times severe, it is treatable. Most PN are chronic and usually develop over several months. Coronavirus disease 2019 (COVID-19) is a contagious disease caused by SARS-CoV-2. Symptoms of COVID-19 are variable, but often include fever, cough, headache, fatigue, breathing difficulties, and loss of smell or taste. Neurological complications have been reported in the context of COVID-19 infection both in the acute and subacute phase, as part of the post-COVID syndrome or as a result of the vaccination against SARS-CoV-2. In the acute phase, it has been reported that GBS prevalence is 15 cases per 100,000 SARS-CoV-2 infections. Demyelinating GBSs variant in particular is the most prevalent. Although not necessarily directly caused by SARS-CoV-2, prolonged stay in ICUs is associated with increased risk of ICU related neuro-myopathy. In the chronic phase, preliminary results of ongoing prospective observational studies suggest that patients suffered from COVID-19 have increased risk of developing mild axonal peripheral neuropathy that shows evidence of length dependency. Interestingly, it has been reported that – even in the absence of electrophysiologically confirmed PN – 1 in 5 patients reported deterioration of pre-existing neuropathic symptoms or development of new neuropathic symptoms, particularly pain, after COVID-19. Such symptoms tend to persist for months. Further studies are needed to describe the natural history of the PNS involvement during and after COVID-19 infection.
{"title":"Peripheral neuropathy in the COVID-19 era","authors":"P. Zis","doi":"10.22514/sv.2021.189","DOIUrl":"https://doi.org/10.22514/sv.2021.189","url":null,"abstract":"The term peripheral neuropathy refers to disorders of the peripheral nervous system (PNS) including single and multiple (asymmetric) mononeuropathies, and symmetrical involvement of many nerves (polyneuropathy). Further classification depends on a mixture of phenomenological, neurophysiological, pathological and aetiological parameters. The temporal evolution of symptoms divides polyneuropathy (PN) into acute or chronic. Acute PN e.g. Guillain-Barre syndrome (GBS) is rare but an important entity to recognise because whilst at times severe, it is treatable. Most PN are chronic and usually develop over several months. \u0000Coronavirus disease 2019 (COVID-19) is a contagious disease caused by SARS-CoV-2. Symptoms of COVID-19 are variable, but often include fever, cough, headache, fatigue, breathing difficulties, and loss of smell or taste. Neurological complications have been reported in the context of COVID-19 infection both in the acute and subacute phase, as part of the post-COVID syndrome or as a result of the vaccination against SARS-CoV-2. In the acute phase, it has been reported that GBS prevalence is 15 cases per 100,000 SARS-CoV-2 infections. Demyelinating GBSs variant in particular is the most prevalent. Although not necessarily directly caused by SARS-CoV-2, prolonged stay in ICUs is associated with increased risk of ICU related neuro-myopathy. In the chronic phase, preliminary results of ongoing prospective observational studies suggest that patients suffered from COVID-19 have increased risk of developing mild axonal peripheral neuropathy that shows evidence of length dependency. Interestingly, it has been reported that – even in the absence of electrophysiologically confirmed PN – 1 in 5 patients reported deterioration of pre-existing neuropathic symptoms or development of new neuropathic symptoms, particularly pain, after COVID-19. Such symptoms tend to persist for months. Further studies are needed to describe the natural history of the PNS involvement during and after COVID-19 infection.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42056583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chara Savva, E. Kalliontzi, Eleni Papaioannou, D. Karousos, A. Liosi, D. Danassi, A. Lampadariou
Aim of study: is to present case of ropivacaine toxicity after surgical wound infiltration. Case report: Female 49-year-old patient, with chronic renal failure, underwent kidney transplantation from living donor. Her medical history, revealed hypertension. No known allergies were mentioned. She had had laparoscopic cholecystectomy and placement of peritoneal catheter. She also had dental surgeries under local anaesthetic without any complications. Preanaesthetic examination was normal, apart from the expected. Patient was intraoperatively haemodynamically stable. During reperfusion, there was no remarkable haemodynamic instability (Blood Pressure (BP): 140/70 mmHg, Heart rate (HR): 62 bpm). Before closure, surgical wound was infiltrated with ropivacaine, 0.375% 20 mL. 18 minutes later, BP and cardiac output-CO were abruptly decreased (mean BP – MBP <55 mmHg and CO dropped from 7.1 to 2.5 L/min). H1, H2 receptor antagonists and crystalloids were administered iv, and noradrenaline infusion maintained MBP between 70–80 mmHg. Cardiac ultrasound was normal and troponin count was negative. Surgical wound was reopened for investigation, which did not reveal haemorrhage. One hour postoperatively, patient was stabilized, extubated, and was transferred to ICU for observation, without any sympathokinetic drugs’ infusion. Post-awakening, she complained about tongue numbness. Two months later, as renal function was normal, she was scheduled for peritoneal catheter removal. Ropivacaine 0.357% 10 mL was administered for wound infiltration. Milder decrease in BP and CO 20 min later, was immediately managed with noradrenaline iv infusion. Post-extubation, the patient reported metallic taste that raised furthermore initial suspicion of ropivacaine toxicity. Conclusion: Ropivacaine wound infiltration has been probably the reason of decrease in MBP and CO (local anaesthetic toxicity) in this case. International literature review was not conclusive, apart from cases of prolonged ropivacaine duration, in renal failure patients [1, 2]. Further observation of similar cases is necessary to confirm ropivacaine toxicity after wound local infiltration.
{"title":"Ropivacaine toxicity after surgical wound local infiltration in a patient with renal failure","authors":"Chara Savva, E. Kalliontzi, Eleni Papaioannou, D. Karousos, A. Liosi, D. Danassi, A. Lampadariou","doi":"10.22514/sv.2021.162","DOIUrl":"https://doi.org/10.22514/sv.2021.162","url":null,"abstract":"Aim of study: is to present case of ropivacaine toxicity after surgical wound infiltration. Case report: Female 49-year-old patient, with chronic renal failure, underwent kidney transplantation from living donor. Her medical history, revealed hypertension. No known allergies were mentioned. She had had laparoscopic cholecystectomy and placement of peritoneal catheter. She also had dental surgeries under local anaesthetic without any complications. Preanaesthetic examination was normal, apart from the expected. Patient was intraoperatively haemodynamically stable. During reperfusion, there was no remarkable haemodynamic instability (Blood Pressure (BP): 140/70 mmHg, Heart rate (HR): 62 bpm). Before closure, surgical wound was infiltrated with ropivacaine, 0.375% 20 mL. 18 minutes later, BP and cardiac output-CO were abruptly decreased (mean BP – MBP <55 mmHg and CO dropped from 7.1 to 2.5 L/min). H1, H2 receptor antagonists and crystalloids were administered iv, and noradrenaline infusion maintained MBP between 70–80 mmHg. Cardiac ultrasound was normal and troponin count was negative. Surgical wound was reopened for investigation, which did not reveal haemorrhage. One hour postoperatively, patient was stabilized, extubated, and was transferred to ICU for observation, without any sympathokinetic drugs’ infusion. Post-awakening, she complained about tongue numbness. Two months later, as renal function was normal, she was scheduled for peritoneal catheter removal. Ropivacaine 0.357% 10 mL was administered for wound infiltration. Milder decrease in BP and CO 20 min later, was immediately managed with noradrenaline iv infusion. Post-extubation, the patient reported metallic taste that raised furthermore initial suspicion of ropivacaine toxicity. Conclusion: Ropivacaine wound infiltration has been probably the reason of decrease in MBP and CO (local anaesthetic toxicity) in this case. International literature review was not conclusive, apart from cases of prolonged ropivacaine duration, in renal failure patients [1, 2]. Further observation of similar cases is necessary to confirm ropivacaine toxicity after wound local infiltration.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48212092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The aim of this study is to briefly present and to evaluate the elements that show whether the psychological background of the patients, particularly anxiety disorder and depression, are involved in the mechanism of postoperative pain, to examine the mechanisms involved in the intensity of pain and to report the methods used to evaluate and treat pain after a surgical procedure in this vulnerable group of patients. Methods: We performed a literature review of relevant articles, mainly published during the last decade, in MEDLINE database and 15 articles were used. Results: Clinical studies lead us to the conclusion that the intensity of postoperative pain is directly related to the levels of anxiety and to the presence of depression. Undertreatment and delay in managing acute postoperative pain can lead to the development of chronic pain syndromes with consequent negative effects in life and in the level of functionality of patients. A number of neurobiological processes could further explain the effect of psychological factors on pain, especially after surgical procedures. Conclusion: The psychological aspect of acute postoperative pain can be evaluated during the preoperative period, in order to relieve the intense negative psychological experience of pain after surgery, by using pharmacological therapy as well as psychotherapy. It is of great importance to perform psychological monitoring of patients after surgery, since it has been observed that the psychological phenotype of patients is altered during the first postoperative days. Catastrophology is involved in elevated intensity of postoperative pain, therefore the appropriate use of relevant clinical interventions would be beneficial. Psychosocial and psychophysiological evaluation is of great importance in order to detect patients at high risk and to offer individualized management and targeted preventive preoperative planning. The heterogeneity of patient population going to surgery increases the need for further studies which would evaluate appropriate therapeutic regimens, individualized for each special group of patients.
{"title":"Effect of anxiety disorder and depression in postoperative pain","authors":"S. Poulida, Lucia Makra","doi":"10.22514/sv.2021.178","DOIUrl":"https://doi.org/10.22514/sv.2021.178","url":null,"abstract":"Introduction: The aim of this study is to briefly present and to evaluate the elements that show whether the psychological background of the patients, particularly anxiety disorder and depression, are involved in the mechanism of postoperative pain, to examine the mechanisms involved in the intensity of pain and to report the methods used to evaluate and treat pain after a surgical procedure in this vulnerable group of patients. Methods: We performed a literature review of relevant articles, mainly published during the last decade, in MEDLINE database and 15 articles were used. Results: Clinical studies lead us to the conclusion that the intensity of postoperative pain is directly related to the levels of anxiety and to the presence of depression. Undertreatment and delay in managing acute postoperative pain can lead to the development of chronic pain syndromes with consequent negative effects in life and in the level of functionality of patients. A number of neurobiological processes could further explain the effect of psychological factors on pain, especially after surgical procedures. Conclusion: The psychological aspect of acute postoperative pain can be evaluated during the preoperative period, in order to relieve the intense negative psychological experience of pain after surgery, by using pharmacological therapy as well as psychotherapy. It is of great importance to perform psychological monitoring of patients after surgery, since it has been observed that the psychological phenotype of patients is altered during the first postoperative days. Catastrophology is involved in elevated intensity of postoperative pain, therefore the appropriate use of relevant clinical interventions would be beneficial. Psychosocial and psychophysiological evaluation is of great importance in order to detect patients at high risk and to offer individualized management and targeted preventive preoperative planning. The heterogeneity of patient population going to surgery increases the need for further studies which would evaluate appropriate therapeutic regimens, individualized for each special group of patients.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49631078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Diamantaki, V. Nyktari, G. Papastratigakis, G. Stefanakis, P. Vasilos, Dimitrios Kouvidakis, A. Papaioannou
Introduction: Despite advances in treatment strategies, patients with severe burns rapidly develop complex metabolic changes and multiorgan failure, compromising survival. Severe burns are the ones complicated by major trauma or inspiratory injury, chemical or electrical ones and generally any burns in adults occupying >20% of body surface area, except for superficial burns. Methods: The presentation of ethical dilemmas in the management of a critically ill burn patient in the emergency department (ED). Results: A 31-year-old patient was admitted to the ED with 2nd and 3rd degree burns >80% of the total body surface after a tank explosion with hot water and chemicals. Initially presented in full awareness, without wheeze, in hypoxia, hemodynamically unstable with constant unbearable, agonizing pain. A multidisciplinary team consisting of anesthetists, emergency physicians, ENT, intensivist and plastic surgeon was immediately gathered. Some members of the team raised the issue of delayed anesthesia and endotracheal intubation so that the patient could speak to his family who were on the way, as his imminent death was considered almost certain. However, immediate intubation was performed. The patient eventually died 4 hours later in ICU after marked hemodynamic instability and multiorgan failure. Conclusion: During management of patients with predicted high mortality, immediate decisions are often required to enhance even minimum chances of survival. These decisions often do not consider the real benefit and wishes of the patient at that moment, which raises some ethical dilemmas. Triage of patients for palliative care without transfer to a specialised burn centre is a difficult decision, especially in the absence of both legal framework and a pre-recorded “medical will” of patients, where the goals of care based on their values and wishes are clear.
{"title":"Ethical dilemmas in managing severe burns:Is there a place for palliative care?","authors":"E. Diamantaki, V. Nyktari, G. Papastratigakis, G. Stefanakis, P. Vasilos, Dimitrios Kouvidakis, A. Papaioannou","doi":"10.22514/sv.2021.155","DOIUrl":"https://doi.org/10.22514/sv.2021.155","url":null,"abstract":"Introduction: Despite advances in treatment strategies, patients with severe burns rapidly develop complex metabolic changes and multiorgan failure, compromising survival. Severe burns are the ones complicated by major trauma or inspiratory injury, chemical or electrical ones and generally any burns in adults occupying >20% of body surface area, except for superficial burns. Methods: The presentation of ethical dilemmas in the management of a critically ill burn patient in the emergency department (ED). Results: A 31-year-old patient was admitted to the ED with 2nd and 3rd degree burns >80% of the total body surface after a tank explosion with hot water and chemicals. Initially presented in full awareness, without wheeze, in hypoxia, hemodynamically unstable with constant unbearable, agonizing pain. A multidisciplinary team consisting of anesthetists, emergency physicians, ENT, intensivist and plastic surgeon was immediately gathered. Some members of the team raised the issue of delayed anesthesia and endotracheal intubation so that the patient could speak to his family who were on the way, as his imminent death was considered almost certain. However, immediate intubation was performed. The patient eventually died 4 hours later in ICU after marked hemodynamic instability and multiorgan failure. Conclusion: During management of patients with predicted high mortality, immediate decisions are often required to enhance even minimum chances of survival. These decisions often do not consider the real benefit and wishes of the patient at that moment, which raises some ethical dilemmas. Triage of patients for palliative care without transfer to a specialised burn centre is a difficult decision, especially in the absence of both legal framework and a pre-recorded “medical will” of patients, where the goals of care based on their values and wishes are clear.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45575589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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