Acta clinica Croatica
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In 10% to 30% cancer-pain cases standard analgesic therapy fails to provide effective pain relief. Interventional techniques, such as peripheral nerve blocks, neuraxial analgesia along with neurolytic blocks may be used for such refractory pain. Peripheral nerve blocks can be used when pain occurs in the territory of one or more peripheral nerves, but rarely as main therapy. ⋯ Neurolysis is the targeted destruction of a nerve or nerve plexus, using chemicals, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures; however, it rarely completely eliminates pain because patients frequently experience coexisting somatic and neuropathic pain as well. Complex conditions of palliative patients along with limited high-quality randomized controlled trials limit the use of interventional procedures. Even so, some cancer patients benefit from interventional procedures to achieve pain alleviation and consequently improve quality of life.
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Acta clinica Croatica · Sep 2022
ReviewPERIPHERAL NERVE BLOCKS IN PATIENTS ON ANTITHROMBOTIC DRUGS - A RESCUE OR AN UNNECESSARY RISK?
Bleeding complications after peripheral nerve blocks (PNBs) in patients treated with an antiplatelet agent and/or an anticoagulant drug are rare, with estimated incidence of 0.67% (0.51-0.83%). However, they can result in significant patient morbidity and may require follow-up investigations and interventions. The evidence for bleeding risks and complications after PNB is very low or nonexistent, therefore, recommendations and guidelines are based on retrospective analyses, case reports, expert opinions and expert panel consensus. ⋯ A bleeding risk should be minimized with the optimization of patient's coagulation: appropriate antithrombotic drug timing before PNB, dose of antithrombotic drug, indication for the drug and risk factors that may influence drug pharmacokinetics (bodyweight, age, renal and hepatic function). Superficial PNBs may be performed in the presence of antithrombotic drug. For deep PNBs, a recommendations for neuraxial procedures should be considered.
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Acta clinica Croatica · Sep 2022
EVAULATION OF BLINK REFLEX BETWEEN PATIENTS WITH IDIOPATHIC TRIGEMINAL NEURALGIA AND HEALTHY VOLUNTEERS.
The purpose of the study was to find differences in the parameters of the response to the blink reflex (BR) between patients with idiopathic trigeminal neuralgia (TN) and health volunteers. A prospective cohort study was conducted over 2 years. The TN-subgroup included 15 patients (mean age / SD 62.3 ± 10.7 years). ⋯ On the basis of the presence of R1c and R3 latencies and upon considering the abnormal findings of the BR, no statistically significant differences were found between the examined subgroups (p > 0.05). Blink-reflex parameters (R1, R2 and R2c) were significantly abnormal comparing TN-patients with healthy volunteers. The R3 component of the BR was related to noxious stimuli, likewise by innocuous stimuli.
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In the past few decades, many changes have been noticed in all medical branches, especially in surgery. Enhanced Recovery After Surgery (ERAS) is a completely new approach, with the main goal to change the period of patient's recovery, making perioperative time easier and shorter. The patient's recovery is faster, better and the patient's satisfaction is bigger. ⋯ Creation and implementation of ERAS protocol is hard work, which includes multidisciplinary team work and especially a team leader, who coordinates the medical team, the patient and hospital management. Conclusion: Creation of an ERAS protocol is very serious and long- lasting work. It is multidisciplinary and it usually has to be individually tailored for each institution itself in coordination with the health care system and with the final implementation in the medical system.
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Acta clinica Croatica · Sep 2022
SIMULATION-BASED TRAINING OF REGIONAL ANESTHESIA MEDICAL SIMULATION CENTER, UNIVERSITY MEDICAL CENTER LJUBLJANA, SLOVENIA.
Simulation-based training is a technique, which uses technological devices to reproduce different clinical situations like in the real world. Procedures and simulation scenarios performed on simulators can be planned and repeated with no harm for the patient. Simulation-based training introduced new educational applications in medicine to improve patient safety. Simulation education was introduced in the anesthesia curriculum in 2017 as a first specialization in Slovenia.