After 2min of ventricular fibrillation (VF) mechanical ... the efficacy of the lidocaine patch 5% in different types of neuropathic pain. Materials and methods: A ...
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Acute and Chronic Pain Management
Results and discussion: To assess the quality of CPR we compared initial (i.e. before termination of the dispatchers comments) and over-all no-flow-time (NFT), compression depth and frequency as well as ventilation parameters. The initial NFT was lower in G2 (12,1 +/-5,4 %) compared with G3 (20,7 +/8,1 %). Over-all NFT was lowermost in G1 (21,3 +/- 14,4), followed by G3 (49,1 +/- 8,5 %) and by G1 (57,6 +/- 16,4 %). The mean compression depth was similar in all three groups: 40,6 +/- 13,0 mm (G1), 41,0 +/- 12,2 mm (G2) and 38,8 +/- 15,8 mm (G3). The average compression frequencies were 75,8 +/- 37,6 1/min (G1), 86,1 +/- 24,2 1/min (G2) and 94,6 +/- 23,5 1/min (G3). As a parameter of ventilation quality the mean minute volumes were 2,2 +/- 2,5 l/ min (G1) and 1,2 +/- 1,7 l/min (G3). Conclusion(s): As compression rate was similar in all three groups, just the compression frequency was superior in the standard T-CPR group. Compared with its poor NFT, best quality of layperson CPR was achieved by compression-only T-CPR based on the shortest NFT. Further prospective studies have to be conducted to give a definitive recommendation for compressiononly T-CPR for bystander CPR.
13AP2-8 NIRS may be a reliable marker of CPR-quality because it correlates with systemic haemodynamics and reflects cerebral ox ygenation Putzer G.1, Braun P.1 , Falk M.2, Paal P.1 , Brugger H.3, Mair P.1 Medical Universit y Innsbruck, Dept of Anaesthesiology & Intensive Care, Innsbruck, Austria, 2Inova Q GmbH, Statistical Of fice, Brunico, Italy, 3Institute of Mountain Emergency Medicine at the European Academy, Research and Development Depar tment, Bolzano, Italy 1
Background and Goal of Study: Patients with severe accidental hypothermia of ten undergo prolonged periods of cardiopulmonary resuscitation (CPR). Consequently, CPR-quality is a decisive factor of outcome in particular in victims with concomitant asphyxia. End-tidal CO2 (etCO2), mean arterial pressure (MAP) and mixed venous oxygen saturation (SmvO2) are accepted parameters to monitor the ef ficacy of ex ternal chest compression during prolonged CPR. Near-infrared-spectroscopy (NIRS) is a non-invasive measure of cerebral perfusion and may be a marker of CPR-quality. So far it has not been evaluated suf ficiently what NIRS values really reflect and best correlate with. We therefore assessed if NIRS correlates with etCO2, MAP and SmvO2, as well as with parameters reflecting cerebral oxygen balance, e.g. partial pressure of brain tissue oxygen (PbtO2) and cerebral venous oxygen saturation (ScvO2). Materials and methods: Fourteen 30-40kg pigs were surface cooled to a core temperature of 28°C. Hypoxia and hypercapnia were induced to simulate an asphyxial state. Af ter 2min of ventricular fibrillation (VF) mechanical chest compressions (LUCAS2, Physio-Control, Redmond, WA) were started for 15min, followed by 2min of VF and another 15min of mechanical chest compressions. Then the animals received epinephrine (45µg/kg) and additional 15min of LUCAS2 CPR. Results and discussion: Preliminary statistical data show that NIRS correlates with MAP (r 0.669, p < 0.0001), SmvO2 (r 0.785, p < 0.0001), PbtO2 (r 0.447, p 0.032) and ScvO2 (r 0.527, p 0.01). In contrast, MAP correlates with SmvO2 ( r 0.583, p 0.003) and ScvO2 (r 0.622, p 0.001) but not with PbtO2 (r 0.035, p 0.871), whereas etCO2 does not correlate with any of the parameters of cerebral oxygen balance. Conclusion(s): In this pig model of hypothermic asphyxial CPR, NIRS correlated with systemic haemodynamic parameters, e.g. MAP and SmvO2 as well as with parameters reflecting cerebral oxygen supply and consumption, e.g. PbtO2 and ScvO2. Thus, in deep hypothermia NIRS does not only inform on brain tissue oxygenation, but also monitor correctly the quality of CPR ef forts.
Acute and Chronic Pain Management 14AP1-1 Analysis of the ef ficacy of the lidocaine patch 5% in the treatment of neuropathic pain: “our feedback” Hernández-Puiggròs P.1 , Peláez R.1, Yañez A.2, Morell A.1, Aguilar J.L.1 Hospital Son Llatzer, Dept of Anaesthesiology & Pain Medicine, Palma, Spain, 2FISIB, Research and Development Depar tment, Palma, Spain
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Background and Goal of Study: The objective of this study was to evaluate the ef ficacy of the lidocaine patch 5% in dif ferent types of neuropathic pain. Materials and methods: A prospective, longitudinal, observational study on a sample of 16 patients who consulted for neuropathic pain. A lidocaine patch 5% was applied to the painful area and as primary endpoint, the severity of the pain was studied using the Verbal Numeric Rating Scale (VNRS). Secondary quality of life-related endpoints were sleep during the night, mood and patient global impression of the treatment. Results: Demographic data: 62.5% female and 37.5% male; mean age 55.31±13.9 years; time since onset of the pain 8.4 months; and classified into 4 diagnosis groups: post-herpetic neuralgia 18.8%; complex regional pain syndrome 25%; surgical wound 50%; and others 6.3%. There was a reduction of more than 2 points in pain on the VNRS (median 6.5 to 3.5; p= 0.001), an improvement in sleep during the night, mood and relief (p< 0.05), less use of analgesics, no complications and over 30% of subjects reported improvement of over 50%. Conclusion(s): The lidocaine patch 5% could be a useful tool for the control of neuropathic pain, not only for post-herpetic neuralgia, and it has a good safety and tolerability profile1,2.It would be interesting to investigate whether the patch’s ef fect at the level of the mechanoreceptors in the skin could act
as inhibitory in pain transmission based on the Gate Theory3 and to study the possible ef fect of long-term tolerance of the patch relate with tachyhyla xis. References: 1. Mick G et al. Topical pain management with the 5% lidocaine medicated plaster-a review. Curr Med Res Opin 2012; 28: 937-951 -Hashmi J.A et al. Lidocaine patch 5% is no more potent than placebo in treating chronic back pain when tested in a randomized double blind placebo controlled brain imaging study. Mol pain 8, 29 2. Geha PY et al. Brain activity for spontaneous pain of postherpetic neuralgia and its modulation by lidocaine patch therapy. Pain 2007 Mar; 128:88-100 3. Moayedi et al. Theories of pain: from specificity to gate control. J Neurophysiology 2013; 109: 5-12
Acknowledgements: I wish to acknowledge the help provided by Dr. Aguilar, Mr. Pous and to my family.
14AP1-2
Comparison between the combination of gabapentin, ketamine, lornoxicam and local ropivacaine and each of these drugs alone for pain af ter laparoscopic cholecystectomy: a randomized trial Kotsovolis G.1, Karakoulas K.2, Grosomanidis V.2 1 424 Militar y Hospital of Thessaloniki, Dept of Anaesthesiology & Intensive Care, Thessaloniki, Greece, 2AHEPA Universit y Hospital, Dept of Anaesthesiology & Intensive Care, Thessaloniki, Greece Background and Goal of Study: The main purpose of the study was to test if the combination of gabapentin (600mg 4h before surgery, 600mg af ter 24h), ketamine (0.3mg/kg before anesthesia), lornoxicam (8mg before anesthesia and 8mg/12h) and local ropivacaine (5ml 7.5% at insertion sites) provides
