The Chronic Pain Grade Questionnaire: validity, reliability and responsiveness in Greek chronic hip pain sufferers.

BACKGROUND: The Chronic Pain Grade Questionnaire (CPGQ) was developed to assess the global severity of chronic pain based on pain intensity and pain-related disability. This study aimed to translate, culturally adapt, and validate the Greek version of the CPGQ (CPGQ-Gr).  Methods: Adaptation into Greek followed established guidelines. We invited orthopedic outpatients suffering from chronic hip pain to participate in the study. The validity, reliability, and responsiveness of the CPGQ-Gr were assessed. RESULTS: Factor analysis yielded two factors (subscales), disability score (DS) and characteristic pain intensity (CPI). CPGQ-Gr items, total and subscale scores were highly correlated with the 12-Item Short Form Health Survey (SF-12) physical component summary score, and slightly correlated or not correlated with the SF-12 mental component summary score. Cronbach's alpha correlation coefficients for the CPGQ-Gr total scale, DS, and CPI subscales were 0.90, 0.95, and 0.83 respectively. All measures showed excellent temporal stability (intraclass correlation coefficients of 0.84, 0.92, and 0.91, respectively). Cliff's delta effect sizes ranged from 0.47 to 0.82. The values of the area under the receiver operating characteristic curve were consistent with good to excellent discriminatory ability (range: 0.747-0.902). CONCLUSION: Our findings suggest that the Greek version of the CPGQ is a valid, reliable, and sensitive to changes, instrument for grading the severity of chronic hip pain. HIPPOKRATIA 2018, 22(1): 37-42.

"Enteroatmospheric fistulae"--gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique.

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.

Pharmacokinetic profile and efficacy of a fentanyl transdermal delivery system for acute postoperative pain after intra-abdominal gynecologic surgery for cancer.

PURPOSE: This prospective, randomized, single-blind study evaluated the efficacy and pharmacokinetic profile of a transdermal delivery system for fentanyl to provide relief of acute postoperative pain in patients undergoing intra-abdominal gynecologic surgery for cancer. METHODS: Forty female patients were randomized to either transdermal fentanyl 50 microg/hour (n = 20) or transdermal placebo (n = 20). Transdermal systems were placed 1 hour preoperatively and removed 25 hours later. Pain control was supplemented with a nonopioid drug, bupivacaine 0.125-0.25%, administered through an epidural catheter via patient-controlled epidural analgesia. Serum fentanyl concentrations, bupivacaine consumption, pain scores [visual analog scale (VAS)], sedation rating score, adverse events, and physiological parameters were recorded for 48 hours postoperatively. RESULTS: The minimum effective concentration of fentanyl in serum (0.63 ng/mL) was achieved at 11.3 +/- 4.9 hours after application, and serum concentrations remained above this level until 13 hours after removal. The TTS-F group had lower VAS pain scores and a significant 66% reduction in utilization of bupivacaine compared with placebo. Pain scores were significantly correlated with serum fentanyl concentration (P = 0.025). All physiological parameters fluctuated within normal range and no differences were observed between treatments. Adverse events were similar between the groups with only the incidence of local erythema significantly higher in the TTS-F group (30% vs. 5%, P < 0.05), and sedation scores were significantly higher in the TTS-F group during the immediate postoperative period. CONCLUSION: The transdermal therapeutic system for administration of fentanyl, combined with epidural administration of a nonopioid analgesic such as bupivacaine is effective in controlling postoperative pain after gynecologic surgery. Additionally, the safety/tolerability of this regimen was similar to placebo plus bupivacaine.