Effectiveness of scheduled intravenous acetaminophen in the postoperative pain management of video-assisted thoracic surgery.

PURPOSE: The scheduled administration of intravenous acetaminophen (scheduled-IV-AcA) is one of the more effective multimodal analgesic approaches for postoperative pain in abdominal/orthopedic surgeries. However, there is little evidence concerning scheduled-IV-AcA after general thoracic surgery, especially when limited to video-assisted thoracoscopic surgery (VATS). We investigated the efficacy of scheduled-IV-AcA administration in patients after undergoing VATS. METHODS: Ninety-nine patients who underwent VATS lobectomy or segmentectomy via an 8-cm access window and 1 camera port were retrospectively reviewed by categorizing them into groups either with scheduled-IV-AcA (Group AcA: n = 29) or without it (Group non-AcA: n = 70). Group AcA received 1 g of IV-AcA every 6 h from the end of the operation until the end of POD2. Postoperative pain was measured using a numeric rating scale (NRS) three times per day until discharge. RESULTS: NRS scores were significantly lower in Group AcA with motion (on POD1 to the first point of POD2) than in Group non-AcA. Group non-AcA was also more likely to use additional analgesics than Group AcA (39% vs. 17%, p = 0.058). CONCLUSIONS: Scheduled-IV-AcA administration is a safe and effective multimodal analgesic approach in patients undergoing VATS pulmonary resection via an 8-cm access window.

[A case report of advanced gastric cancer with carcinomatous ascites successfully treated by outpatient chemotherapy].

The patient was a 54-year-old male with peritoneal dissemination and carcinomatous ascites of advanced gastric cancer. Although 4 months of temporary partial responses were obtained by a combination chemotherapy with TS-1 and DOC, retention of ascites appeared. Second-line combination chemotherapy with 5-FU and PTX was not effective, and we attempted to use intraperitoneal chemotherapy of low-dose CDDP. After 100 mg of CDDP had been administered, ascites almost disappeared. Then,intraperitoneal injection of low-dose CDDP and intravenous injection of 5-FU were given. Tumor marker decreased remarkably, and CT revealed reduction of peritoneal dissemination. These regimens seem to be effective in ambulant patients with advanced gastric cancer with peritoneal dissemination and carcinomatous ascites.

[A case report of recurrent gastric cancer in which combination chemotherapy with paclitaxel and 5-fluorouracil made for successful biliary stenting and improvement in QOL].

The patient was a 49-year-old female who had undergone a total gastrectomy for gastric cancer on March 9 2001. Pathological diagnosis revealed sig, T 3 (SE), N 2, H 0, P 1, CY 0, M 0, Stage IV, and the curability was C. 5' DFUR 800 mg/day was administered as adjuvant chemotherapy. CDDP 10 mg/body/week intraperitoneally and 5-FU 500 mg/body/week were added. Retention of ascites, peritoneal dissemination, obstructive jaundice and right hydronephrosis appeared in June, 2003, and we started combination chemotherapy with paclitaxel and 5-fluorouracil. 5-fluorouracil (600 mg/m2/day) was infused continuously for 120-hours (days 1-5), and paclitaxel (80 mg/m2) was infused on days 8, 15, and 22 on an outpatient basis. Ascites and peritoneal dissemination had disappeared, and swollen lymph nodes were reduced after 2 courses of the chemotherapy. Furthermore, billiary stenting was performed and a PTCD tube could be removed after 4 courses. No serious adverse effect was observed, and the patient maintained good QOL through this treatment.