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907 NEUROMODULATION TREATMENT – NINE YEARS OF EXPERIENCE
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
Results: The average time of IDDS use (from the laying of the pump to the death of the patient) was 120.2 days (minimum 7 days, and maximum 467 days). First intrathecal Ropivacaine dose was 3.72±1.51 mg/day. The Ropivacaine dose ranged from 0.4 to 18 mg/day with an average of 4.12±2.66 mg. Intrathecal Morphine was administered simultaneously at an average daily dose of 13.7 mg/day, and clonidine at an average daily dose of 7.58±1.50 mg/day. We do not observe motor block or cardiovascular toxicity. The evolution of VAS pain is represented in the graph. Discussion: Ropivacaine seems to be an efficient co analgesic for Intrathecal treatment of refractory cancer pain. Reference(s) [1] Neuromodulation 2007;10;4;300–328. [2] J support. Oncol. 2005; 3:6–12.
906 HYPOBARIC SPINAL BUPIVACAINE FOR UNILATERAL LOWER LIMB SURGERY B. Hadri *, I. Krasniqi. University Clinical Center of Kosova, Prishtina, Republic of Kosova, Albania Aim: Evaluation of effects of unilateral hypobaric spinal Bupivacaine administered at patients that underwent different orthopedic surgical interventions for lower limbs. Merthods: One hundred and twenty five patients, ASA I-III, not premedicated, with operative side up, received a spinal injection of 2.5 ml of plain bupivacaine 0.5% mixed with 2.5 ml of distilled water (hypobaric). Lateral decubitus position is kept for 10 minutes. Sensory level and degree of motor block were evaluated by pinprick method and modified Bromage score, respectively, on the nondependent and dependent sides. The onset and duration of sensory and motor block, intensity and duration of motor block vital signs and side effects were recorded. Results: Onset of motor and sensory block was rapid. The median time of onset of sensory block was 10 min (range 5–15 min). The median duration of sensory block was 110 min (range 90–160 min). The median duration of complete motor block (modified Bromage Scale 3) was 90 min (range 80–130 min). 40% achieved light sensory block in nondependent side, while there was no motor block in nondependent side. Vasopressors were needed only for 5 patients. 2 patients had nausea. Conclusion: Application of hypobaric bupivacaine in spinal block provides unilateral profound satisfactory block for orthopedic operations for lower limbs, with sufficient duration, with less side effects, with very fast onset time. Table 1: Demographic data Gender Age Height Weight ASA I/II/III
50 F; 75 M 30 (18–73) 172 (158–188) 73 (57–95) (80%)/(16%)/(4%)
907 NEUROMODULATION TREATMENT – NINE YEARS OF EXPERIENCE M. Hakl1 *, R. Hrib1 , P. Sevcik2 , O. Haklova2 . 1 Fakultni Nemocnice U Sv. Anny, Brno, Czech Republic; 2 Department of Pain Treatment and Paliative Care, Teaching Hospital Brno Bohunice and Masaryk University, Brno, Czech Republic Background: The neuromodulation treatment is established as a standard method in the Czech Republic as the first country in Eastern Europe. Methods: Patients indicated for neuromodulation treatment undergo several examinations. Patients undergo a test period. The test period is two weeks long, patients spend the first week of the test period in hospital as inpatients and then they are release
S257
so that they gain experience with the method in their everyday life. Implantation of neuromodulation device is indicated in case of more than 50% pain relief. Results: From January 2000 to January 2009, 37 patients were indicated for neuromodulation pain treatment, 27 of them did not have contraindication in pre-implantation examinations and had positive results from the test period. 14 programmable spinal pumps (11 for application of spinal morphin, 3 for application of spinal baclofen) and 13 SCS were implanted. The average VAS before neuromodulation treatment was 8.1 (7–9), one year after the implantation the VAS dropped to 4.3. Ashword’s score decrease from 4.0 to 2.8, muscle spasms score decreased from 3.1 to 0.3. The average dose of spinal morphin was 4.6 (1.2–10) mg daily, the dose of intrathecal baclofen was 233 mg per day. Dose usually stabilized by the end of the first post-implantation year. The most frequent diagnoses were Failed Back Surgery Syndrome (FBSS), Central spasticity syndrome and CRPS. As for complications we met only with dislocation of electrode in two cases. Conclusion: The neuromodulation has proved a highly effective method with low number of complications. 908 RETROSPECTIVE ANALYSIS OF THE RESULTS OF EPIDURAL STEROID INJECTIONS (ESIS) AT OUR DEPARTMENT R. Hrib1 *, M. Hakl2 , P. Sˇ evcik3 . 1 Fakultni nemocnice u sv. Anny v Brne, Brno, Czech Republic; 2 Fakultni nemocnice u sv. Anny v Brne, Brno, Czech Republic; 3 Fakultn´ı nemocnice Brno, Brno, Czech Republic Introduction: Procedure and results of the epidural steroid injections (ESIs) at our Department Methods: The most often and therapeutically most successful indication for the ESIs at our department represent lumbosacral disk herniation particularly during the first three month of the nerve root inflammation occurrence. The intervention is indicated on the basis of clinical inspection and results of CT or MRI. The intervention is being performed during half-day stationary observation. We usually perform the administration of bupivacaine and methylprednisolone into the epidural space of the lumbosacral disk herniation. During the next four days, the confinement and homeworkless regimes are being ordained. Afterwards, during next 4–5 weeks, the sickness leave regime occurs with outing without any physical stress. At that time we indicate either intervention repeat or rehabilitation. Results: During the years 2001–2008 we have administrated 623 patients with total of 1150 epidural corticoid administrations. 256 patients were treated due to the lumbosacral disk herniation (M51.1), confirmed by CT or MRI and with the symptoms duration up to 5 months. The average age was 49.5 years (22–85 years), 136 women and 120 men. In 179 cases, one application was sufficient, in 53 cases 2 and in 24 cases 3 applications were necessary. In a period of 6 months after the intervention (4–7), 223 patients were without any symptoms of radicular irritation (87.1%). Conclusions: In well-indicated cases, the ESIs represents effective method that is a useful approach of partial elimination of problems accompanied with backbone degenerative disease. 909 SPINAL ANALGESIA AND INTRACEREBRAL BLEEDING U. Kock *, G. Scharbert, G. Goldner. Medical University of Vienna Dept. of Special Anaesthesia and Pain Therapy AKH, Vienna, Austria Intracranial bleeding is a rare, but serious complication of dural puncture, accidentally, or intentionally, for single shot analgesia as well as for continuous application of analgesic medication via catheter; it has also been reported to occur in connection with epidural analgesia. Dural puncture can cause an activation of minor intracerebral lesions, a cerebral rebleeding, or can enlarge a preexisting haemorrhage. In most cases, anamnestic risk factors and/or preceeding traumata can be identified by specific
Results: The average time of IDDS use (from the laying of the pump to the death of the patient) was 120.2 days (minimum 7 days, and maximum 467 days). First intrathecal Ropivacaine dose was 3.72±1.51 mg/day. The Ropivacaine dose ranged from 0.4 to 18 mg/day with an average of 4.12±2.66 mg. Intrathecal Morphine was administered simultaneously at an average daily dose of 13.7 mg/day, and clonidine at an average daily dose of 7.58±1.50 mg/day. We do not observe motor block or cardiovascular toxicity. The evolution of VAS pain is represented in the graph. Discussion: Ropivacaine seems to be an efficient co analgesic for Intrathecal treatment of refractory cancer pain. Reference(s) [1] Neuromodulation 2007;10;4;300–328. [2] J support. Oncol. 2005; 3:6–12.
906 HYPOBARIC SPINAL BUPIVACAINE FOR UNILATERAL LOWER LIMB SURGERY B. Hadri *, I. Krasniqi. University Clinical Center of Kosova, Prishtina, Republic of Kosova, Albania Aim: Evaluation of effects of unilateral hypobaric spinal Bupivacaine administered at patients that underwent different orthopedic surgical interventions for lower limbs. Merthods: One hundred and twenty five patients, ASA I-III, not premedicated, with operative side up, received a spinal injection of 2.5 ml of plain bupivacaine 0.5% mixed with 2.5 ml of distilled water (hypobaric). Lateral decubitus position is kept for 10 minutes. Sensory level and degree of motor block were evaluated by pinprick method and modified Bromage score, respectively, on the nondependent and dependent sides. The onset and duration of sensory and motor block, intensity and duration of motor block vital signs and side effects were recorded. Results: Onset of motor and sensory block was rapid. The median time of onset of sensory block was 10 min (range 5–15 min). The median duration of sensory block was 110 min (range 90–160 min). The median duration of complete motor block (modified Bromage Scale 3) was 90 min (range 80–130 min). 40% achieved light sensory block in nondependent side, while there was no motor block in nondependent side. Vasopressors were needed only for 5 patients. 2 patients had nausea. Conclusion: Application of hypobaric bupivacaine in spinal block provides unilateral profound satisfactory block for orthopedic operations for lower limbs, with sufficient duration, with less side effects, with very fast onset time. Table 1: Demographic data Gender Age Height Weight ASA I/II/III
50 F; 75 M 30 (18–73) 172 (158–188) 73 (57–95) (80%)/(16%)/(4%)
907 NEUROMODULATION TREATMENT – NINE YEARS OF EXPERIENCE M. Hakl1 *, R. Hrib1 , P. Sevcik2 , O. Haklova2 . 1 Fakultni Nemocnice U Sv. Anny, Brno, Czech Republic; 2 Department of Pain Treatment and Paliative Care, Teaching Hospital Brno Bohunice and Masaryk University, Brno, Czech Republic Background: The neuromodulation treatment is established as a standard method in the Czech Republic as the first country in Eastern Europe. Methods: Patients indicated for neuromodulation treatment undergo several examinations. Patients undergo a test period. The test period is two weeks long, patients spend the first week of the test period in hospital as inpatients and then they are release
S257
so that they gain experience with the method in their everyday life. Implantation of neuromodulation device is indicated in case of more than 50% pain relief. Results: From January 2000 to January 2009, 37 patients were indicated for neuromodulation pain treatment, 27 of them did not have contraindication in pre-implantation examinations and had positive results from the test period. 14 programmable spinal pumps (11 for application of spinal morphin, 3 for application of spinal baclofen) and 13 SCS were implanted. The average VAS before neuromodulation treatment was 8.1 (7–9), one year after the implantation the VAS dropped to 4.3. Ashword’s score decrease from 4.0 to 2.8, muscle spasms score decreased from 3.1 to 0.3. The average dose of spinal morphin was 4.6 (1.2–10) mg daily, the dose of intrathecal baclofen was 233 mg per day. Dose usually stabilized by the end of the first post-implantation year. The most frequent diagnoses were Failed Back Surgery Syndrome (FBSS), Central spasticity syndrome and CRPS. As for complications we met only with dislocation of electrode in two cases. Conclusion: The neuromodulation has proved a highly effective method with low number of complications. 908 RETROSPECTIVE ANALYSIS OF THE RESULTS OF EPIDURAL STEROID INJECTIONS (ESIS) AT OUR DEPARTMENT R. Hrib1 *, M. Hakl2 , P. Sˇ evcik3 . 1 Fakultni nemocnice u sv. Anny v Brne, Brno, Czech Republic; 2 Fakultni nemocnice u sv. Anny v Brne, Brno, Czech Republic; 3 Fakultn´ı nemocnice Brno, Brno, Czech Republic Introduction: Procedure and results of the epidural steroid injections (ESIs) at our Department Methods: The most often and therapeutically most successful indication for the ESIs at our department represent lumbosacral disk herniation particularly during the first three month of the nerve root inflammation occurrence. The intervention is indicated on the basis of clinical inspection and results of CT or MRI. The intervention is being performed during half-day stationary observation. We usually perform the administration of bupivacaine and methylprednisolone into the epidural space of the lumbosacral disk herniation. During the next four days, the confinement and homeworkless regimes are being ordained. Afterwards, during next 4–5 weeks, the sickness leave regime occurs with outing without any physical stress. At that time we indicate either intervention repeat or rehabilitation. Results: During the years 2001–2008 we have administrated 623 patients with total of 1150 epidural corticoid administrations. 256 patients were treated due to the lumbosacral disk herniation (M51.1), confirmed by CT or MRI and with the symptoms duration up to 5 months. The average age was 49.5 years (22–85 years), 136 women and 120 men. In 179 cases, one application was sufficient, in 53 cases 2 and in 24 cases 3 applications were necessary. In a period of 6 months after the intervention (4–7), 223 patients were without any symptoms of radicular irritation (87.1%). Conclusions: In well-indicated cases, the ESIs represents effective method that is a useful approach of partial elimination of problems accompanied with backbone degenerative disease. 909 SPINAL ANALGESIA AND INTRACEREBRAL BLEEDING U. Kock *, G. Scharbert, G. Goldner. Medical University of Vienna Dept. of Special Anaesthesia and Pain Therapy AKH, Vienna, Austria Intracranial bleeding is a rare, but serious complication of dural puncture, accidentally, or intentionally, for single shot analgesia as well as for continuous application of analgesic medication via catheter; it has also been reported to occur in connection with epidural analgesia. Dural puncture can cause an activation of minor intracerebral lesions, a cerebral rebleeding, or can enlarge a preexisting haemorrhage. In most cases, anamnestic risk factors and/or preceeding traumata can be identified by specific