The Greek e-journal of Perioperative Medicine

1

Authors: Petrou A

[Greek]

23-32

Authors: Chatziioakimidis Ch, Veroniki F, Pourzitaki Ch, Iordanidou S, Konstandinidis D, Papalexi H, Papadopoulos V, Donas G, Gorgias N

This study compares the cardiovascular effects of spinal levobubivacaine or ropivacaine, in equipotent doses, for endoscopic urologic surgery. Eighty elderly, hypertensive patients, with physical status ASA I-III, scheduled to undergo transurethral procedures, were randomly allocated to receive spinal anesthesia with either 15 mg of levobupivacaine or 22.5mg of ropivacaine, in hyperbaric solutions. A standard technique was used for spinal anesthesia and all patients were treated similarly with respect to intraoperative fluid administration. Hemodynamic variables were recorded before spinal blockade (baseline values) and at 10, 20, 30, 45 and 60 min after subarachnoid local anesthetic administration. Hypotension was defined as systolic blood pressure less than 90 mmHg or 25% decrease from preoperative baseline values and was treated with repetitive 5mg ephedrine boluses. Systolic blood pressure was significantly decreased (p = 0,019) throughout the observation period, compared to baseline in both groups, but more pronounced hypotension was recorded in ropivacaine group between 30 min and 60 min after the spinal block. Ephedrine requirements were comparable among groups (p = 0,317). We conclude that during subarachnoid blocks, both local anesthetics behave similarly regarding their hemodynamic effects in elderly hypertensive patients, with no difference in the intensity of vasopressor therapy required to treat hypotension.

37-50

Authors: Amaniti E

Opioid analgesics are widely accepted as first-line treatment for moderate to severe cancer pain: while their use in patients with non-cancer pain syndromes has increased substantially over the last years. However, opioid analgesia produces numerous adverse effects. These effects have a negative impact on patient’s quality of life, may impair adherence to treatment and finally limitate opioid use. Most of opioid-related side effects are well established, i.e. constipation, nausea and vomiting, pruritus, respiratory depression or cognitive impairment, while others, i.e. opioid-induced immunosuppression, hypogonadism or opioid-induced hyperalgesia have gained attention only in the past few years. Beside the fact that some of them are potentially life-threatening, like respiratory depression, the potential risk of iatrogenic addiction still remains the most significant barrier to their use and frequently leads to pain undertreatment. The aim of this review is to present opioid-related side effects, the underlying mechanisms and the proposed treatment modalities, focusing on the existing evidence.

63-68

Authors: Zouka M

Opioid use for cancer pain is well established in medical literature. Recommended by the european guidelines (European Society for Medical Oncology – ESMO, European Association for Palliative Care – EAPC), the World Health Organization (WHO) analgesic ladder remains the gold standard in cancer pain management. Besides increasing use of chronic opioid therapy for non cancer pain during the past few years, controversies over opioid efficacy and safety and the absence of strong evidence constitute an important obstacle in establishing opioid medication as a standard universal approach for chronic non cancer pain therapy.