Comparison between CT-scan and trans-abdominal sonography in celiac and splanchnic plexus blocks in patients with advanced pancreatic head cancer

Malignant diseases are usually associated with severe pain during their course especially at the end stages. Pancreatic head cancer is one of these diseases which can be associated with severe intolerable pains in the end stages. Sometimes, these pains are extremely severe and interfere with patient's normal life. There are various techniques to control the pain out of which, celiac and splanchnic plexus blocks [temporary and permanent] are widely accepted procedures especially in severe cases and can control the pain efficiently. There are different approaches for performing this block which are all acceptable technically but are different in case of efficacy, accuracy and potential complications. Two groups were studied prospectively in 3 academic centers to evaluate different techniques of celiac plexus block in terms of feasibility and complications. For this purpose, 61 patients with a confirmed pancreatic head cancer who experienced severe pains were divided into two groups. CT- and sonographically-guided celiac and splanchnic plexus blocks were evaluated in group 1 [n=32] and group 2 [n=29], respectively. This study showed that the pain control and patients' satisfaction were greater in the CT-scan group [group A, p=0.18]. The success rate of performing a ganglion block was higher in the ultrasound group [group B, p=0.000]. The need for a re-block was also higher in the latter group. But, the quality of life improved more in the first group [CT-scan group]. However, no statistically significant difference was found between the two groups regarding these two variables. Pain relief started earlier and lasted longer in the CT-scan group. No complication was detected except for one case of abdominal infection in the sonography group and in some cases a mild pain [score<3] was reported which was not significant. Considering the limited number of cases, it seems that although there was no significant difference in the outcome of plexus block or related complications between the two above-mentioned procedures, the suggested imaging technique for celiac plexus block is CT-scan because of its feasibility, accuracy and lower number of trials to achieve a favorable result. More complementary assessments are recommended to obtain more precise results

Familiarity of physicians with the aims of pre-operative anesthesia evaluation clinics

The role of the anaesthesiologist in the quality of care rendered to patients during the pre-operative period is well known. The role of pre-operative anesthesia clinics in providing better conditions for patients undergoing anesthesia is now well documented. This study was performed to evaluate the familiarity of Iranian physicians with the aims of anesthesia clinics 10 years after the establishment of such clinics in Iran. Materials and All physicians working in 2 university medical centers were selected. A questionnaire was given to them and answers were analyzed and interpreted by statistical methods. Three-hundred forty-four Iranian physicians were questioned about their knowledge regarding anesthesia clinics out of which, 38% were faculty members, about half of them had working experience more than 10 yrs., 57.3% of them were surgeons, 27.6% of them were non-surgical clinical physicians, 6.4% were paraclinicians and the remaining were general practitioners. Forty-one percent of physicians were familiar with the aims of anesthesia clinics. Only 34% of physicians had referred patients to such clinics. The most important goals of establishment of these clinics from the physicians' point of view were to prepare the patients for operation [71%], reduce the complications of surgery [54%], reduce the time required for preparing patients for surgery [36%] and reducing the costs [34%]. Considering the results, it seems that a great majority of Iranian physicians are still unfamiliar with the aims of anesthesia clinics. Direct communication between anaesthesiologists and medical staff and stressing the benefits of establishing such clinics in medical congresses are beneficial and highly recommended by the authors

Acquaintance of patients with the aims of pre-operative anesthesia evaluation clinics

Anesthesia is peri-operative medicine. The role of anesthesiologist in the quality of care rendered to patients during the pre-operative period is well known. The role of pre-operative anesthesia clinics in providing better conditions for patients undergoing anesthesia is now well documented. This study was performed to evaluate the familiarity of Iranian patients with the aims of anesthesia clinics 10 years after the establishment of such clinics in Iran. All patients referred to anesthesia clinics in two university medical centers were evaluated during a 2-week period. A questionnaire was given to them and answers were analyzed and interpreted by statistical methods. Of the 286 patients who participated in this study, 56% were males and 44% were females; 43% of them were familiar with the goals of pre-op anesthesia, 83% of the patients mentioned that pre-op evaluation was the reason of their referral and 67% gave a positive feed-back on the clinic. The need for creating more motivation in patients and physicians was mentioned by 83% of the patients. Considering the statistical results, it seems that there is a great need to familiarize patients with the goals of these clinics and to create some motivation in them. By doing so, we can hope to offer better services to patients and reduce the anesthesia complications and anxiety