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We present two cases of weaning from high-dose opioids (fentanyl and oxycodone. The first case concerns a 26-year-old patient with mitochondrial syndrome and neuropathic pain in the lower limbs, addicted to high doses of transdermaland transmucosal fentanyl (transdermal fentanyl 150 g/h in the form of patches every 3 days and transmucosalfentanyl 300 g/dose applied intranasally every 1 hour). The second case concerns a 32-year-old patient with chronicpost-traumatic pain and post-traumatic stress disorder, addicted to a high dose of oxycodone (1600 mg/day).Unfortunately, only in the first case, the desired effect was achieved discontinuation of fentanyl and remission of pain.In the second case, the patient resigned from further treatment in the pain management clinic despite achieving theintended therapeutic effect switching oxycodone to buprenorphine and reducing pain intensity

Uszkodzenie tkanek na skutek urazu lub procesu chorobowego powoduje uwolnienie z nich kaskady mediatorów prowadzących do rozwoju stanu zapalnego, procesów sensytyzacji struktur układu nerwowego, a w konsekwencji do powstania zapalnego komponentu bólu. Ból zapalny stanowi konsekwencję obronnej reakcji organizmu. Komponent bólu zapalnego występuje w zespołach bólu zarówno ostrego, jak i przewlekłego. Najczęściej ból zapalny dotyczy narządu ruchu i wiąże się z chorobą zwyrodnieniową stawów lub ma postać bólów dolnego odcinka kręgosłupa. Ból zapalny w narządzie ruchu charakteryzuje się brakiem poprawy po odpoczynku (tym różni się od bólu somatycznego przeciążeniowego, mechanicznego) i nasilaniem się w nocy, zwłaszcza w jej drugiej części. Ze względu na złożony patomechanizm bólu zapalnego jego leczenie musi mieć charakter multimodalny, a odpowiednio dobrana, kontekstowa farmakoterapia jest jednym z kluczowych elementów leczenia.

Neuropathic pain affects an average of 7–10% of the population and is more often in elderly people and in women. It is a chronic pathological pain, resistant to analgesics from the first step of the analgesic ladder (paracetamol, metamizole, non-steroidal anti-inflammatory drugs). Neuropathic pain may be caused by: infectious diseases, trauma, ischemia, metabolic diseases, neurological diseases, toxic, consequences of damage to the nervous system resulting from the treatment of neoplastic disease, pressure, inflammation, as well as deficiencies. The American Academy of Neurology, Special Interest Group on Neuropathic Pain, and the European Federation of Neurological Societies recommend gabapentin/pregabalin and antidepressants as first choice in the treatment of neuropathic pain. In neuropathic pain accompanying neoplastic disease, due to its mixed nature, i.e., the coexistence of receptor pain, opioid analgesics are always used in the treatment: tramadol for moderate pain and strong opioids for high pain. The following article describes the differences in the pharmacokinetics and pharmacodynamics of gabapentin and pregabalin.

Neuropathic pain is still a challenging problem. It is experienced by millions of people worldwide, with an approximate prevalence of 7‒10% in the general population. Despite the availability of a variety of treatment methods, a significant proportion of patients suffer from poorly controlled neuropathic pain. Capsaicin is a highly selective TRPV1 (Transient Receptor Potential Vanilloid Type 1) agonist. When applied topically, it leads to the defunctionalisation of hyperactive nociceptive receptors, temporary destruction of peripheral nerve endings, and a significant reduction or cessation of pain. Therefore 8% capsaicin patches are used to treat several peripheral, localized neuropathic pain syndromes. The study aimed to present a case series of patients suffering from peripheral, localized neuropathic pain in case the use of repeated applications of 8% capsaicin patches significantly reduced the intensity of pain. In 5 out of 6 patients we observed a gradual extension of the pain relief period until the pain disappeared, which led to the reduction or discontinuation of systemic pharmacotherapy. In summary, a therapy limited to a certain area of the body, without potential systemic adverse effects, which requires repetition at fairly long intervals, appears to be a good treatment option.

Advanced pancreatic cancer is commonly associated with significant visceral pain, radiating in a belt-like distribution to the upper abdomen, referring to the lower back, and significantly affecting patients’ quality of life (QoL). The pain is often poorly controlled by pharmacotherapy, or the doses necessary to control the pain produce substantial adverse effects. Other available pain management options include invasive celiac plexus block or neurolysis, palliative radiotherapy, and systemic chemotherapy, all with limited efficacy. In this case report, we present the first non-invasive celiac plexus radiosurgery performed in Europe in a patient with pancreatic cancer, demonstrating that significant pain relief can be achieved through a non-invasive procedure performed within 2 outpatient visits.

Usage of opioids in chronic pain may cause many adverse effects. One of them is a risk of addiction. We would like to present a case report of detoxification of a 76-years old patient. She was addicted to high doses of fentanyl (totally 14400 μg fentanyl per day – 400 μg/h in transdermal system and 12 transmucosal pills per day).

In December 2020 representatives of the responsible entities in consulation with European Medicines Agency and Office for Registration of Medicinal Products, Medical Devices and Biocidal Products published a safety communication on the possible occurrence of drug-induced liver injury (DILI) in the use of metamizolecontaining medicinal products. According to the message, metamizole should not be re-used in patients with a history of liver damage during treatment with metamizole, when no other cause that could lead to liver damage has been identified. Clinical practice, including spontaneous monitoring of side effects, shows that metamizole is still an effective and safe analgesic, which is included in the current recommendations for the treatment of acute, postoperative and cancer patients.

Patients with chronic low back pain are a heterogeneous group. Therapeutic management of these patients should address the underlying mechanism of pain, which can be revealed after performing diagnostic tests. The management of patients with the predominant central sensitization component of includes multimodal therapy consisting of pharmacological and non-pharmacological treatment. An important element is also the identification and exclusion of the most important pathophysiological factors affecting the maintenance of central sensitization mechanisms in each patient. The paper describes pharmacological and non-pharmacological therapeutic options in patients with central sensitization component, considering that these methods may differ significantly in the patients. It should be stated that despite the individualized, multimodal therapy based on pain mechanisms, in some patients substantial pain relief may not be achieved.

Chronic low back pain is a substantial clinical problem because of its high prevalence, incidence, complex and heterogeneous symptomatology. The majority of patients experience nociceptive pain only, but in almost 40% of patients neuropathic component may be present. In many patients with low back pain symptoms associated with central sensitization may be present as well and therefore their pain can be classified as nocyplastic. (functional) This paper describes how clinicians can differentiate these types of pain, taking into account that in a given patient several mechanisms may contribute to chronic pain development, and pain results from complex mechanisms. In the second part, therapeutic options are presented for people with symptoms of central sensitization, with emphasis on non-pharmacological methods.

The current epidemiological situation due to the SARS-CoV-2 pandemic affects many clinical aspects of managing patients with acute and chronic pain. Currently problems and controversies arise regarding treatment of acute pain and fever associated with the viral infection itself, introducing and / or continuing analgesics and coanalgesics, drug safety and possible interactions, conducting invasive procedures for pain management, follow-up at the pain clinic and possible chronic pain as a complication of the viral infection. The team of PASP experts have developed the position statement concerning the above-listed clinical issues in accordance with contemporary literature.

Core body temperature is strictly regulated (± 0.2 °C) and coordinated at the level of central nervous system located in the hypothalamus via several protective effector mechanisms that prevent overcooling and overheating. The central regulation permits both circadian and monthly variations of even 1°C; under normal conditions, however, the activation of effective protective mechanisms prevents even the slightest overcooling and core temperature elevation at any moment of the day.

BACKGROUND Shivering during caesarean section (CS) under spinal anaesthesia is a common phenomenon. It could not only alter patient's physiology by increasing oxygen consumption but also affect the parturient's experience of childbirth. Shivering is thought to be associated with intraoperative hypothermia, but the risk factors and exact mechanism remain unclear. METHODS We conducted a prospective, observational study to examine the potential risk factors for intraoperative shivering, including anxiety levels. Two hundred patients undergoing elective CS under spinal anaesthesia were recruited. Parturient anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI) questionnaire. Age, weight, height, BMI, anxiety level, number of previous deliveries, sensory block level, level of education, temperature difference during surgery and American Society of Anesthesiologists score were investigated as potential risk factors. Stepwise logistic regression was used to assess the predictors for shivering. RESULTS Data from 155 parturients were analysed. Shivering incidence was 21.9% (34 parturients). The statistical model predicted 8.5% of a shivering incidence variability (R-square Nagelkerke = 0.085). Out of all measured variables, only the number of previous deliveries [(W) = 4.295 Exp(B) = 0.562 P

The article discusses inflammatory pain in an interdisciplinary way, including opinions on methods of treatment of disease entities in which a component of inflammatory pain appears by various specialists: a rheumatologist, neurologist, physiotherapist, clinical pharmacologist and pain medicine specialist. The pathomechanism of inflammatory pain, which determines the choice and effectiveness of therapy, has been widely discussed. The most common type of inflammatory pain is pain in the organ of the movement, which also dominates as the most frequent reason for experiencing pain and the cause of disability of patients, which is why this topic was discussed the most widely.

ObjectivesThe Central Sensitization Inventory (CSI) is a new, simple clinimetric instrument intended to help doctors who deal with pain of unclear origin. It may be particularly useful when there is a large component of neuropathic pain and to assess non-specific symptoms associated with the phenomenon of central sensitization known under the common name of the central sensitization syndrome. The aim of this study is to perform translation of the CSI into Polish, its cultural adaptation and its preparation for further validation. The proposed adaptation of the scale may be applied both at the clinical level and at the level of primary care.Material and methodsThe CSI translation process took place in several stages. Firstly, the text of the questionnaire was translated from English to Polish by five independent translators. Secondly, the optimal version of the text was determined and, at the third stage, it was submitted to a linguist in order to assess it in the context of the idiomatic and semantic clarity. Thirdly, the translation was passed on to a native speaker who verified the congruence of the Polish translation with its original version. At a later stage, the effect of translating the scale and its usefulness were discussed by a group of experts in order to adapt a cultural tool. The final step was to provide it to be completed and evaluated by twenty anonymous patients with the aim of pre-assessing the level of its understanding.ResultsThe final result of the undertaken activities is the Polish version of the CSI ready for validation.ConclusionsAfter the multistage preparation and thorough verification of the Polish questionnaire at conceptual, empirical, semantic and idiomatic levels, necessary due to numerous cultural and linguistic differences, the Polish translation of the CSI seems to be a product ready for further validation and introduction to clinical practice.

The efficacy of neuropathic pain control remains unsatisfactory. Despite the availability of a variety of therapies, a significant proportion of patients suffer from poorly controlled pain of this kind. Consequently, new drugs and treatments are still being sought to remedy the situation. One such new drug is mirogabalin, a selective ligand for the α2δ subunits of voltage-gated calcium channels (VGCC) developed by Sankyo group for the management of neuropathic pain. In 2019 in Japan, mirogabalin was approved for peripheral neuropathic pain following the encouraging results of clinical trials conducted with diabetic peripheral neuropathic pain (DPNP) and postherpetic neuralgia (PHN) patients. The ligand selectivity of mirogabalin for α2δ-1 and α2δ-2 and its slower dissociation rate for α2δ-1 than for α2δ-2 subunits of VGCC may contribute to its strong analgesic effects, wide safety margin, and relatively lower incidence of adverse effects compared to pregabalin and gabapentin. This article discusses the mechanism of action of mirogabalin, presents data on its pharmacodynamics and pharmacokinetics, and reviews the available experimental and clinical studies that have assessed the efficacy and safety of the drug in the treatment of selected neuropathic pain syndromes.

The optimal intrathecal dose of local anaesthetic for caesarean section (CS) anaesthesia is still being debated. We performed a study to compare the effectiveness and safety of spinal anaesthesia with 12.5 mg of hyperbaric bupivacaine and a dosing regimen of conventional doses adjusted to parturient height. One hundred and forty parturients scheduled for elective CS were enrolled. The fixed-dose group (FD) received a spinal block with 12.5 mg of hyperbaric bupivacaine with fentanyl, whereas the adjusted-dose group (AD) received a height-adjusted dose of bupivacaine (9&ndash, 13 mg) with fentanyl. Sensory block &ge, T5 dermatome within 10 min and no need for supplementary analgesia were set as the composite primary outcome (success). Rates of successful blocks and complications were compared. Complete data were available for 134 cases. Spinal anaesthesia was successful in 58 out of 67 patients in the FD group and 57 out of 67 in the AD group (p &gt, 0.05). Eight spinals in each group failed to produce a block &ge, T5 in 10 min, and one patient in the FD group and two in the AD group required i.v. analgesics despite sensory block &ge, T5. No differences were noted in terms of hypotension, bradycardia and nausea between the FD and AD groups. Compared to the height-adjusted dose regimen based on conventional doses of hyperbaric bupivacaine, the fixed dose regimen of 12.5 mg was equally effective and did not increase the risk of spinal block-related complications.

for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, and Polish Society of Anaesthesiology and Intensive Therapy. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as “pain”, “cancer”, “pharmacotherapy”, “analgesics”, and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the pharmacotherapy of pain in cancer patients with organ dysfunctions (circulatory failure, chronic obstructive pulmonary disease, renal or hepatic failure) were also discussed. In addition, principles for the management of crisis situations as well as cases of opioid overdose or opioid-induced respiratory depression were presented. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients.

The issues concerning the transfer of drugs into mothers' milk and their influence on breastfed babies have not been fully studied. Assessment of the situation should include such aspects as drug transfer into fetal blood and into mother's milk, the real risk of inhibiting lactogenesis 2 in women after birth, as well as the psychological consequences for the mother of suspending breastfeeding. The risk of feeding a newborn with formula based on cow's milk is another fateful issue. The following paper presents the pharmacokinetic characteristics of drugs which determine their transfer level through the placenta and into mother's milk during the perinatal period and lactation.

Cesarean section requires the administration of drugs that should be limited to specific medical indications. It is important to remember that most of the available and currently administered anesthetics can affect the fetus and the newborn. In obstetric anesthesia, only such medication that demonstrates a beneficial pharmacokinetic profile and maximum effectiveness should be administered. In this article, the authors reviewed the pharmacodynamic and pharmacokinetic properties of the drugs used during anesthesia in obstetric procedures. The analysis of the influence of these drugs on the clinical condition of the newborn at birth and during breastfeeding was also presented. Drug safety was determined in the aspect of lactation and natural feeding.

It is estimated that there are over 310 million surgeries performed in the world every year. Appropriate analgesic management in the perioperative period constitutes a fundamental right of every patient, significantly reducing the number of postoperative complications and the time and costs of hospitalization, particularly in the high-risk group of patients (ASA III-V) subject to extensive surgical procedures and hospitalized in intensive care units. Despite such significant arguments speaking for the conduct of effective analgesia in the perioperative period, nearly 79% of patients operated in hospitalization settings and 71% of patients operated in outpatient settings (so-called first day surgery) experienced postoperative pain of moderate, strong or extreme intensity. Hence, effective relief of postoperative pain should constitute one of the priorities of integrated, modern perioperative management, the components of which apart from adequate analgesia involve early nutrition through the alimentary canal, early patient activation and active physiotherapy. In the currently published “Guidelines”, a team of authors has updated the previous “Recommendations” primarily in terms of methods for optimizing postoperative pain relief and new techniques and drugs introduced for postoperative pain therapy in recent years. The algorithms of postoperative pain management in different treatment categories were also updated.

The aim of the study was to measure the frequency of such emotional disturbances as anxiety, depression and aggression among patients treated in a pain clinic, as well as assess the factors contributing to such disorders. Research was conducted from January 2014 to April 2018 and involved patients treated in two pain clinics in the city of Warsaw, Poland. The study used the Hospital Anxiety and Depression Scale&mdash, Modified Version (HADS-M) and the Numerical Rating Scale (NSR). 1025 patients were recruited. The main reasons for their attending the pain clinic were osteoarticular pain (43.61%) and neuropathic pain (41.56%). Emotional disturbances in the form of anxiety were diagnosed in 32.39% of all the patients, depression in 17.85%, and aggression in 46.15%. The factors determining the level of anxiety in the study group were: sex, age, pain intensity and the lack of pharmacological treatment. Depression was determined by sex, pain intensity and the time of treatment in the clinic, while aggression by age and pain intensity.

Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as “pain”, “cancer”, “pharmacotherapy”, “analgesics”, and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients.

Introduction. Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions. Objective. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions. Materials and method. 18 women were treated between January 2010 – October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3–9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7–10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin). Results. In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms. Conclusions. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther) and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.

5% lidocaine medicated plasters (5% LMP) have been appointed as a first-line treatment for post-herpetic neuralgia (PHN), while formerly used sympathetic nerve blocks (SNBs) were recently denied their clinical efficacy. The aim of this study was to compare the results of PHN management with the use of SNBs and 5% LMP as a first-line treatment.This study was designed as a retrospective, consecutive, case-series study. Data of 60 consecutive PHN patients with allodynia treated with the use of SNBs and 60 subsequent patients managed with 5% LMP were analyzed. Pain severity after 8 weeks was assessed to recognize the results of the implemented therapy, with numeric rating scale (NRS) score3 or =3 considered a success. Additionally, the number of pain-free patients (NRS=0) after 8 weeks were identified in both groups and compared.The rate of failures in SNBs and 5% LMP group was similar (18.9% vs. 27.1% of poor treatment results, respectively), with the average change in NRS of 5.88 ± 2.41 in nerve blocks and 5.01 ± 1.67 in lidocaine group (p=0.02). Significant difference was also noted in the rates of pain-free patients: 20 patients (34.4%) treated with SNBs and 8 (13.5%) using 5% LMP were pain-free after 8 weeks of treatment.It may be concluded that SNBs may still be considered useful in PHN management, as it appears that in some cases this mode of treatment may offer some advantages over 5% LMP.

Neuropathic pain still present a major diagnostic and therapeutic challenge despite considerable progress in understanding of its mechanisms and publication of number of studies which assessed the efficacy and safety of drugs used in the symptomatic treatment. In practice, it is diagnosed less frequently than recognised in the epidemiological studies, and many patients do not achieve satisfactory outcomes of treatment. A multidisciplinary team of Polish experts, commissioned by the Polish Association for the Study of Pain and the Polish Neurological Society, has reviewed the literature on neuropathic pain, with special focus on the published international recommendations, and formulated recommendations on neuropathic pain diagnosis and treatment, in accordance with the principles of evidence- based medicine. The paper presents also background information on the neuropathic pain definition, epidemiology, pathomechanism and method of assessment. The diagnosis of neuropathic pain may be established based on medical history and physical examination including special assessment of the somatosensory system. First-line drugs used in pharmacological management of neuropathic pain are: tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, opioids and lidocaine patches.

Inadvertent intraoperative hypothermia is by far the most commonly occurring anaesthesia-related complication. It can increase the risk of unfavourable events perioperatively. Higher rates of surgical site infections and blood transfusions, coagulation and drug metabolism disturbances are said to be the most relevant issues linked to this phenomenon. Although they have been available for several years now, dedicated systems designed to prevent it are still not part of routine anaesthesia conducted in Poland. This review aims to discuss the factors which may potentially increase the risk of hypothermia, and to present tools that are readily available and effective in perioperative temperature management.

Here we report on the use of neurolytic block of ganglion impar (ganglion of Walther) for the management of intractable chronic pelvic pain, which is common enough to be recognized as a problem by gynecologists, likely to be difficult to diagnose and even more challenging to manage. Following failure in controlling the symptoms with pharmacological management, nine women underwent neurolysis of the ganglion impar in our Pain Clinic from 2009 to March 2013. The indication for the procedure was chronic pelvic pain (CPP) of either malignancy-related (4) or other origin (5). The Numeric Rating Scale (NRS) and duration of pain relief were employed to assess effectiveness of the procedure. Neurolysis was efficacious in patients with both malignancy-related CPP and CPP of non-malignant origin. Reported relief time varied from 4 weeks to 3 years, while in 4 cases complete and permanent cessation of pain was achieved. No complications were noted.

Background Abdominal pain in chronic pancreatitis (CP) is the most common symptom with a highly unfavorable impact on the quality of life. It has been shown that bilateral thoracoscopic splanchnicectomy (BTS) may produce marked pain relief for the majority of patients. The aim of this study was to evaluate the effectiveness of BTS in pain control and quality-of-life improvement in patients with a severe form of CP. Methods Between April 2000 and April 2009, a total of 30 patients qualified for BTS due to CP-related pain. Their age ranged from 28 to 60 years. A 12-month follow-up period was planned for all the patients enrolled. To evaluate effectiveness of BTS, an 11-point Numeric Rating Scale (NRS) and the Quality of Life Questionnaire C-30 (QLQ-C30) in its basic form, developed by European Organization for Research and Treatment of Cancer, were used. An NRS value between 0 and 3 was considered a positive postoperative pain control result. Results The bilateral splanchnicectomy procedure was performed successfully in 27 of 30 qualified patients. A positive effect based on decreased pain (p

Inadvertent perioperative hypothermia complicates a large percentage of surgical procedures and is related to multiple factors. Strictly regulated in normal conditions (± 0.2°C), the core body temperature of an anaesthetised patient may fall by as much as 6°C, while a 2°C decrease is very common. This is due to a combination of anaesthesia-related impairment of the central thermoregulatory control and a cool operating room temperature, which, when superimposed on insufficient insulation and a failure to actively warm the patient, may result in profound temperature disturbances. As a result, prolonged wound healing, increased risk of wound infection, a higher rate of cardiac morbidity, and greater intraoperative blood loss and postoperative blood transfusion requirements may occur. The reasons for this are said to include underlying changes in microcirculation, coagulation, immunology and an increase in the duration of action of most anaesthesia medications. As effective methods have been available for a number of years now, it is currently indicated to maintain intraoperative normothermia in order to minimise procedure-related risk and improve patient comfort.

After many years of experience in surgery, a series of recommendations have been created by a group of European specialists to improve the quality of perioperative care and maximize postoperative outcomes. Early mobilization and oral feeding, preoperative oral intake of carbohydrate-rich fluids, proper fluid and pain management, intensive postoperative nausea and vomiting prophylaxis, and antimicrobial and thromboembolism prophylaxis are the interventions that may decrease surgery-induced metabolic stress and facilitate the return of bowel function and early discharge. The Enhanced Recovery After Surgery (ERAS) Society is the group that focuses on these perioperative issues. This paper aims to summarize the role of anaesthesiologists in the implementation of the ERAS protocol.