Fentanyl transdermal therapy system [ITS-patch] for post-traumatic blunt chest injury

Proper post-extubation pain control in traumatic blunt chest injury represents a challenge to provide adequate analgesia for proper lung inflation and to prevent re-intubation. In this case, the average opioid [Remifentanil] infusion drip in a traumatic blunt chest injury patient in the 48 hours prior to extubation was calculated and converted to the equivalent analgesic one of the Fentanyl Transdermal Therapeutic System [Fentanyl TTS Patch]. The analgesic gap before the onset of action for the applied fentanyl patch was covered by frequent injections of tramadol. Evaluation of the Fentanyl TTS effect through the post-extubation period was carried out by measuring the analgesic effect on a visual analogue scale, the alertness status by simple sedation score, while the respiratory performance was followed by the negative inspiratory force. The outcome in this case showed that Fentanyl Patch is a reliable, favorable, safe and non-invasive method that produces a good analgesic effect and positive impaction on the post-extubation course of respiratory performance with a satisfactory outcome and no side effects

Pathogenesis and control of painful conditions in advanced breast cancer

This work was carried out on 42 females patients referred to the pain clinic at the National Cancer Institute, Cairo University complaining of pain 19 monthes to 4 years after radical mastectomy. Pain complaints took one or more of the following forma: Heavy painfull arm [26%], post-mastectomy pain [19%], back pain due to metastasis in vertebrebral column [12%], Epigastric and right hypochondrial pain due to liver metastasis [12%], joint pain in the hip [7%] and shoulder [15%], herpes zoster [7%], rib metastasis [5%], and sciatic or ulnar neuralgias [7%]. Medical treatment in the form of oral simple analgesics containing a combination of paracetomal and dextropropoxyphene given 6 hours together with amitroptyline were given to all patients. Anticonvalsants were added for neuralgias, antibiotics for infections, corticosteroids for bone metastasis and diuretics for odema. Medical treatment could control 47% of cases according to a verbal rating score T.E.N.S. when added, was found usefull in only 10% of cases for a limited period. Simple invasive treatments were applied for 53% of cases. Local marcaine steroid block was usefull in bony metastasis. Stellate ganglion block was tried successfully in 7 out of 9 cases of heavy painful arms, while thoracic epidural using marcaine could releif the pain of herpes zoster. Subarachnoid chemical rhizotomy using phenol was only needed in 6% of cases. Painfull conditions in advanced cases of cancer breast took various clinical forms, needing multiple lines of treatment, but medical control proved to be beneficial