key: cord-0075962-f2bdmi6t
authors: nan
title: Abstracts des 28. Wissenschaftlichen Kongresses der Österreichischen Schmerzgesellschaft
date: 2022-03-22
journal: Schmerz
DOI: 10.1007/s00482-022-00638-w
sha: a8403ca9fbb3e0611cd564bfba7831554fc524c6
doc_id: 75962
cord_uid: f2bdmi6t

nan

Introduction: In patients with intra-abdominal malignancies, chronic abdominal pain has a prevalence up to 50 %, and has huge impact on patients' quality of life and disability. Percutaneous interventional techniques like CT guided coeliac plexus blockade ( CPB) or neurolysis ( CPN) are commonly used pain management strategies to decrease pain, increase quality of life and reduce opioid therapy. Compared to CPB with injection of corticosteroids and/or long-acting local anesthetics, CPN leads to permanent destruction of the coeliac plexus after injection of phenol or ethanol. CPB is commonly practiced prior to CPN as a diagnostic blockade, although its clinical significance in clinical routine is questionable. CPN may be accomplished using an anterior para-aortic, a bilateral posterior para-aortic, a posterior transaortic, or a trans-intervertebral disc approach. In all of these approaches, using multidetector computed tomography guidance, patient anatomy, tumor masses and the needle tip are clearly visible, and hence complication rates are low. The most typical side effect is back pain, which mostly radiates to the shoulder, resulting from neurolysis of sensory nerve fibers. Other side effects are transient pain at the injection site, or diarrhea and hypotension, due to sympathetic blockade. Serious side events, like bleeding complications, retroperitoneal hematoma, lower extremity paralysis, thrombosis of the coeliac trunk or vasospasm of the coeliac artery leading to hepatic, splenic, gastric, or bowel infarction are rare. Using CT-guidance, complications due to poor needle placement, e. g. kidney injuries, pneumothorax, or neurologic complications due to inadvertent injection of neurolytic agent are scarce.

The primary objective of this study was to evaluate pain outcomes among patients with intra-abdominal malignancies who underwent CT-guided coeliac plexus neurolysis. Methods: This retrospective study was approved by the Ethical Committee of Carinthia (S2020-14, 18th April 2020), conducted according to the Helsinki declaration and IASP's guidelines for pain research in animals and humans, and authorized by the hospital general management. The requirement for written informed consent was waived by the Ethical Committee.

All patients with intra-abdominal malignancies who underwent CT-guided CPB and/or CPN for pain control at the general hospital Klagenfurt am Wörthersee between January 2010 and January 2019 were identified using our clinical data retrieval system and procedure notes. Results: 84 procedures (24 CPB and 60 CPN) were performed on 52 patients. 62 % had pancreatic cancer. CPN led to significant pain reduction and decreased BTcP intensity. Patients receiving repeated CPN showed higher individual pain reduction. Higher pre-procedural pain intensity was correlated with higher pain reduction. No difference in pain reduction in patients receiving a diagnostic CPB prior to CPN compared to patients without a diagnostic CPB was found. Higher pain reduction after CPN led to longer lasting pain relief. The time frame from diagnosis to CPN was 472 (±416) days. Patients experienced a mean duration of pain prior to CPN of 330 (±53) days. The time frame from diagnosis to CPN was shorter in patients with pancreatic cancer compared to other intra-abdominal malignancies. In 58 % of patients pain medication was stable or was reduced after CPN. 16 % of patients complained about pain during the procedure; no major complications occurred. There was no correlation of median survival after CPN and pain outcomes.

In patients with intra-abdominal malignancy related abdominal pain, CPN is a safe and effective procedure which can provide long-lasting significant relief in background pain and BTcP. As part of a multimodal approach, CPN should be considered as an earlier option for pain management in patients with intractable abdominal cancer pain.

Background: Despite the existence of internationally consistent guidelines for the management of pain, efficient regional anesthesia techniques, safe pain medications, and organizational structures e. g. acute pain services, various studies have shown that pain is still common among both, surgical and non-surgical in-patients.

The primary objective of this study was to evaluate, on a multi-center basis, the point pain prevalence of surgical and non-surgical inpatients. We further analyzed pain intensities, in-hospital pain triggers, pain-related impairments, pain assessments, patient information about pain, and patient satisfaction with pain therapy. This benchmark information should lead to better implementation of pain management strategies and thus improve health care quality.

We surveyed all adult in-patients in 3 general hospitals in Austria (general hospital Klagenfurt am Wörthersee, general hospital Villach, general hospital Wolfsberg) on Index Day with two standardized questionnaires for both surgical and non-surgical patients. Results: Overall, a pain prevalence of 40.0 %, with no statistically significant difference between surgical and non-surgical patients has been shown. Higher pain prevalence in female patients, and high pain prevalence in the age group 18-30 years and highest pain prevalence in the age group over 90 years old was found. Overall pain intensity was relatively low, but unacceptable maximum pain within the preceding 24 h was shown. Different in-hospital pain triggers like patient's care and mobilization have been found. Our survey has shown that pain has impact on personal hygiene, mobilization, mood, sleep and appetite. However, patients were very satisfied with their pain therapy. 

CT-Guided Coeliac Plexus Neurolysis in Patients with Intra-Abdominal Malignancy: A Retrospective Evaluation of 52 Palliative In-Patients. Pain Ther Pain in Austrian hospitals: Evaluation of 1089 in-patients S

The adjuvanted recombinant zoster vaccine ( RZV) confers long-term protection against herpes zoster: Interim results of an extension study ( ZOSTER-049) of two clinical trials ( ZOE-50 and ZOE-70) H. Rouha 1 on behalf of C. Boutry 2 , A. Hastie 3 , M. Shi 3 , J. Diez-Domingo 4 , J. C. Tinoco 5 , C.-J. Yu 6 , P. Pirrotta 7 , G. Kalema 8 , A. Schuind 3* , on behalf of the Zoster-049 study group 1 GSK, Vienna, Austria; 2 Aixial, Bruxelles, Belgium, on behalf of GSK; 3 GSK, Rockville, Maryland, USA; currently: PATH, Essential Medicines, Washington DC, USA; 4 FISABIO, Valencia, Spain; 5 Hospital General de Durango, Durango, Mexico; 6 National Taiwan University Hospital, Taipei, Taiwan; 7 GSK, Wavre, Belgium; 8 Keyrus Biopharma, Waterloo, Belgium, on behalf of GSK Background: About 1 in 3 persons will develop herpes zoster ( HZ), caused by reactivation of latent varicella zoster virus. The predominant symptom in all phases of HZ is pain, up to 30 % of patients with HZ develop post herpetic neuralgia ( PHN). A new adjuvanted recombinant zoster vaccine ( RZV) was developed for the prevention of HZ and PHN. RZV had a clinically acceptable safety profile, was highly immunogenic and demonstrated >90 % efficacy in adults ≥50 years in 2 large-scale phase 3 clinical trials ( ZOE-50 and ZOE-70) with a mean follow-up of 3.1 and 3.7 years respectively. Here we report interim results after at least 2 years of follow-up. ( SD = 6.9) Tagen. Vor der Implantation der SCS lag der durchschnittliche Schmerz, erhoben mittels NRS, bei 6.9 ( SD = 1.66) und in der Testphase lag der Mittelwert des NRSs bei 3.1 ( SD = 2.1). Es zeigte eine Signifikanz von p = <.001. Der durchschnittliche Prozentsatz der Schmerzreduktion in der Testphase liegt bei 54 %, der Unterschied nach Diagnosegruppen ist nicht signifikant (p = .338). In der gesamten Stichprobe von n = 79 brachen 7 (9 %) in der Testphase ab. Es waren in der Testphase 67 % Responder. 48 Stunden nach der Implantation des Impulsgenerators lag der erhobene NRS-Mittelwert bei 2.5 ( SD = 1.7