[Efficacy of Tapentadol for Neuropathic Pain in Cancer].

Neuropathic pain in patients with cancer often do not respond to both opioid and non-opioid analgesics. Tapentadol has two medical effects: action on the µ opioid receptor and inhibition of noradrenaline reuptake; thus, it is expected to be effective for neuropathic pain. We investigated its effect on neuropathic pain in 40 patients with cancer who received tapentadol between June 2017 and May 2020 at the Japanese Red Cross Nagoya Daini Hospital. We compared the level of neuropathic pain using an NRS before and after tapentadol administration. The NRS score(median)decreased from 7 to 4.5 within 15 days after first administration or dose increase(p<0.05). Twenty-two patients(55%)showed more than 33% improvement in the NRS score. These results suggest that tapentadol may contribute to a reduction in neuropathic pain.

[A case of bilateral recurrent laryngeal nerve palsy after thyroid surgery under intraoperative nerve monitoring].

A 66-year-old woman suffering from Basedow disease had total thyroidectomy under intraoperative monitoring (IOM) of recurrent laryngeal nerve (RLN) using Medtronic Xomed Nerve Integrity Monitor-2 (Medotronic, Mineapolice, Minesota, USA). IOM indicated a positive signal for her right RLN while the signal for her left RLN disappeared during the operation. During the surgery, surgeons identified her left RLN which was anatomically intact. During the attempted extubation of the endotracheal tube, the patient experienced severe dyspnea resulting in re-intubation. Fiber-optic examination revealed bilateral vocal cord immobility. On POD3, dysfunction of her vocal cord continued, therefore, she had tracheotomy With long-term follow up, her vocal cord function returned to normal on POD37 and tracheotomy tube was removed. In conclusion, positive signals of IOM are not always correlated with proper function of vocal cord. Therefore, respiratory condition should be carefully observed during postoperative period.

Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review.

We report here a case of Pasteurella multocida infection caused by cat exposure presenting with septic shock, sinusitis, and pneumonia. The patient was a febrile 20-year-old woman who had been experiencing disturbed consciousness progressively. She had close contact with a domestic cat and had received some scratches on both arms. A magnetic resonance imaging (MRI) scan of the head showed a high intensity in the paranasal cavity, and a computed tomographic (CT) scan of the chest showed bilateral lung consolidations. The pathogen was identified as P. multocida by the cultures from blood and nasal discharge. She was given intensive antibiotic therapy with ceftriaxone and piperacillin, continuous hemodiafiltration (CHDF) therapy, and anticoagulation therapy. Owing to these therapeutic regimens, the septic shock was successfully treated without complications. We also review the literature on P. multocida septicemia.