Epidural anesthesia is no longer the standard of care in abdominal surgery with ERAS. What are the alternatives?

Epidural anesthesia has been considered the gold standard for perioperative analgesia, but the implementation of enhanced recovery after surgery (ERAS) protocols and a shift from open to laparoscopic surgery have diminished the advantage of epidural anesthesia. The authors summarize data from two newer meta-analyses and discuss the consequences for the role of epidural anesthesia (EA) in the perioperative setting. These meta-analyses enabled to distinguish between pre- and post-ERAS outcomes.

Home Telemonitoring Improved Pain Registration in Patients With Cancer.

Introduction: For adequate pain treatment in patients with cancer, it is important to monitor and evaluate pain regularly. Although the numeric rating scale (NRS) is implemented in hospitals in the Netherlands, pain is still not systematically registered during outpatient consultations. The aim of this study was to assess whether home telemonitoring increases pain registration in medical records of outpatients with cancer.

Sublingual sufentanil for postoperative pain relief: first clinical experiences.

Background: The sublingual sufentanil tablet system (SSTS) is a novel hand-held patient-controlled analgesia device developed for treatment of moderate-to-severe postoperative pain. Here we present the first results of its clinical use.

Methods: Adult patients undergoing major surgery in five hospitals in the Netherlands received the SSTS for postoperative pain relief as part of multimodal pain management that further included paracetamol and a nonsteroidal anti-inflammatory drug (NSAID).

The efficacy of standard laxative use for the prevention and treatment of opioid induced constipation during oxycodone use: a small Dutch observational pilot study.

Background: Dutch clinical guidelines recommend that a standard laxative treatment (SLT) should be prescribed concomitantly when starting opioid treatment to prevent opioid-induced constipation (OIC).

Methods: Clinical evidence for SLT in the treatment of OIC is lacking, therefore an observational pilot study was performed to explore the efficacy and tolerability of SLT on OIC in patients treated with the opioid oxycodone.

Results: Twenty-four patients (58% female, median (range) age 65 (39-92)) were included in this pilot study.

Fixed ratio (2:1) prolonged-release oxycodone/naloxone combination improves bowel function in patients with moderate-to-severe pain and opioid-induced constipation refractory to at least two classes of laxatives.

Objective: The effects of combined oxycodone/naloxone prolonged release tablets (OXN PR) were investigated in patients with moderate-to-severe chronic cancer-related or non-cancer pain. All patients had opioid-induced constipation (OIC) which persisted despite substantial laxative therapy.

Research Design And Methods: This pooled analysis included 75 patients with OIC at study entry that was refractory to at least two laxatives with different modes of action.

23. Pain in patients with cancer.

Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life.

Intrathecal administration of high-dose morphine solutions decreases the pH of cerebrospinal fluid.

Terminally ill patients suffering from intractable cancer pain are treated in our hospital on an outpatient basis with a percutaneous intrathecal (i.t.) catheter and a portable pump delivering morphine continuously.