Availability and approval of cannabis-based medicines for chronic pain management and palliative/supportive care in Europe: A survey of the status in the chapters of the European Pain Federation.

BACKGROUND: There is considerable public and political interest in the use of cannabis products for medical purposes. METHODS: The task force of the European Pain Federation (EFIC) conducted a survey with its national chapters representatives on the status of approval of all types of cannabis-based medicines, the covering of costs and the availability of a position paper of a national medical association on the use of medical cannabis for chronic pain and for symptom control in palliative/supportive care. RESULTS: Thirty-one out of 37 contacted councillors responded. Plant-derived tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray is approved for spasticity in multiple sclerosis refractory to conventional treatment in 21 EFIC chapters. Plant-derived THC (dronabinol) is approved for some palliative care conditions in four EFIC chapters. Synthetic THC analogue (nabilone) is approved for chemotherapy-associated nausea and vomiting refractory to conventional treatment in four EFIC chapters'. Eight EFIC chapters' countries have an exceptional and six chapters an expanded access programme for medical cannabis. German and Israeli pain societies recommend the use of cannabis-based medicines as third-line drug therapies for chronic pain within a multicomponent approach. Conversely, the German medical association and a team of finish experts and officials do not recommend the prescription of medical cannabis due to the lack of high-quality evidence of efficacy and the potential harms. CONCLUSIONS: There are marked differences between the countries represented in EFIC in the approval and availability of cannabis-based products for medical use. EFIC countries are encouraged to collaborate with the European Medicines Agency to publish a common document on cannabis-based medicines. SIGNIFICANCE: There are striking differences between European countries in the availability of plant-derived and synthetic cannabinoids and of medical cannabis for pain management and for symptom control in palliative care and in the covering of costs by health insurance companies or state social security systems.

Haemodynamic effects of subarachnoid blockade: 20% lignocaine versus 0.5% plain bupivacaine.

BACKGROUND: Our study compared the haemodynamic changes after spinal anaesthesia with 2% lignocaine and 0.5% plain bupivacaine. METHODS: A controlled, randomized trial was performed on 30 patients scheduled for arthroscopic knee surgery. Two percent lignocaine and 0.5% plain bupicacaine was used for spinal anesthesia. We measured cardiac output, blood pressure and level of sensory blockade before and for 25 minutes after spinal anaesthesia. RESULTS: In patients developing sensory block below T6 there were no differences between the study drugs in heamodynamic measurements. In patients who developed a sensory block at or above T6 there was a greater drop in mean arterial pressure and cardiac output and a faster decrease in heart rate in patients receiving bupivacaine. CONCLUSION: In patients developing a sensory block at or above the T6 dermatome, the decrease in cardiac output and mean arterial pressure in the first 25 min. after spinal anaesthesia is smaller if 2% lignocaine rather than 0.5% bupivacaine is used for blockade.

[Hemodynamic effects of spinal anesthesia with 2% lidocaine in comparison to 0.5% isobaric bupivacaine]. / Hämodynamische Effekte einer Spinalanästhesie mit 2% Lidocain im Vergleich zu 0,5% isobarem Bupivacain.

BACKGROUND: Our study compared the haemodynamic changes after spinal anesthesia with 2% lignocaine and 0.5% plain bupivacaine. METHODS: A controlled, randomized trial was performed on 30 patients scheduled for arthroscopic knee surgery. 2% lignocaine and 0.5% plain bupivacaine were used for spinal anaesthesia. We measured cardiac output (electrical bioimpedance cardiography), blood pressure and development of sensory blockade before and for 25 minutes after spinal anaesthesia. RESULTS: In patients developing a sensory block below T6 there were no differences between both anaesthetics in haemodynamic parameters. But in patients developing a sensory block at or above T6 there was a greater drop in mean arterial pressure and cardiac output and a faster decrease in heart rate for bupivacaine compared to patients receiving Lignocaine. CONCLUSION: In patients developing a sensory block at or above the T6 dermatome, the decrease in cardiac output and mean arterial pressure in the first 25 min after spinal anaesthesia is smaller when 2% lignocaine rather than 0.5% bupivacaine is used for blockade.