Inadequate management of opioid-induced constipation in European cancer pain patients: results of a real-world, multicentre, observational study ("E-StOIC").

PURPOSE: The objectives of the study were to determine the prevalence of (uncontrolled) OIC, relevant medications / interventions employed by healthcare professionals, and the additional strategies utilised by patients, amongst European patients with cancer pain. METHODS: This study was a prospective observational study conducted at 24 research sites in ten European countries. Cancer patients receiving opioid analgesics for at least a week were recruited, and asked to complete a questionnaire including background information, single question (Are you constipated?), Rome IV diagnostic criteria for OIC, Bowel Function Index (BFI), and Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL). Participants were characterised as having / not having OIC on the basis of the Rome IV diagnostic criteria. RESULTS: 1200 participants completed the study. 59.5% met the Rome IV diagnostic criteria for OIC: only 61.5% that met these criteria self-reported constipation. 72% participants were prescribed a regular conventional laxative / peripherally acting mu-opioid receptor antagonist (PAMORA). However, only 66% took their prescribed laxatives every day. Many participants had utilised other strategies / interventions to manage their OIC. Furthermore, 27% had needed to use suppositories, 26.5% had needed to use an enema, and 8% had had a manual evacuation. The use of PAMORAs, and other novel effective medications, was relatively uncommon. CONCLUSION: The results of this study suggest that management in Europe is often inadequate, and this undoubtedly relates to a combination of inadequate assessment, inappropriate treatment, and inadequate reassessment.

Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging.

The purpose of the study was to evaluate uterine ischaemia after uterine artery embolisation (UAE) using magnetic resonance imaging and the role of myometrial and fibroid ischaemia in the pathogenesis of post-procedural pain. T1-weighted gradient echo imaging before and after contrast agent was performed on 62 women before and 24 h after UAE. We assessed the severity (mild, moderate, severe) of myometrial ischaemia, and the percentage and volume of ischaemic tissue in myometrium and fibroids. The Verbal Rating Scale was used to assess in-hospital post-procedural pain (1-3 mild, 4-6 moderate, 7-10 severe). Mean maximal pain was 7.7. Myometrial ischaemia was mild, moderate and severe in 29, 23 and 10 patients, respectively. Moderate or severe myometrial ischaemia (p = 0.041), the percentage (p = 0.037) and volume (p = 0.012) of ischaemic tissue in the myometrium, and a large volume of embolic material (p = 0.038) correlated with severe pain. In summary, pain following UAE is common and partly explained by myometrial ischaemia.

Cochlear Implant Surgery in the Elderly: The Feasibility of a Modified Suprameatal Approach Under Local Anesthesia.

OBJECTIVE: Although cochlear implantation is a relatively safe procedure, there is some reticence to subject elderly people, especially those with significant comorbidity, to the risks of general anesthesia. The purpose of the study was to explore the feasibility of cochlear implant surgery under local anesthesia and sedation in elderly people. STUDY DESIGN: Case report study (Clinical Capsule Report). SETTING: Single tertiary academic referral center. PATIENTS: Seven elderly subjects with severe or severe-to-profound sensorineural hearing impairment underwent cochlear implantation under local anesthesia and sedation. All subjects had significant comorbidities with an American Society of Anesthesiologists (ASA) classification 3 to 4 and explicitly expressed their concerns regarding general anesthesia. The subjects were implanted with 24 mm straight electrode array devices via a modified suprameatal approach. INTERVENTIONS: Therapeutic. MAIN OUTCOME MEASURE: The evaluation of a modified suprameatal approach for cochlear implant surgery under local anesthesia and sedation with respect to patient safety and compliance. RESULTS: Cochlear implantation under local anesthesia and sedation was successful and well tolerated in all subjects. No intra- or postoperative complications occurred. Recovery was quick and all subjects were discharged on the first postoperative day. All subjects would opt again for the procedure under local anesthesia. CONCLUSION: Cochlear implantation under local anesthesia and sedation was found to be feasible. The modified suprameatal approach lends itself for procedures under local anesthesia, because only minimal drilling is required. The application of this technique provides a safe alternative especially for the elderly with significant comorbidity and increased risks for general anesthesia.