Despite our study's limitations, results suggest that long-term IDDS for refractory malignant pain due to pancreatic cancer was both efficacious and safe in pancreatic cancer pain. We have demonstrated, in the largest series of IDDS for pancreatic cancer pain reported yet, a clinically and statistically significant pain reduction in patients receiving IDDS.

Objective Intrathecal (IT) drug delivery has shown its efficiency in treating refractory cancer pain, but switching opioids from the systemic to the intrathecal route is a challenging phase. Moreover, associations are widely used and recommended. Few data deal with the initial dosage of each drug. Analyzing conversion factors and initial dosages used in intrathecal therapy seems essential to decreasing the length of titration and to delivering quick pain relief to patients. Methods We retrospectively analyzed data from consecutive adult patients implanted with an intrathecal device for cancer pain and treated at the Institut de Cancérologie de l’Ouest, in Angers, France, for four years. The main goal was to identify factors associated with early pain relief after intrathecal drug delivery system (IDDS) implantation. Results Of the 220 IDDS-treated patients, 70 (32%) experienced early pain relief (EaPR) and 150 (68%) delayed pain relief (DePR). Performance Status stage and initial IT ropivacaine:IT morphine ratio were the variables independently associated with EaPR. The best IT ropivacaine:IT morphine ratio to predict EaPR was 5:1, with a 73% (95% confidence interval [CI] = 64.8% to 79.6%) sensitivity and a 67.1% (95% CI = 54.9% to 77.9%) specificity. EaPR subjects experienced better pain relief (–84% vs –60% from baseline pain score, P < 0.0001), shorter length of hospitalization (7 vs 10 days, P < 0.0001), and longer survival (155 vs 82 days, P = 0.004). Conclusions Local anesthetic:morphine ratio should be considered when starting IDDS treatment. EaPR during the IT analgesia titration phase was associated with better pain relief and outcomes in patients with refractory cancer-related pain.

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Objective Vertebroplasty is a percutaneous minimally invasive procedure indicated for vertebral collapse pain treatment. Among the known complications of the procedure is the augmented risk of new vertebral fractures. There are no specific studies in this patient population describing the risk of new vertebral fractures after vertebroplasty. This study analyzed risk factors associated with new vertebral fractures after vertebroplasty in patients with multiple myeloma. Methods Observational retrospective study in patients with multiple myeloma. The data collection took place from January 1, 2010, to December 30, 2017, at the National Cancer Institute. Clinical data and procedural variables such as cement volume, cement leaks, fracture level, number of treated vertebrae, pedicular disease, and cement distribution pattern, with two years follow-up, were analyzed with the Wilcoxon test, and a logistic regression model was used to identify risk factors related to new vertebral fractures. A confidence interval of 95% was used for analysis. Results At one-year follow-up, 30% of fractures were reported after vertebroplasty, most of them at low thoracic and lumbar level (50% adjacent level). Vertebroplasty was most commonly performed at the thoracolumbar and lumbar area. We demonstrated a 70.7% median numerical rating scale reduction at one-year follow-up; a significant decrease in opioid consumption occurred only during the first month. Conclusions Pedicle involvement, disc leakage, cement volume, thoracolumbar and lumbar level, and number of treated vertebrae by intervention are important risk factors when performing vertebroplasty. Prospective randomized studies are needed to evaluate these factors in this specific population.

Pain is a distressing symptom that affects 66% of cancer patients in advanced, metastatic or terminal disease. When systemic pharmacological analgesics fail to offer sufficient relief, invasive strategies such as continuous nerve blocks are often used for mid-term pain relief. Cancer related pelvic visceral and somatic pain is difficult to treat using continuous regional techniques. Standard approaches such as paravertebral block or chronic neuraxial techniques may be associated with potential severe complications, particularly in anticoagulated patients and patients with high infection risk. Erector spinae plane block (ESPB) has proven efficacious in anesthetic practice for visceral and somatic pain from several anatomical regions. This block provides somatic and visceral analgesia by local anesthetic diffusion into the neural foraminal, epidural and intercostal spaces and over several vertebral levels from a single non-neuraxial point of injection. We present the use of an ESPB with a catheter for the management of severe oncologic pain in a complex case with good results. We have found this block is helpful in a patient with Burkitt Lymphoma related pain for whom a temporary continuous block was needed before a definitive neuromodulation technique was offered. Current evidence for this technique to treat cancer pain is reviewed and we discuss possible areas of research. rESumENEl dolor es un síntoma angustiante que afecta al 66% de los pacientes con cáncer en enfermedad avanzada, metastásica o terminal. Cuando la analgesia sistémica no ofrece un alivio suficiente, las estrategias mínimamente invasivas son una opción viable. El dolor visceral y somático pélvico relacionado con el cáncer es difícil de tratar utilizando técnicas regionales continuas. Los enfoques

Un caso infrecuente de acodamiento de un tubo endotraqueal reforzado en una unidad de cuidados intensivos: reporte de un caso A rare case of kinked reinforced endotracheal tube in an intensive care unit: a case report

Background: Hemorrhoidectomy is the treatment of choice for symptomatic hemorrhoids, reserved for patients with grade III or IV hemorrhoids or no response to conservative treatment. There are several surgical techniques, whose degree of resolution of symptoms and patient satisfaction has varied results. Objectives: To evaluate in the short term the symptomatology and degree of satisfaction of patients undergoing conventional hemorrhoidectomy in Complejo Asistencial Dr. Sótero del Río. Material and Methods: A retrospective telephone survey was applied to patients undergoing conventional hemorrhoidectomy from June 2015 to January 2016. The survey includes questions about symptoms in the pre-operative, at the month and at 6 or more months post-operated. Bleeding, pruritus, pain, prolapsed sensation and incontinence were evaluated. The statistical analysis considered the results according to the 5 symptoms evaluated in the survey and then dichotomized according to clinical relevance. A significant p value < 0.01 was considered. Results: 43 patients answered the survey, with a median age of 55 years (17-80). The median evaluation was 8 months (6-12). Considering the symptoms: bleeding, pruritus, pain and prolapse, 35 patients (79%) had 3 or more preoperative symptoms considered significant. Persistent follow-up ranges from 9 to 28%. In the statistical analysis with dichotomized symptoms, there is a statistically significant decrease at one month and at 6 or more months post-surgery. Conclusion: Conventional hemorrhoidectomy is well evaluated by patients in relation to a significant resolution of hemorrhoidal disease symptoms.