Eperisone versus tizanidine for treatment of chronic low back pain.

AIM: Many therapies exist for treatment of chronic low-back pain (LBP) including the use of muscle relaxant and analgesic drugs. The aim of this paper was to compare efficacy and tolerability of eperisone and tizanidine in combination treatment with tramadol in chronic LBP. METHODS: Sixty patients affected by chronic LBP associated with contractures of paravertebral muscles were randomized in two groups: Group E (30 patients) treated with eperisone; Group T (30 patients) treated with tizanidine. Both groups received tramadol retard 100 mg/day. VAS at rest and with effort were used at baseline (T0) and after 5 (T5), 10 (T10), 15 (T15) and 30 (T30) days of treatment. The Summed Pain Intensity Difference (SPID), the SPID percentage (SPID%) and the Total Pain Relief (TOTPAR), at rest (-r) and with effort (-e) were calculated. RESULTS: In both groups a statistically significant reduction in VAS-r and VAS-e was observed during the treatment; similar reductions occurred in both groups at every timepoint. SPID-r and -e, SPID%-r and -e and TOTPAR-r and -e resulted similar between groups. A significant difference between groups occurred for incidence of somnolence: 16.6% for Group E versus 43.3% for Group T. Treatment was stopped due to adverse events in 5 patients of Group E and in 9 patients of Group T, without statistically significant difference. CONCLUSION: Both associations assumed for one month, have shown effective for LBP at rest and with effort. Eperisone/tramadol, reducing discontinuation and allowing a better adherence to the therapy, may be considered a viable option for the treatment of chronic LBP.

[Intraoperative awareness: a true or false problem?]. / Il risveglio intraoperatorio: un problema vero o falso?

The authors base their remark on a few cases of awareness which have been reported in their hospital and on the history a patient who experienced intraoperative awareness during cesarean section. Attention is focused on the ethical, social and medico-legal aspects of this phenomenon. Awareness may severely affect the patient's psychic equilibrium with the consequent onset of severe neuroses leading to the possibility of legal action and claims for compensation. Clinical experience has shown that the use of halogenate anesthetics, even in low concentrations, may help to avoid this phenomenon. Correct relations between the anesthetist and patient before and after surgery may also, even in the event of awareness, reduce the incidence and severity of consequent psychological sequelae.

[Operative risk. Patient evaluation, informed consent]. / Rischio operatorio. Valutazione del paziente, consenso informato.

It is mandatory, the Authors say, to obtain a previous and definite consent before the patient undergoes the operation. Moreover the patient shall be well acquainted about the risk connected to the operation before he gives his consent. On the contrary, as already confirmed by the Italian Supreme Court of Justice, the consent shall not be valid and the Doctors could be found guilty of "psychic violence". Finally the Authors, to evaluate the probable risks liked to the operation, use scales as ASA and prognostic indexes as SAPS to avoid appraisage too subjective.