The Greek e-journal of Perioperative Medicine

1

Authors: Mouloudi E, Papagiannopoulou P

Εκ μέρους της επιτροπής σύνταξης του περιοδικού σας ευχαριστούμε για τη μέχρι σήμερα εμπιστοσύνη και συνεργασία και προσδοκούμε στην περαιτέρω συνεισφορά σας ώστε να συνεχίσει την πορεία του στο χώρο τόσο του ελληνικού όσο και του διεθνούς ιατρικού τύπου.

22-30

Authors: Aslanidis Τh, Charitidou S, Μ atiaki Ε, Μ ilona s A, Georgopoulou Ε, Anagnostara Ε , Aslanidis K

The application of statistical methods in order to extract safer conclusions from samples of medical data has become a key methodology for synthesis and evaluation in any medical research. This study makes a retrospective overview of statistical methods used for oral presentations in the summaries of Greek anesthesia conferences and tries to “capture” the change in the use of statistics in recent years. Nine hundred and twenty five oral presentations from seven Greek anesthesia conferences were included for further analysis. The results, recorded an increase of randomized studies, the majority of which, had the character of single-blind study, using relatively small samples (n=31-51). Nevertheless, there is a trend towards studies with larger samples. References to the software used for processing of data also increase over the years. The majority of statistic analyses are done by using descriptive statistical methods.Tests for normality of the data are presented in the last conferences, but there is no reference to the power of any study. Extrapolations are mainly based on p value, although, over the years, the use of confidence intervals is appearing also as an alternative. Finally, more and more and different methodologies and statistical analysis tests are being selected. Although these findings refer to only 25% of all abstracts of the 28 conferences carried out until the beginning of this study (2009), they give us a first insight look on the use of statistics among Greek anesthesiologists. The last seems to ameliorate as the e-ducation in that field getting better with time.

44-59

Authors: Ntritsou V, Papagiannopoulou P,Kostoglou Ch, Metaxioti E, Ioannidis A, Zachariadou Ch

The study compares the efficacy of postoperative analgesia after the intravenous administration of opioids (nalbuphine, tramadol or morphine) in combination with ketamine in patients undergoing radical prostatectomy.Eighty eight patients scheduled for radical prostatectomy were randomly assigned in three groups. In Group A (n=31) Morphine was administered {bolus dose (BD) 0.05mg/Kg and continuous infusion (CI) at a dose [mg/24h =18-(agex0.15)]}, in Group B (n=28) Nalbuphine (BD 0.2mg/kg and CI at a rate 0.05mg/kg/h) and in Group C (n=29) Tramadol (BD 1.5mg/Kg and CI at a rate 0.15mg/Kg/h). In all groups opioids were administered in combination with ketamine (BD 10mg and CI at a rate 0.15mg/Kg/h). Infusion pumps were designed to provide 24h postoperative pain relief. In all patients, efficacy of postoperative analgesia was evaluated at 6h and 24h postoperatively. Pain intensity was assessed by Numerical Rating Scale at rest and movement. The additional analgesics and the adverse effects were also assessed 24h postoperatively. Group C showed statistical significant higher NRS pain scores at movement compared to other groups at 6h postoperatively. At 24h postoperatively, at rest, group B showed statistical significant higher pain scores compared to group A and C. Group B showed higher incidence of pruritus, bowel movement and rescue analgesics compared to groups A and C. We conclude that in patients undergoing radical prostatectomy, the combination of tramadol plus ketamine was less effective concerning postoperative pain and patients needed more rescue analgesics compared to morphine plus ketamine and nalbuphine plus ketamine groups.

74-83

Authors: Amaniti E, Zaralidou A, Maidatsi P , Mitos G,Thoma G , Vasilakos D.

Despite stable background pain, most cancer patients suffer 3-4 episodes of breakthrough pain daily. Aim of the present study was the evaluation of potential correlation between effective doses of sublingual fentanyl citrate, administered for controlling breakthrough pain, with transdermal fentanyl used for background pain. Fifty-six cancer patients were prospectivelly recruited. All patients were suffering episodes of breakthrough pain and managed with transdermal fentanyl 25-300μg/h for their background pain. Patients were assigned into two groups, group A (n=26) and group B (n=30), based on their transdermal fentanyl needs, 25-100μg/h or 125-300μg/h respectively. Sublingual fentanyl citrate titration was followed standard protocol, with a starting dose of 100μg. Dose effectiveness was evaluated by the patient, fifteen minutes later. If starting dose was considered inadequate, an extra dose of 100 μg was administered. The subsequent episode was treated with a starting dose of 200μg and an extra dose of 100μg, if needed, following the same stepwise approach to a maximum of 800 μg, per episode. Doses of transdermal fentanyl and sublingual fentanyl, as well as proportion of patients, titrated to 100, 200, 300, 400, 600 and 800μg of sublingual fentanyl were recorded for both groups. Statistical analysis was conducted using χ2 and Mann Whitney U tests. Correlation between transdermal fentanyl and sublingual fentanyl doses was studied using χ2 and Spearman rank correlation coefficient r. Level of significance was set at p=0.05. Transdermal fentanyl doses (mean±SD) were 65.38±27.45 and 186.66 ±62.53 μg/h for groups A and B respectively. Sublingual fentanyl doses (mean±SD) were 265.38±26 μg and 396.67±30 μg for groups A and B, revealing significant differences between groups. Proportion of patients titrated to 100, 200, 300, 400, 600 and 800 μg between groups revealed significant association between transdermal fentanyl and sublingual fentanyl. The present study showed that, despite distinguishable characteristics of breakthrough pain, compared to background pain, patients administered high doses of slow releasing opioid regimen for background pain management, required proportionally high doses of rapid onset opioid for their breakthrough pain relief.