Browsing by Author "Jovanović, Vesna (57224641487)"

Chronic postoperative pain (CPOP) is a serious health issue that affects millions of patients every year. The incidence of CPOP is the highest after amputations, inguinal hernioplasty, thoracotomies, cardiac surgery and breast surgery. In addition to surgical factors, the other risk factors are: female gender, younger age, preoperative pain, psychological state and acute postoperative pain. The most common expression of CPOP is neuropathic pain after surgical trauma. The treatment of chronic postoperative neuropathic pain (CPNP) is difficult. Various methods have been recommended for its prevention, the most important being techniques that avoid nerve damage and adequate perioperative analgesia. The goal of this review was to discuss data from published studies examining the incidence, risk factors and mechanisms of CPOP, with a focus on surgery, the unique opportunity to implement pharmacological strategies for prevention of CPNP and current pharmacotherapy approaches for treatment of CPNP. Commonly used drugs to prevent and treat CPNP in the current clinical setting are: opioids, α2-adrener-gic agonists, cyclooxygenase antagonists, gabapentin, pregabalin, steroids, N-methyl-D-aspartate receptor antagonists and local anesthetics. © 2023, Dr. Mladen Stojanovic University Hospital. All rights reserved.

Background/Aim. The incidence of postoperative delirium (POD) after non-cardiac surgery is a problem not often recognized by many anesthesiologists. The objective of our study was to detect POD and its possible cause, in patients undergoing radical retropubic prostatectomy (RRP) under general anesthesia. Methods. After Ethical Committee approval, we enrolled 80 patients, ASA (the American Society of Anestesiology) status II, scheduled to undergo RRP under general anesthesia, in a prospective study. All patients completed MMSE tests (the Folstein Mini Mental State Exam) the evening before, and 48 hours after the surgery. Assessment for the presence and severity of delirium was performed using CAM (the Confusion Assessment Method), and an assessment of the degree of agitation and sedation using RASS (the Richmond Agitation and Sedation Scale). Results. The average preoperative MMSE score (28.59 ± 1.04) significantly decreased following the surgery (27.74 ± 1.52) (p < 0.0001). The average postoperative MMSE score trend descended in correlation to intraoperative bleeding (p = 0.036). The patients with higher pain scores had significant decline in MMSE after the surgery (28.75 vs. 26.25; p < 0.001). Five patients were considered positive for delirium, and four of them reported regular alcoholic drinks intake (> 1 drink per day) preoperatively (p < 0.0001). Based on RASS score, 13 patients (16.3%) were agitated or sedated, and they had statistically significantly higher intraoperative bleeding (p < 0.001). Conclusion. Results of this study emphasize the importance of proper preoperative evaluation; especially regarding the alcohol consumption since all the patients that developed POD reported moderate alcohol consumption. Furthermore, greater intraoperative bleeding and postoperative pain scores did not influence the occurrence of delirium, but resulted in lower postoperative MMSE scores, which highlights the importance of adequate intraoperative treatment of patients during surgery and anesthesia in order to reduce the risk of developing POD. © 2021 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.