Reduction In Analgesic Requirements Research Articles

Outcomes of percutaneous vertebroplasty in multiple myeloma: a tertiary neurosciences experience with long-term follow-up.

Multiple myeloma is diagnosed in 5,800 people in the United Kingdom (UK) each year with up to 64% having vertebral compression fractures at the time of diagnosis. Painful vertebral compression fractures can be of significant detriment to patients' quality of life. Percutaneous vertebroplasty aims to provide long-term pain relief and stabilize fractured vertebrae. Data was collected from all cases of percutaneous vertebroplasty performed on patients with multiple myeloma from November 2017 to January 2019. Pain scores were measured using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) pre-procedure, 2 months post procedure and 4 years post-procedure. Procedure related complications and analgesia use were also documented. 22 patients were included with a total of 119 vertebrae treated. Patients reported a significant improvement in overall pain score with a median pre-procedure VAS of 8 and a median post-procedure VAS of 3.5 (p<0.0001). There was a median pre-procedure ODI score of 60% and a median post-procedure ODI score of 36% (p<0000.1). There was improvement across all ODI domains and a 77% reduction in analgesic requirement. There were small cement leaks into paravertebral veins or endplates at 15 levels (12%) which were asymptomatic. There were 8 responders to the long-term follow-up questionnaire at 4 years. This demonstrated an overall stable degree of pain relief in responders with a median VAS of 3.5 and median ODI of 30%. At this center, vertebroplasty has been shown to reduce both VAS and ODI pain scores and reduce analgesia requirements in patients with VCFs secondary to multiple myeloma with long lasting relief at 4 years post-procedure.

214.4: The Genetic Epidemiology of Hereditary Pancreatitis in Australia and Its Effect on Patients of Total Pancreatectomy and Islet Auto Translation (TP-IAT)

Introduction: Hereditary Pancreatitis (HP) is a cause of pancreatitis in childhood leading to lifelong disability and an elevated risk of pancreatic cancer. The clinical and genetic features of HP have not been characterised in Australia. This project aims to understand the effects of HP-associated variants on disease risk and progression, and their pertinence on past and future patients of TP-IAT. Methods: HP patients were identified from existing hospital records. Interviews were administered to collect HP-associated data including pain management, medical prescriptions, interventions, smoking and alcohol history, and overall quality of life. Saliva samples were obtained for whole-exome-sequencing (WES). Genetic data were analysed using standard bioinformatics toolkits for variant discovery and correlation with HP phenotype. This was compared to a control sample of 2,504 patients with adult-onset chronic pancreatitis. Results: A total of 44 HP patients from 10 independent pedigrees were identified. Eighty-four percent of HP cases presented with clinical onset before the age of 10. Eighty-six percent of HP patients reported ongoing opioid use to control pain and 79% of patients reported ongoing moderate to severe pain. The majority (57%) of the HP cohort self-identified as Indigenous Australians and HP was 67 times more prevalent in Indigenous populations than non-Indigenous. Overall, 14/16 individuals underwent TP-IAT exhibited substantial reduction in analgesic requirement. The estimated prevalence of HP in SA was 2.48 per 100,000. HP was ~67 times more prevalent in Indigenous people than non-Indigenous South Australians. The study cohort had a younger age of onset and higher female ratio when compared to 2,504 of control adult-onset CP cases. Conclusion: Our estimated prevalence of HP is higher than previously described and disproportionately affect Indigenous populations. The percentage of HP patients requiring lifelong analgesics is alarming and genetic factors are an important cause of pancreatitis in Australian children. Finally, TP-IAT has been successful as a new therapy for HP management.

Comparing dexmedetomidine and propofol for sedation and hemodynamic stability in cardio-thoracic intensive care unit for patients following off-pump coronary artery bypass graft surgery

Background: Most patients in intensive care unit (ICU) require both sedation and analgesia to encourage natural sleep, facilitate assisted ventilation and modulate physiologic response to stress. The ideal sedative after Coronary artery bypass grafting (CABG) should have rapid onset, immediate resolution of both pain and anxiety, promote cardiac and respiratory stability, maintain a reusability during sedation, allow rapid recovery after discontinuation, and attenuate the cardiovascular, neuroendocrine, and inflammatory response. All these properties may improve outcome in cardiac patients after CABG.Methods: Setting-cardiac ICU. A prospective, randomised, single blind study including 60 patients divided into 2 groups. Data collection tools-study proforma and Ramsay sedation scale (RSS). Data analysed using science and statistical packaged (SPSS) version 20, independent sample `t` test, chi-square test, analysis of variance (ANOVA) and p value ≤0.05 was considered statistically significant.Results: Sedation levels and length of stay of patients on ventilator were comparable in both groups, however, analgesic requirement was significantly less in dexmedetomidine group. Dexmedetomidine group showed significantly lower heart rates compared to propofol group.Conclusions: Dexmedetomidine and propofol are safe sedative agents during mechanical ventilation in ICU for patients undergoing off pump coronary artery bypass (OPCAB). There is more than 50% reduction in analgesic requirement and a significant reduction in heart rate in dexmedetomidine sedated patients.

Compressive cryotherapy is superior to cryotherapy alone in reducing pain after hip arthroscopy

Abstract The early post-operative period after hip arthroscopy for femoroacetabular impingement is characterized by pain and swelling. Minimization of pain is of critical importance to the patient, but pain might also reduce patients’ compliance to early physiotherapy, delay rehabilitation and hospital discharge. Avoiding early mobilization represents a risk factor for developing capsulolabral adhesions. Compressive cryotherapy (CC) has been shown to reduce pain after knee and hip replacement surgery. The aim of this study was to assess the effect of the inclusion of CC in the pain management and early discharge after hip arthroscopy. A prospective cohort of 20 patients who received CC and 20 retrospectively matched controls who received standard cryotherapy (SC) were compared. The CC was added to the standard post-operative analgesia and rehabilitation protocol. Using non-parametric tests, the percentage of patients discharged in post-operative day one, pain VAS scores and analgesia requirement were compared. The CC group reported significantly lower pain scores compared to SC; VAS 1 (0–3) and 2 (0–5) (P = 0.0028), respectively. A non-significant reduction in analgesic requirement 1.75 versus 2.8 doses per patient was found and 20/20 patients were discharged on post-operative day one versus 17/20 in the SC group (P = 0.23). Patients treated with CC after hip arthroscopy reported lower levels of pain during the early post-operative phase and were able to be discharged home sooner when compared with a matched control group receiving ice therapy alone. A trend towards lower opioid analgesia requirement was observed.

Outcome after Lateral Pancreaticojejunostomy for Chronic Calcific Pancreatitis: A Short Term Prospective Study

Chronic pancreatitis is a fairly common condition with pain being the major symptom and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess the outcome of LPJ for chronic calcific pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational study enrolling 28 patients was conducted in the department of surgery of Shaheed Suhrawardy Medical College Hospital from January 2018 to December 2018. This study involved identification of various risk factors related to chronic pancreatitis, pancreaticojejunostomy, early post-operative outcome and postoperative assessment of pain relief at 1 and 6 months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief of pain in post-LPJ; the degree of relief was less in the alcoholics than non-alcoholics (p=0.09) and in smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. In chronic pancreatitis, there is a significant relief of pain in post-LPJ, although the degree of relief is less in the alcoholics and smokers.&#x0D; J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 13-16

Role of drain in early clinical outcomes following primary total knee arthroplasty

PurposeTo compare and study the short-term clinical outcome in patients with or without a drain usage in primary total knee arthroplasty (TKA). MethodsA prospective cohort study in a consecutive series of 61 women and 39 men (mean age, 66 years) with primary osteoarthritis underwent unilateral TKA. In the first 50 patients a low suction pressure drain was used for six hours, and in the next 50 patients no drain was used following TKA. ResultsThe 2 groups were comparable in terms of preoperative characteristics, age group, the proportion of patients with pharmacological prophylaxis for deep vein thrombosis, usage of anti fibrinolytics before surgery, the tourniquet time, mode of anaesthesia, operative approach and steps and type of implant used. The mean drain output in the drain group was 92ml. The time to achieve straight-leg raising was earlier in the drain group (2.1 vs. 3.2 days, p<0.005), and time to achieve knee flexion to 90° is earlier in patients with drain group (6.2 vs. 7.7 days, p<0.005). In addition, patients of drain group had lesser postoperative wound soakage, need for dressing change and analgesics. The fall in haemoglobin rate was slightly more in drain group however there was no significant difference in the rate of blood transfusions in both groups and no significant difference in infection rate. ConclusionThe use of a short duration (six hours), low suction pressure drain following total knee replacement enabled earlier return of quadriceps power, and range of motion, without increasing infection and blood transfusion rate. It also resulted in less pain and reduction in analgesic requirement in early postoperative period.

Computed tomography-guided celiac plexus neurolysis for intractable pain of unresectable pancreatic cancer

Aim of this studyTo appraise the value of CT-guided celiac plexus neurolysis (CPN) as an effective method for alleviating intractable pain in patients with unresectable pancreatic cancer. Patients and methods22 patients (their ages ranged between 45 and 73years) with severe pain due to unresectable pancreatic cancer were subjected to CT-guided CPN by 25–30mL of 97% ethanol via anterior approach and single puncture technique. The pain intensity scoring, both before and after the procedure, was done using the Visual Analogue Scale (VAS). ResultsAll patients showed a significant pain reduction after CPN (P<0.001), with peak reduction in the first day after CPN. Also, the mean ranks of analgesic requirements showed significant reduction (P<0.001) and this reduction in analgesic requirements was maintained up to 3months after the CPN. Less than half of the study population (45.5%) had some post-procedural adverse events, which were minimal and transient. ConclusionThe CT-guided CPN via using anterior median approach and single puncture technique with injection of 25–30mL of 97% of ethanol is an ideal palliative treatment for controlling severe pain caused by unresectable pancreatic cancer, with a significant reduction in the analgesic requirements.

The Effect of Comedy Videos in Alleviating Post Operative Pain

Humour is considered as an universal language. It influences the human life at various stages. A randomized controlled study involving 90 patients who were to undergo surgery was conducted at Coimbatore Medical College Hospital,Coimbatore.45 patients selected at random and were exposed to the comedy videos which was played at their bedside from admission to one day post operatively and they receive analgesic immediately after surgery and further pain was assessed using VAS and if needed analgesics given and recorded in observational chart. The control group of 45 patients did not see the videos during their stay in the hospital and received routine analgesic dosages at timed dosage schedule. An observation chart was attached in which the requirement of analgesics by the patient and pain was assessed during 0, 3, 6, 12, 24 hours post operatively using visual analogue scale. On completion of the study and on analysis,playinghumour videos had a significant effect in post operative pain management which was evidenced by the reduction in analgesic requirement by 50 % in those who watched humourvideos.A significant p value of <0.001 was obtained.

Apport de la radiothérapie métabolique au samarium-153 dans le cancer de la prostate

IntroductionProstate cancer is the third most common cancer of men in Tunisia, according to the three national cancer registers. Despite progress in the treatment of this osteophilic cancer, bone metastases remain found in 30–70% of patients. In this case, the pain is the most common symptom and the most difficult to support. Its treatment aims to improve the quality of life of patients. Metabolic radiotherapy with 153Sm-EDTMP is used in Tunisia since 2001 as an analgesic treatment of painful bone metastases, it is based on the action of targeted radioactive beta- particles emitted at the metastatic bone lesions. The aim of our study was to evaluate the value of this therapy in prostate cancer. MethodsA retrospective, descriptive, longitudinal study was carried about 13years on 67 patients with prostate adenocarcinoma with bone metastases, in the nuclear medicine department of Salah Azaiez Institute. All these patients were treated with at least one cure of 153Sm-EDTMP. For assessment of therapy effectiveness, three parameters were evaluated: motor activity, pain relief and reduction in analgesic requirements. Toxicity of 153Sm-EDTMP was also estimated. ResultsTreatment response was positive in 87.21% of cases. This positive response was complete in 32.56% and partial in 54.65% of the total of cures. The administration of successive cures of 153Sm-EDTMP, with 3 months interval between treatments, showed a similar response as in the first cure. Neither status of the patients before treatment nor treatment previously received had influence on this metabolic radiotherapy response. The therapeutic effectiveness was at least equivalent to those of other therapeutic modalities, with almost no side effects. The only observed toxicity was hematologic, usually mild and reversible in the months that were following cure. ConclusionDue to its efficiency and low toxicity, 153Sm-EDTMP should no longer be a solution of last resort. Its early introduction in the management of patients with prostate cancer and painful bone metastases could greatly improve their quality of life.

Evaluation of Pain Preoperatively and Postoperatively in Patients with Chronic Pancreatitis Undergoing Longitudinal Pancreaticojejunostomy.

Chronic pancreatitis is a fairly common condition with pain being the major symptom, and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess relief of pain post-LPJ for chronic pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational non-interventional study enrolling 28 patients. This study involved a questionnaire studying various risk factors and pain related to chronic pancreatitis, pancreaticojejunostomy, and postoperative assessment of pain relief at 1 and 6months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ; the degree of relief was less in the alcoholics vs non-alcoholics (p = 0.09) and smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. Fifty-seven percent of patients had a complete remission of their pain after LPJ for CP. In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ, although the degree of relief is less in the alcoholics and smokers.

Effect of the Raga Ananda Bhairavi in Post Operative Pain Relief Management

Music is considered as an universal language and has influences the human existence at various levels.In recent years music therapy has evolved as a challenge of research with a clinical approach involving science and art. Music therapy has been used for various therapeutic reasons like Alzheimer's disease,Hypertension and mental disorders to name a few. We conducted a study to establish the effect of the classical ragam Anandhabhairavi on post operative pain relief. A randomized controlled study involving 60 patients who were to undergo surgery was conducted at PSG Institute of Medical Sciences and Research,Coimbatore.30 patients selected at random and were exposed to the ragam Anandhabhairavi which was played in their room pre operatively (from the day they got admitted for surgery) and 3days post operatively. The control group did not listen to the music during their stay in the hospital. An observation chart was attached in which the requirement of analgesics by the patient was recorded. On completion of the study and on analysis,the ragam Anandhabhairavi had a significant effect in post operative pain management which was evidenced by the reduction in analgesic requirement by 50% in those who listened to the ragam.A significant p value of <0.001 was obtained.

A Randomized, Double-blind, Placebo-controlled Trial of Epidural Morphine Analgesia After Vaginal Delivery

BACKGROUND: Pain after vaginal delivery can interfere with the activities of daily living. We hypothesized that epidural medication administered after delivery would be of benefit for acute postpartum pain management. The objective of this study was to assess whether epidural morphine after vaginal delivery would reduce the analgesic requirements for perineal pain. METHODS: This randomized, double-blind, placebo-controlled trial included 228 parturients who received epidural morphine, 2.5 mg, or epidural saline within 1 h of delivery. The primary outcome was the proportion of women who received additional analgesics in the first 24 h postpartum. We also evaluated the time to first request for analgesia, pain and satisfaction scores, and the incidence of side effects due to epidural morphine. RESULTS: The majority of the 228 women participating in the study were Caucasian, primiparous patients >30 yr old. The proportion of women requiring additional analgesics was less among those who received epidural morphine (8 of 113; 7%) compared with saline (37 of 115; 32%), regardless of the degree of perineal trauma (RR = 0.22, 95% CI: 0.12-0.41). The relative risk reduction in receiving additional analgesics for primiparous patients receiving epidural morphine compared with saline was 0.25 (95% confidence interval [CI]: 0.13-0.49) and for multiparous women was 0.12 (95% CI: 0.02-0.63). The time to first request for analgesics was later for those who received morphine (mean 22.9 h, 95% CI: 22.2-23.7) compared with saline (mean 18.9 h, 95% CI: 17.4-20.4) (P < 0.0001). The side-effect incidence (pruritus, nausea and vomiting, and sedation) was not different between the 2 groups. CONCLUSION: There was a 78% reduction in analgesic requirements in women given epidural morphine after vaginal delivery compared with placebo for both primiparous and multiparous patients. Women who receive epidural labor analgesia for vaginal deliveries and stay in the hospital for 24 h after delivery may benefit from postpartum administration of epidural morphine.

Percutaneous Vertebroplasty for Thyroid Cancer Metastases to the Spine

Spinal metastases secondary to thyroid cancer of follicular and parafollicular cell origin are uncommon but may require stabilization of the compromised vertebrae to prevent fracture with spinal cord injury. Such treatment may also relieve pain and improve survival and quality of life. Percutaneous vertebroplasty (PV) is a minimally invasive, radiologically guided procedure whereby bone cement is injected into a structurally weakened vertebra to provide immediate stability. The authors present two cases of thyroid cancer with spinal metastases. Both patients successfully underwent PV. Following PV, the patients experienced significant pain relief with immediate reduction in analgesic requirements and improvement in other symptoms. Both were able to return to their daily activities. PV is a minimally invasive spinal procedure and should be considered for patients with metastatic thyroid cancer with spinal metastases.

A Randomized, Double-Blind, Placebo-Controlled Trial of Epidural Morphine Analgesia After Vaginal Delivery

Pain after vaginal delivery can interfere with the activities of daily living. We hypothesized that epidural medication administered after delivery would be of benefit for acute postpartum pain management. The objective of this study was to assess whether epidural morphine after vaginal delivery would reduce the analgesic requirements for perineal pain. This randomized, double-blind, placebo-controlled trial included 228 parturients who received epidural morphine, 2.5 mg, or epidural saline within 1 h of delivery. The primary outcome was the proportion of women who received additional analgesics in the first 24 h postpartum. We also evaluated the time to first request for analgesia, pain and satisfaction scores, and the incidence of side effects due to epidural morphine. The majority of the 228 women participating in the study were Caucasian, primiparous patients >30 yr old. The proportion of women requiring additional analgesics was less among those who received epidural morphine (8 of 113; 7%) compared with saline (37 of 115; 32%), regardless of the degree of perineal trauma (RR = 0.22, 95% CI: 0.12-0.41). The relative risk reduction in receiving additional analgesics for primiparous patients receiving epidural morphine compared with saline was 0.25 (95% confidence interval [CI]: 0.13-0.49) and for multiparous women was 0.12 (95% CI: 0.02-0.63). The time to first request for analgesics was later for those who received morphine (mean 22.9 h, 95% CI: 22.2-23.7) compared with saline (mean 18.9 h, 95% CI: 17.4-20.4) (P < 0.0001). The side-effect incidence (pruritus, nausea and vomiting, and sedation) was not different between the 2 groups. There was a 78% reduction in analgesic requirements in women given epidural morphine after vaginal delivery compared with placebo for both primiparous and multiparous patients. Women who receive epidural labor analgesia for vaginal deliveries and stay in the hospital for 24 h after delivery may benefit from postpartum administration of epidural morphine.

Systematic Review on the Procedure for Prolapse and Hemorrhoids (Stapled Hemorrhoidopexy)

The procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy) has been introduced as an alternative to conventional hemorrhoidectomy. This is a systematic review on stapled hemorrhoidopexy of all randomized, controlled trials that have been published until August 2006. All published, randomized, controlled trials comparing stapled hemorrhoidopexy to conventional hemorrhoidectomy were identified from Ovid MEDLINE, EMBASE, CINAHL, and all Evidence-Based Medicine Reviews (Cochrane Central Register of Controlled Trial, Cochrane Database of Systemic Review, and Database of Abstracts of Reviews of Effects) between January 1991 and August 2006. Meta-analysis was performed by using the Forest plot review if feasible. A total of 25 randomized, controlled trials with 1,918 procedures were reviewed. The follow-up duration was from 1 to 62 months. Stapled hemorrhoidopexy was associated with less operating time (weighted mean difference, -11.35 minutes; P = 0.006), earlier return of bowel function (weighted mean difference -9.91 hours; P < 0.00001), and shorter hospital stay (weighted mean difference, -1.07 days; P = 0.0004). There was less pain after stapled hemorrhoidopexy, as evidenced by lower pain scores at rest and on defecation and 37.6 percent reduction in analgesic requirement. The stapled hemorrhoidopexy allowed a faster functional recovery with shorter time off work (weighted mean difference, -8.45 days; P < 0.00001), earlier return to normal activities (weighted mean difference, -15.85 days; P = 0.03), and better wound healing (odds ratio, 0.1; P = 0.0006). The patients' satisfaction was significantly higher with stapled hemorrhoidopexy than conventional hemorrhoidectomy (odds ratio, 2.33; P = 0.003). Although there was increase in the recurrence of hemorrhoids at one year or more after stapled procedure (5.7 vs. 1 percent; odds ratio, 3.48; P = 0.02), the overall incidence of recurrent hemorrhoidal symptoms--early (fewer than 6 months; stapled vs. conventional: 24.8 vs. 31.7 percent; P = 0.08) or late (1 year or more) recurrence rate (stapled vs. conventional: 25.3 vs. 18.7 percent; P = 0.07)--was similar. The overall complication rate did not differ significantly from that of conventional procedure (stapled vs. conventional: 20.2 vs. 25.2 percent; P = 0.06). Compared with conventional surgery, stapled hemorrhoidopexy has less postoperative bleeding (odds ratio, 0.52; P = 0.001), wound complication (odds ratio, 0.05; P = 0.005), constipation (odds ratio, 0.45; P = 0.02), and pruritus (odds ratio, 0.19; P = 0.02). The overall need of surgical (odds ratio, 1.27; P = 0.4) and nonsurgical (odds ratio, 1.07; P = 0.82) reintervention after the two procedures was similar. The Procedure for Prolapse and Hemorrhoid (stapled hemorrhoidopexy) is safe with many short-term benefits. The long-term results are similar to conventional procedure.

Lidocaine in Liposuction Wetting Solution has a Minimal Effect on Analgesic Requirements when used in Conjunction with General Anesthesia

Lidocaine has become a common additive to liposuction wetting solutions, even for liposuction conducted under general anesthesia. Recent focus on the morbidity associated with liposuction has prompted a review of this practice. The analgesic requirements of patients undergoing liposuction of multiple sites under general anesthetic, with and without a lidocaine-containing wetting solution, were reviewed. The results suggest that while lidocaine does provide a reduction in analgesic requirements, this reduction is small, is readily compensated for by oral analgesics, and may not balance the potential risks associated with lidocaine.

Paediatric coblation tonsillectomy

Objective: Tonsillectomy has been described using a number of techniques. Recently Coblation Technology has been used to remove tonsils with anecdotal evidence of a reduction in post-operative morbidity. In this study we aim to see if there is any difference in post-operative pain, tonsillar fossae healing and return to a normal diet performing tonsillectomy, using tissue coblation compared with standard bipolar dissection. Methods: A double blind randomised control trial to compare the technique of tissue coblation with standard bipolar dissection to remove tonsils in 38 children on the waiting list for tonsillectomy, with a history of chronic tonsillitis or obstructive tonsils. Results: A significant reduction in post-operative pain was found in the children whose tonsils were removed by tissue coblation ( P<0.0001). More rapid healing of the tonsillar fossae was found in the coblation group. Children who had their tonsils removed by coblation were found to return to their normal diet far sooner than those who underwent bipolar dissection. There were no episodes of primary or secondary haemorrhage in either group. Conclusions: This new technique using tissue coblation for tonsil removal offers significant advantages in the post-operative period, with rapid return to a normal diet and a drastic reduction in analgesic requirements following the surgery.

RheothRx (Poloxamer 188) Injection for the Acute Painful Episode of Sickle Cell Disease: A Pilot Study

AbstractRheothRx (Glaxo Wellcome Inc, Research Triangle Park, NC; poloxamer 188) Injection is a nonionic surfactant with hemorrheologic properties that suggest it may be useful in treating acute painful episodes (vasoocclusive crises) of sickle cell disease (SCD). We conducted a randomized, double-blind, placebo-controlled pilot study to evaluate the safety and efficacy of poloxamer, formulated as RheothRx Injection, in 50 patients with SCD. Patients with moderate to severe painful episodes requiring parenteral analgesics were randomized to receive a 48-hour infusion of either RheothRx or placebo. Pain was assessed every 4 hours. Efficacy endpoints included: (1) painful episode duration, (2) days of hospitalization, (3) quantity of analgesics used, and (4) pain intensity scores. Three subgroups of patients were considered for efficacy analyses based on the actual duration of the study drug infusion and the completeness of pain score data collection. Compared with placebo and depending on the subgroup, RheothRx-treated patients showed a 16% to 45% decrease in duration of painful episodes, a 1- to 2-day reduction in hospital stay, a threefold to fivefold reduction in analgesic requirements, and a 1-point reduction (using a 5-point scale) in average pain intensity scores at 72 hours. RheothRx was well tolerated; no clinically significant differences were observed between treatments with respect to adverse experiences or other safety measures. In addition, there were no differences between treatment groups in the incidence of recurrent painful episodes. In this study, RheothRx significantly reduced total analgesic use and pain intensity and showed trends to shorter duration of painful episodes and total days of hospitalization. In patients with moderate to severe vasoocclusive pain, RheothRx was safe and may offer a therapeutic benefit.

Bone pain palliation with strontium-89 in breast cancer patients with bone metastases and refractory bone pain.

Fifteen patients with breast cancer and skeletal metastases who had bone pain refractory to opioid analgesics and who were not eligible for or had not responded to local field radiotherapy, were treated with strontium-89. All patients had received previous treatment with chemotherapy and radiotherapy for bone metastases. Severity of bone pain, sleeping pattern, mobility and dependency on analgesics were evaluated before and 4, 8 and 12 weeks after 89Sr administration. Patients received 2 MBq/kg (118-148 MBq) of 89Sr by i.v. injection. Pain relief and a reduction in analgesic requirements were observed in 7 of the 15 (47%) patients, with a reduction in the severity score from 34% to 71%. Duration of the response varied from 3 to 7 months. A decrease in peripheral blood cell count was observed in 11 patients: a 15%-66% reduction in white cell count and a 14%-75% reduction in platelet count were detected at 12 weeks after treatment in these patients. We conclude that 89Sr is effective (47% response rate) for bone pain palliation in patients with bone metastases from breast cancer. Dependency on opioid analgesics may be reduced in patients with refractory bone pain.

Does the Option to Ambulate During Spontaneous Labour Confer Any Advantage or Disadvantage?

The objective of this study was to determine if there is any advantage or disadvantage to giving the option to ambulate in labour compared with labour in a recumbent position in relation to length of labor, need for analgesia, mode of delivery, and maternal satisfaction. This study was designed as a prospective randomised controlled trial.One hundred ninety-six women in spontaneous established labour with a singleton fetus in a cephalic presentation between 37 and 42 weeks gestation who had the ability to ambulate in labour were randomised either to an ambulation as desired group or a recumbent group. Amniotomy was performed if the membranes were intact and fetal heart rate monitoring was achieved by radiotelemetry in the ambulant group and direct electronic monitoring in the recumbent group.The demographic characteristics of the two randomised treatment groups were similar. There were no significant differences in any of the maternal or neonatal outcomes between women in the intention-to-ambulate group and the recumbent group. The mean length of labour (SD) from trial entry was 5.0 (3.9) h and 4-9 (3.5) h, respectively. Only 37 of the 96 women (39%) allocated to the ambulation group were upright for half an hour or more. The mean length of labour (SD) for this ambulant group was 6.2 (4.1) h compared with 4.2 (3.5) h for those who reneged on the option to ambulate (N.S.). There was a trend for higher maternal satisfaction (N.S.) amongst those who had the option to ambulate with radiotelemetry with regards to their attitude to electronic fetal monitoring.No advantages or disadvantages accrued from being given the option to adopt an upright posture or ambulate in labour. Addition of this data to a meta-analysis of similar trials in the literature strengthens this conclusion and the opinion that women appreciate the chance to determine their own position in labour. The only significant advantage to ambulant labour in this new meta-analysis is a reduction in analgesic requirements. Delivery suite personnel should provide an environment that allows all options of labour positions, including fetal cardiotelemetry, and should not dictate any routine position in normal labour.