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Bongiorno G, Biancuzzi H, Dal Mas F, Bednarova R, Vittori A, Miceli L. Pulsed radiofrequency on peripheral nerve as a rehabilitation aid. J Anesth Analg Crit Care 2024; 4:22. [PMID: 38504294 PMCID: PMC10949595 DOI: 10.1186/s44158-024-00156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
The work described below explores the field of the effects of pulsed radiofrequency for pain relief purposes. While the effects of this technique on pain modulation (A-delta and C fibers) are relatively well-known, little has been written yet about the potential of pulsed radiofrequency interactions with other fibers. The proposed algorithm, specifically elaborated, investigates the effect of this technique on neuromuscular fatigue, through a surface electromyographic study of the femoral nerve of a patient with residual pain after knee arthroplasty surgery, before and after the treatment. This work yields a preliminary result that is encouraging for subsequent large-scale studies.
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Affiliation(s)
- Giulia Bongiorno
- Friuli Riabilitazione Rehabilitation Center, City of Roveredo in Piano, Pordenone, Italy
| | - Helena Biancuzzi
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
- Collegium Medicum, University of Social Sciences, Lodz, Poland
| | - Rym Bednarova
- Pain Medicine, Hospital of Latisana, Udine, Latisana, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Luca Miceli
- Department of Pain Medicine, IRCCS C.R.O. National Cancer Institute of Aviano, Pordenone, Aviano, Italy.
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Vittori A, Bellini V, Cascella M, Montomoli J, Francia E, Bignami EG. Artificial intelligence in anesthesia, critical care and pain medicine: the Artificial Intelligence Act helps us master a necessary change. Minerva Anestesiol 2024; 90:216-217. [PMID: 37823220 DOI: 10.23736/s0375-9393.23.17697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valentina Bellini
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS Fondazione Pascale, Naples, Italy
| | - Jonathan Montomoli
- Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO Roma, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elena G Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy -
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Scorrano G, Battaglia L, Spiaggia R, Basile A, Palmucci S, Foti PV, David E, Marinangeli F, Mascilini I, Corsello A, Comisi F, Vittori A, Salpietro V. Corrigendum: Neuroimaging in PRUNE1 syndrome: a mini-review of the literature. Front Neurol 2024; 15:1360347. [PMID: 38375463 PMCID: PMC10876049 DOI: 10.3389/fneur.2024.1360347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2023.1301147.].
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Affiliation(s)
- Giovanna Scorrano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Laura Battaglia
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Rossana Spiaggia
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Franco Marinangeli
- Department of Anesthesia, Critical Care and Pain Therapy, University of L'Aquila, L'Aquila, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | | | | | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
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Cascella M, Monaco F, Vittori A, Elshazly M, Carlucci A, Piazza O. Bridging knowledge gaps: a bibliometric analysis of non-invasive ventilation in palliative care studies. J Anesth Analg Crit Care 2024; 4:5. [PMID: 38268041 PMCID: PMC10809455 DOI: 10.1186/s44158-024-00140-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Despite being a useful strategy for providing respiratory support to patients with advanced or terminal illnesses, non-invasive ventilation (NIV) requires in-depth investigation in several key aspects. OBJECTIVES This bibliometric analysis seeks to comprehensively examine the existing research on the subject. Its goal is to uncover valuable insights that can inform the prediction trajectory of studies, guide the implementation of corrective measures, and contribute to the improvement of research networks. METHODS A comprehensive review of literature on NIV in the context of palliative care was conducted using the Web of Science core collection online database. The search utilized the key terms "non-invasive ventilation" and "palliative care" to identify the most relevant articles. All data were gathered on November 7, 2023. Relevant information from documents meeting the specified criteria was extracted, and Journal Citation Reports™ 2022 (Clarivate Analytics) served as the data source. The analysis employed literature analysis and knowledge visualization tools, specifically CiteScope (version 6.2.R4) and VOSviewer (version 1.6.20). RESULTS A dataset with bibliometric findings from 192 items was analyzed. We found a consistent upward of the scientific output trend over time. Guidelines on amyotrophic lateral sclerosis management received the highest number of citations. Most documents were published in top-ranked journals. Less than one-third of the documents pertain to clinical studies, especially retrospective analyses (25%). Key topics such as "decision making", and "communication" were less addressed. CONCLUSIONS Given the substantial clinical implications, further high-quality studies on this subject are recommended. Encouraging international collaborations is needed. Despite the growing volume of documents in the field, this bibliometric analysis indicates a decline in collaborative networks.
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Affiliation(s)
- Marco Cascella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy
| | | | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | | | - Annalisa Carlucci
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Ornella Piazza
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy.
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Scorrano G, Battaglia L, Spiaggia R, Basile A, Palmucci S, Foti PV, David E, Marinangeli F, Mascilini I, Corsello A, Comisi F, Vittori A, Salpietro V. Neuroimaging in PRUNE1 syndrome: a mini-review of the literature. Front Neurol 2023; 14:1301147. [PMID: 38178891 PMCID: PMC10764560 DOI: 10.3389/fneur.2023.1301147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
Prune exopolyphosphatase 1 (PRUNE1) is a short-chain phosphatase that is part of the aspartic acid-histidine-histidine (DHH) family of proteins. PRUNE1 is highly expressed in the central nervous system and is crucially involved in neurodevelopment, cytoskeletal rearrangement, cell migration, and proliferation. Recently, biallelic PRUNE1 variants have been identified in patients with neurodevelopmental disorders, hypotonia, microcephaly, variable cerebral anomalies, and other features. PRUNE1 hypomorphic mutations mainly affect the DHH1 domain, leading to an impactful decrease in enzymatic activity with a loss-of-function mechanism. In this review, we explored both the clinical and radiological spectrum related to PRUNE1 pathogenic variants described to date. Specifically, we focused on neuroradiological findings that, together with clinical phenotypes and genetic data, allow us to best characterize affected children with diagnostic and potential prognostic implications.
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Affiliation(s)
- Giovanna Scorrano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Laura Battaglia
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinic "G. Rodolico-San Marco", Catania, Italy
| | - Rossana Spiaggia
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinic "G. Rodolico-San Marco", Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinic "G. Rodolico-San Marco", Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinic "G. Rodolico-San Marco", Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinic "G. Rodolico-San Marco", Catania, Italy
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinic "G. Rodolico-San Marco", Catania, Italy
| | - Franco Marinangeli
- Department of Anesthesia, Critical Care and Pain Therapy, University of L'Aquila, L'Aquila, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | | | | | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
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Battaglia L, Scorrano G, Spiaggia R, Basile A, Palmucci S, Foti PV, Spatola C, Iacomino M, Marinangeli F, Francia E, Comisi F, Corsello A, Salpietro V, Vittori A, David E. Neuroimaging features of WOREE syndrome: a mini-review of the literature. Front Pediatr 2023; 11:1301166. [PMID: 38161429 PMCID: PMC10757851 DOI: 10.3389/fped.2023.1301166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
The WWOX gene encodes a 414-amino-acid protein composed of two N-terminal WW domains and a C-terminal short-chain dehydrogenase/reductase (SDR) domain. WWOX protein is highly conserved among species and mainly expressed in the cerebellum, cerebral cortex, brain stem, thyroid, hypophysis, and reproductive organs. It plays a crucial role in the biology of the central nervous system, and it is involved in neuronal development, migration, and proliferation. Biallelic pathogenic variants in WWOX have been associated with an early infantile epileptic encephalopathy known as WOREE syndrome. Both missense and null variants have been described in affected patients, leading to a reduction in protein function and stability. The most severe WOREE phenotypes have been related to biallelic null/null variants, associated with the complete loss of function of the protein. All affected patients showed brain anomalies on magnetic resonance imaging (MRI), suggesting the pivotal role of WWOX protein in brain homeostasis and developmental processes. We provided a literature review, exploring both the clinical and radiological spectrum related to WWOX pathogenic variants, described to date. We focused on neuroradiological findings to better delineate the WOREE phenotype with diagnostic and prognostic implications.
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Affiliation(s)
- Laura Battaglia
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Giovanna Scorrano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rossana Spiaggia
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Corrado Spatola
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
| | - Michele Iacomino
- Unit of Medical Genetics, IRCCS Instituto Giannina Gaslini, Genoa, Italy
| | - Franco Marinangeli
- Department of Anesthesia, Critical Care and Pain Therapy, University of L’aquila, L’aquila, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | | | | | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, Catania, Italy
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Piccirillo A, Perri F, Vittori A, Ionna F, Sabbatino F, Ottaiano A, Cascella M. Evaluating Nutritional Risk Factors for Delirium in Intensive-Care-Unit Patients: Present Insights and Prospects for Future Research. Clin Pract 2023; 13:1577-1592. [PMID: 38131687 PMCID: PMC10742123 DOI: 10.3390/clinpract13060138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Malnutrition, hypercatabolism, and metabolic changes are well-established risk factors for delirium in critically ill patients. Although the exact mechanisms are not fully understood, there is mounting evidence suggesting that malnutrition can cause a variety of changes that contribute to delirium, such as electrolyte imbalances, immune dysfunction, and alterations in drug metabolism. Therefore, a comprehensive metabolic and malnutrition assessment, along with appropriate nutritional support, may help to prevent or ameliorate malnutrition, reduce hypercatabolism, and improve overall physiological function, ultimately lowering the risk of delirium. For this aim, bioelectrical impedance analysis can represent a valuable strategy. Further research into the underlying mechanisms and nutritional risk factors for delirium is crucial to developing more effective prevention strategies. Understanding these processes will allow clinicians to personalize treatment plans for individual patients, leading to improved outcomes and quality of life in the intensive-care-unit survivors.
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Affiliation(s)
- Arianna Piccirillo
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Ionna
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | | | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, 80131 Naples, Italy;
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Medicine, Surgery, and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081 Baronissi, Italy
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Vittori A. Pediatric Pain Management: The Time for Action Is Now. Children (Basel) 2023; 10:1894. [PMID: 38136096 PMCID: PMC10742136 DOI: 10.3390/children10121894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
Pediatric anesthesia is a field of research and assistance in which more specialization needs are emerging [...].
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
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Vittori A, Tritapepe L, Chiusolo F, Rossetti E, Cascella M, Petrucci E, Pedone R, Marinangeli F, Francia E, Mascilini I, Marchetti G, Picardo SG. Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study. Perioper Med (Lond) 2023; 12:53. [PMID: 37752610 PMCID: PMC10523757 DOI: 10.1186/s13741-023-00342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Increasing procedures in day-case surgery can mitigate the costs of health service, without reducing safety and quality standards. The Ospedale Pediatrico Bambino Gesù has adopted an educational program for healthcare personnel and patients' families to increase the number of day-case surgery procedures performed without reducing the level of safety. The unplanned admission rate after day-case surgery can be a quality benchmark for pediatric day-case surgery, and in literature, there are no Italian data. METHODS We made a retrospective analysis of the hospital database and focused on children requiring unplanned admission to the central venue of the hospital for the night. The audit covered the period from September 2012 to April 2018. RESULTS We performed general anesthesia for 8826 procedures (urology 33.60%, plastic surgery 30.87%, general surgery 17.44%, dermatology 11.66%, dentistry 3.16%, orthopedics 1.64%, digestive endoscopy 1.63%). Unplanned admission for anesthetic reasons resulted in two cases: one case of syncope and one case of vomit (0.023% rate). No one major complication. CONCLUSIONS Good quality of patient selection, the safety of the structure, family education, and an efficient organizational model combined with an educational program for anesthesiologists can improve the safety of anesthesia for day-case surgery.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Luigi Tritapepe
- Department of Anesthesiology, Critical Care, and Pain Medicine, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
- Unit of Anesthesia and Intensive Care, Sapienza University, Piazzale Aldro Moro 5 00185, Rome, Italy
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuele Rossetti
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Via Lorenzo Natali, 1, 67100, Coppito, L'Aquila, Italy
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, Viale Abramo Lincoln, 5, 81100, Caserta, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, , L'Aquila, Piazzale Salvatore Tommasi, 1, 67100, Coppito, AQ, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Giuliano Marchetti
- Surgery Unit, Bios Medical Center, Via Domenico Chelini, 39, 00197, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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Cascella M, Petrucci E, Marinangeli F, Vittori A. "Emerging Topics in Pain Medicine": Advancing Research and Patient-Centered Health Strategies. J Pers Med 2023; 13:1246. [PMID: 37623495 PMCID: PMC10455183 DOI: 10.3390/jpm13081246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Pain, in all its various forms and manifestations, impacts the lives of millions worldwide [...].
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
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11
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Cascella M, Schiavo D, Cuomo A, Ottaiano A, Perri F, Patrone R, Migliarelli S, Bignami EG, Vittori A, Cutugno F. Artificial Intelligence for Automatic Pain Assessment: Research Methods and Perspectives. Pain Res Manag 2023; 2023:6018736. [PMID: 37416623 PMCID: PMC10322534 DOI: 10.1155/2023/6018736] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/03/2023] [Accepted: 04/20/2023] [Indexed: 07/08/2023]
Abstract
Although proper pain evaluation is mandatory for establishing the appropriate therapy, self-reported pain level assessment has several limitations. Data-driven artificial intelligence (AI) methods can be employed for research on automatic pain assessment (APA). The goal is the development of objective, standardized, and generalizable instruments useful for pain assessment in different clinical contexts. The purpose of this article is to discuss the state of the art of research and perspectives on APA applications in both research and clinical scenarios. Principles of AI functioning will be addressed. For narrative purposes, AI-based methods are grouped into behavioral-based approaches and neurophysiology-based pain detection methods. Since pain is generally accompanied by spontaneous facial behaviors, several approaches for APA are based on image classification and feature extraction. Language features through natural language strategies, body postures, and respiratory-derived elements are other investigated behavioral-based approaches. Neurophysiology-based pain detection is obtained through electroencephalography, electromyography, electrodermal activity, and other biosignals. Recent approaches involve multimode strategies by combining behaviors with neurophysiological findings. Concerning methods, early studies were conducted by machine learning algorithms such as support vector machine, decision tree, and random forest classifiers. More recently, artificial neural networks such as convolutional and recurrent neural network algorithms are implemented, even in combination. Collaboration programs involving clinicians and computer scientists must be aimed at structuring and processing robust datasets that can be used in various settings, from acute to different chronic pain conditions. Finally, it is crucial to apply the concepts of explainability and ethics when examining AI applications for pain research and management.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples 80131, Italy
| | - Daniela Schiavo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples 80131, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples 80131, Italy
| | - Alessandro Ottaiano
- SSD-Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori di Napoli IRCCS “G. Pascale”, Via M. Semmola, Naples 80131, Italy
| | - Francesco Perri
- Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS-Fondazione “G. Pascale”, Naples 80131, Italy
| | - Renato Patrone
- Dieti Department, University of Naples, Naples, Italy
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS, Fondazione Pascale-IRCCS di Napoli, Naples, Italy
| | - Sara Migliarelli
- Department of Pharmacology, Faculty of Medicine and Psychology, University Sapienza of Rome, Rome, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome 00165, Italy
| | - Francesco Cutugno
- Department of Electrical Engineering and Information Technologies, University of Naples “Federico II”, Naples 80100, Italy
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Cascella M, Scarpati G, Bignami EG, Cuomo A, Vittori A, Di Gennaro P, Crispo A, Coluccia S. Utilizing an artificial intelligence framework (conditional generative adversarial network) to enhance telemedicine strategies for cancer pain management. J Anesth Analg Crit Care 2023; 3:19. [PMID: 37386680 DOI: 10.1186/s44158-023-00104-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The utilization of artificial intelligence (AI) in healthcare has significant potential to revolutionize the delivery of medical services, particularly in the field of telemedicine. In this article, we investigate the capabilities of a specific deep learning model, a generative adversarial network (GAN), and explore its potential for enhancing the telemedicine approach to cancer pain management. MATERIALS AND METHODS We implemented a structured dataset comprising demographic and clinical variables from 226 patients and 489 telemedicine visits for cancer pain management. The deep learning model, specifically a conditional GAN, was employed to generate synthetic samples that closely resemble real individuals in terms of their characteristics. Subsequently, four machine learning (ML) algorithms were used to assess the variables associated with a higher number of remote visits. RESULTS The generated dataset exhibits a distribution comparable to the reference dataset for all considered variables, including age, number of visits, tumor type, performance status, characteristics of metastasis, opioid dosage, and type of pain. Among the algorithms tested, random forest demonstrated the highest performance in predicting a higher number of remote visits, achieving an accuracy of 0.8 on the test data. The simulations based on ML indicated that individuals who are younger than 45 years old, and those experiencing breakthrough cancer pain, may require an increased number of telemedicine-based clinical evaluations. CONCLUSION As the advancement of healthcare processes relies on scientific evidence, AI techniques such as GANs can play a vital role in bridging knowledge gaps and accelerating the integration of telemedicine into clinical practice. Nonetheless, it is crucial to carefully address the limitations of these approaches.
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Affiliation(s)
- Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy.
| | - Giuliana Scarpati
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana, " University of Salerno, 84084, Baronissi, SA, Italy
| | - Elena Giovanna Bignami
- Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
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Cuomo A, Marinangeli F, Magni A, Petrucci E, Vittori A, Cascella M. Investigating Functional Impairment in Chronic Low Back Pain: A Qualitative Study from the Patients and Specialists' Perspectives. J Pers Med 2023; 13:1012. [PMID: 37374001 DOI: 10.3390/jpm13061012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Prompt and appropriate treatment of chronic low back pain (cLBP) is of the utmost importance for preventing relevant disability, high burden of disease, and increasing costs for the healthcare system. Recently, the concept of functional impairment has been associated with any type of chronic pain, and mounting attention has been paid to extending the aims of treatment beyond mere pain remission, including restoration of working capacity, everyday functioning, mobility, and quality of life. Nevertheless, a shared definition of functionality is still lacking. Notably, different specialists involved in the treatment of cLBP such as general practitioners, orthopedists, pain therapists, and physiatrists, and patients themselves have different opinions on what "functional impairment" actually means. On these premises, a qualitative interview study was performed to investigate how the concept of "functionality" is interpreted by different specialists involved in the management of cLBP, and by patients. Overall, all different specialists agreed that functionality should be assessed in clinical practice. However, in spite of several instruments available for evaluating functionality, no homogeneity of behavior is observable.
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Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", 80131 Naples, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Alberto Magni
- Italian College of General Practitioners and Primary Care (SIMG), Via del Sansovino 179, 50142 Firenze, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, 67100 L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", 80131 Naples, Italy
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Cascella M, Montomoli J, Bellini V, Ottaiano A, Santorsola M, Perri F, Sabbatino F, Vittori A, Bignami EG. Writing the paper “Unveiling artificial intelligence: an insight into ethics and applications in anesthesia” implementing the large language model ChatGPT: a qualitative study. J Med Artif Intell 2023; 6:9-9. [DOI: 10.21037/jmai-23-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
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Abstract
Despite the growing interest in possible applications of computer science and artificial intelligence (AI) in the field of neurocritical care (neuro-ICU), widespread clinical applications are still missing. In neuro-ICU, the collection and analysis in real time of large datasets can play a crucial role in advancing this medical field and improving personalized patient care. For example, AI algorithms can detect subtle changes in brain activity or vital signs, alerting clinicians to potentially life-threatening conditions and facilitating rapid intervention. Consequently, data-driven AI and predictive analytics can greatly enhance medical decision making, diagnosis, and treatment, ultimately leading to better outcomes for patients. Nevertheless, there is a significant disparity between the current capabilities of AI systems and the potential benefits and applications that could be achieved with more advanced AI technologies. This gap is usually indicated as the AI chasm. In this paper, the underlying causes of the AI chasm in neuro-ICU are analyzed, along with proposed recommendations for utilizing AI to attain a competitive edge, foster innovation, and enhance patient outcomes. To bridge the AI divide in neurocritical care, it is crucial to foster collaboration among researchers, clinicians, and policymakers, with a focus on specific use cases. Additionally, strategic investments in AI technology, education and training, and infrastructure are needed to unlock the potential of AI technology. Before implementing a technology in patient care, it is essential to conduct thorough studies and establish clinical validation in real-world environments to ensure its effectiveness and safety. Finally, the development of ethical and regulatory frameworks is mandatory to ensure the secure and efficient deployment of AI technology throughout the process.
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Affiliation(s)
- Marco Cascella
- Pain Unit and Research, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80100 Napoli, Italy
| | - Jonathan Montomoli
- Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, 47923 Rimini, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy
| | - Helena Biancuzzi
- Department of Economics, Ca’ Foscari University, 30121 Venice, Italy
| | - Francesca Dal Mas
- Department of Management, Ca’ Foscari University, 30121 Venice, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Petrucci E, Cofini V, Pizzi B, Sollecchia G, Cascella M, Stefano N, Vittori A, Marinangeli F. Health Status Perception and Psychological Sequelae in Buried Victims: An Observational Study on Survivors of the Earthquake in Amatrice (Italy), Three Years Later. Prehosp Disaster Med 2023; 38:193-198. [PMID: 36803525 DOI: 10.1017/s1049023x23000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The extrication from rubble is particularly critical for the survival of the victims of an earthquake. Early repeated infusion of sedative agents (SAs) in the acute trauma phase may interfere with neural processes leading to posttraumatic stress disorder (PTSD). STUDY OBJECTIVE This study aimed to analyze the psychological status reported by the buried victims of the earthquake in Amatrice (August 24, 2016; Italy) by considering type of the SAs administered during the extrication maneuvers. METHODS This was an observational study on data from 51 patients directly rescued under the rubble during the earthquake in Amatrice. During extrication maneuvers, a moderate sedation was administered by titrating ketamine (0.3-0.5mg/kg) or morphine (0.1-0.15mg/kg) with respect to the Richmond Agitation and Sedation Scale (RASS; between -2 and -3) in buried victims.Three years following the rescue, the survivors were interviewed on their perceived health status and stress using a questionnaire which consisted of 17 items: the standard four-item set of healthy days core questions (CDC HRQOL-4); the 12-item General Health Questionnaire (GHQ-12); and in addition, survivors were asked if they had a diagnosis for anxiety, depression, or for PTSD. RESULTS The study analyzed data from the complete clinical documentation of 51 survivors; 30 were males and 21 females, with an average age of 52 years. Twenty-six (26) subjects were treated with ketamine, while 25 were treated with morphine, during the extrication procedures. Concerning the quality-of-life analysis, only 10 survivors out of 51 perceived their health status as good; the others reported psychological disorders. The GHQ-12 scores showed that all survivors had psychological distress with a mean total score of 22.2 (SD = 3.5). Eighteen (18) victims declared to have had a diagnosis of generalized anxiety (35%), while 29 were treated for depression (57%) and PTSD (57%) by a specialist. With regards to the perceived distress level and the anxiety disorder, this analysis showed significant associations with SAs used during extrication, with a better performance for ketamine than for morphine. CONCLUSION These findings suggest investigating whether early sedation with ketamine directly in the disaster setting may promote the prophylaxis and reduce the risk of developing trauma-related disorders (TRDs) on the buried victims of major natural disasters in future studies.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, L'Aquila, Italy
| | - Giacomo Sollecchia
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy
| | - Necozione Stefano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Marchetti G, Vittori A, Cascella M, Mascilini I, Piga S, Petrucci E, Castellano A, Caruso R, Francia E, Stocchi F, Marinangeli F, Inserra A, Picardo SG. Pain prevalence and pain management in children and adolescents in an italian third level pediatric hospital: a cross-sectional study. Ital J Pediatr 2023; 49:41. [PMID: 36978099 PMCID: PMC10053721 DOI: 10.1186/s13052-023-01439-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In 2016, we performed a one-day investigation to analyze the prevalence of pain, pain intensity, and pain therapy in the Departments of Surgery and Onco-Hematology of the Ospedale Pediatrico Bambino Gesù. To improve the knowledge gap highlighted in the previous study, refresher courses and even personalized audits have been carried out during these years. The purpose of this study is to evaluate if, after 5 years, there have been improvements in the management of pain. METHODS The study was conducted on 25 January 2020. Pain assessment, pain therapies, pain prevalence and intensity in the preceding 24 h and during the recovery period were recorded. Pain outcomes were compared with previous audit results. RESULTS Out of the 63 children with at least one documented pain assessment (starting from 100 eligible), 35 (55.4%) experienced pain: 32 children (50.7%) experienced moderate /severe pain while 3 patients (4%) felt mild pain. In the preceding 24 h, 20 patients (31.7%) reported moderate/severe pain while 10 (16%) reported moderate or severe pain during the interview. The average value of the Pain Management Index (PMI) was - 1.3 ± 0.9 with a minimum of -3 and a maximum of 0. 28 patients (87%) undergoing analgesic therapy for moderate/severe pain had a PMI of less than 0 (undertreated pain), while 3 patients (13%) scored value of 0 or higher (adequate pain therapy), 4 patients (12.5%) received multimodal analgesia with opioids and 2 patients (6%) opioids alone. Time-based therapy was prescribed to 20 patients (62.5%), intermittent therapy was prescribed to 7 patients (22%) and 5 patients (15.5%) did not receive any therapy. The prevalence of pain was higher during hospitalization and 24 h before the interview, while at the time of the interview, the proportion was the same. In this audit, the daily prescription modality of the therapy had some improvements (time-based: 62.5% vs. 44%; intermittent: 22%vs 25%; no therapy: 15.5% vs. 31%). CONCLUSION Pain management in hospitalized children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov, number (NCT04209764), registered 24 December 2019, https://clinicaltrials.gov/ct2/show/NCT04209764?term=NCT04209764&draw=2&rank=1 .
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Affiliation(s)
- Giuliano Marchetti
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Aurora Castellano
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Roberta Caruso
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesca Stocchi
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Inserra
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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Bignami EG, Vittori A, Lanza R, Compagnone C, Cascella M, Bellini V. The Clinical Researcher Journey in the Artificial Intelligence Era: The PAC-MAN’s Challenge. Healthcare (Basel) 2023; 11:healthcare11070975. [PMID: 37046900 PMCID: PMC10093965 DOI: 10.3390/healthcare11070975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
Artificial intelligence (AI) is a powerful tool that can assist researchers and clinicians in various settings. However, like any technology, it must be used with caution and awareness as there are numerous potential pitfalls. To provide a creative analogy, we have likened research to the PAC-MAN classic arcade video game. Just as the protagonist of the game is constantly seeking data, researchers are constantly seeking information that must be acquired and managed within the constraints of the research rules. In our analogy, the obstacles that researchers face are represented by “ghosts”, which symbolize major ethical concerns, low-quality data, legal issues, and educational challenges. In short, clinical researchers need to meticulously collect and analyze data from various sources, often navigating through intricate and nuanced challenges to ensure that the data they obtain are both precise and pertinent to their research inquiry. Reflecting on this analogy can foster a deeper comprehension of the significance of employing AI and other powerful technologies with heightened awareness and attentiveness.
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Affiliation(s)
- Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
- Correspondence: or ; Tel.: +39-0668592397
| | - Roberto Lanza
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Christian Compagnone
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
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Bellini V, Baciarello M, Cascella M, Saturno F, Compagnone C, Vittori A, Bignami EG. Wireless Peripheral Nerve Stimulation for The Upper Limb: A Case Report. Int J Environ Res Public Health 2023; 20:4488. [PMID: 36901498 PMCID: PMC10001981 DOI: 10.3390/ijerph20054488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Peripheral neuro-stimulation (PNS) has been proved to be effective for the treatment of neuropathic pain as well as other painful conditions. We discuss two approaches to PNS placement in the upper extremity. The first case describes a neuropathic syndrome after the traumatic amputation of the distal phalanx of the fifth digit secondary to a work accident with lack of responsiveness to a triple conservative therapy. An upper arm region approach for the PNS was chosen. The procedure had a favorable outcome; in fact, after one month the pain symptoms were absent (VAS 0) and the pharmacological therapy was suspended. The second case presented a patient affected by progressive CRPS type II in the sensory regions of the ulnar and median nerve in the hand, unresponsive to drug therapy. For this procedure, the PNS device was implanted in the forearm. Unfortunately, in this second case the migration of the catheter affected the effectiveness of the treatment. After examining the two cases in this paper, we changed our practice and suggest the implantation of PNS for radial, median and/or ulnar nerve stimulation in the upper arm region, which has significant advantages over the forearm region.
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Affiliation(s)
- Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori–IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131 Naples, Italy
| | - Francesco Saturno
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Christian Compagnone
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Alessandro Vittori
- Departement of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
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Cuomo A, Cascella M, Vittori A, Baciarello M, Badino M, Bignami E. Comments on "Telemedicine for Managing Cancer Pain. A Great Opportunity to be Exploited for CLinical and Research Purposes". Pain Physician 2023; 26:E108-E110. [PMID: 36988375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Arturo Cuomo
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Badino
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Simonini A, Vittori A, Cascella M, Calevo MG, Marinangeli F. The impact of emergence delirium on hospital length of stay for children who underwent tonsillectomy/adenotonsillectomy: an observational retrospective study. Braz J Anesthesiol 2023; 73:171-176. [PMID: 34843805 PMCID: PMC10068575 DOI: 10.1016/j.bjane.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Emergence Delirium (ED) is a combination of disturbance of perception and psychomotor agitation that is common in pediatric patients after general anesthesia, especially at preschool age. Since the effect of ED on the length of stay has been studied in adults but infrequently in children, the aim of this study was to investigate the relationship between ED and length of stay in this population. METHODS A single center, retrospective, observational study was carried out in children who underwent tonsillectomy or adenotonsillectomy. The Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess ED. In addition to the time to hospital discharge (time frame 24 hours), drugs used, comorbidities, early postoperative complications, and pain were investigated if potentially associated with the complication. RESULTS Four hundred sixteen children aged from 1.5 to 10 years (183 female, 233 male) were included. ED occurred in 25.5% of patients (n = 106). Patients were divided into the ED group and the No-ED group. The discharge time was similar in both groups. No significant differences were observed in the frequency of postoperative complications. The use of fentanyl or dexmedetomidine did not affect ED occurrence. The frequency of pain was greater in the ED group, both in the recovery room and in the ward (p = 0.01). CONCLUSIONS The occurrence of ED in children after tonsillectomy/adenotonsillectomy did not extend the length of stay.
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Affiliation(s)
- Alessandro Simonini
- Salesi Children's Hospital, Department of Pediatric Anaesthesia and Intensive Care, Ancona, Italy.
| | - Alessandro Vittori
- IRCCS, Ospedale Pediatrico Bambino Gesù, ARCO ROMA, Department of Anesthesia and Critical Care, Rome, Italy
| | - Marco Cascella
- Istituto Nazionale Tumori-IRCCS-Fondazione Pascale, Division of Anesthesia and Pain Medicine, Naples, Italy
| | - Maria Grazia Calevo
- IRCCS Istituto Giannina Gaslini, Department of Epidemiology and Biostatistic, Genova, Italy
| | - Franco Marinangeli
- University of L'Aquila, Department of Anesthesiology, Intensive Care and Pain Treatment, Aquila, Italy
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Cobianchi L, Dal Mas F, Agnoletti V, Ansaloni L, Biffl W, Butturini G, Campostrini S, Catena F, Denicolai S, Fugazzola P, Martellucci J, Massaro M, Previtali P, Ruta F, Venturi A, Woltz S, Kaafarani HM, Loftus TJ, Aapoäÿlu R, Abbott KL, Abdelmalik A, Abebe NS, Abu-Zidan F, Adam YAY, Adamou H, Adamovich DM, Agresta F, Agrusa A, Akin E, Alessiani M, Alexandrino H, Bidoli C, Ali SM, Mihai VA, Almeida PM, Al-Shehari MM, Altomare M, Amico F, Ammendola M, Andreuccetti J, Anestiadou E, Annicchiarico A, Antonelli A, Aparicio-Sanchez D, Ardito A, Argenio G, Arvieux CC, Arvieux C, Askevold IH, Atanasov BT, Augustin G, Awad SS, Bacchiocchi G, Bagnoli C, Bahouth H, Baili E, Bains L, Baiocchi GL, Bala M, Balaguà© C, Balalis D, Baldini E, Baraket O, Baral S, Barone M, Gonzãlez Barranquero A, Barreras JA, Bass GA, Bayhan Z, Bellanova G, Ben-Ishay O, Bert F, Bianchi V, Biancuzzi H, Radulescu RB, Bignell MB, Biloslavo A, Bini R, Bissacco D, Boati P, Boddaert G, Bogdanic B, Bombardini C, Bonavina L, Bonomo L, Bottari A, Bouliaris K, Brachini G, Brillantino A, Brisinda G, Bulanauca MM, Buonomo LA, Burcharth J, Buscemi S, Calabretto F, Calini G, Calu V, Campanile FC, Campo Dall’Orto R, Campos-Serra A, Carvas JM, Cascella M, Pattacini GC, Celentano V, Centonze DC, Ceresoli M, Chatzipetris D, Chessa A, Chiarello MM, Chirica M, Chooklin S, Chouliaras C, Chowdhury S, Cianci P, Cillara N, Cimbanassi S, Cioffi SPB, Colãis-Ruiz E, Colak E, Conti L, Coppola A, de Sa TC, Costa SD, Cozza V, Curro’ G, Dabekaussen KFASA, D’acapito F, Damaskos D, D’Ambrosio G, Das K, Davies RJ, de Beaux AC, De Lebrusant Fernandez SP, De Luca A, De Simone B, De Stefano F, Degrate L, Demetrashvili Z, Demetriades AK, Detanac DS, Dezi A, Di Buono G, Carlo IDI, Di Lascio P, Di Martino M, Di Saverio S, Diaconescu B, Diaz JJ, Dibra R, Dimitrov EN, Dinuzzi VP, Dios-Barbeito S, Diyani JFA, Dogjani A, Domanin M, D’Oria M, Munoz-Cruzado VD, East B, Ekelund M, Ekwen GT, Elbaih AH, Elhadi M, Enninghorst N, Ernisova M, Escalera-Antezana JP, Esposito S, Esposito G, Estaire-Gãmez M, Farã CN, Farre R, Favi F, Ferrario L, Ferrario di Tor Vajana A, Filisetti C, Fleres F, Fonseca VC, Forero-Torres A, Forfori F, Fortuna L, Fradelos E, Fraga GP, Fransvea P, Frassini S, Frazzetta G, Frigerio I, Frountzas M, Gachabayov M, Galeiras R, Garcãa BM, Garcia Vazquez A, Gargarella S, Garzali IU, Ghannam WM, Ghazi FN, Gillman LM, Gioco R, Giordano A, Giordano L, Giove C, Giraudo G, Giuffrida M, Capponi MG, Gois E, Gomes CA, Gomes FC, Gonsaga RAT, Gonullu E, Goosen J, Goranovic T, Gracia-Roman R, Graziano GMP, Griffiths EA, Guagni T, Hadzhiev DB, Haidar MG, Hamid HKS, Hardcastle TC, Hayati F, Healey AJ, Hecker A, Hecker M, Garcia EFH, hodonou AM, huaman EC, Huerta M, Ibrahim AF, Ibrahim BMS, Ietto G, Inama M, Ioannidis O, Isik A, Ismail N, Ismail AMH, Jailani RUHIF, Jang JY, Kalfountzos C, Kalipershad SNR, Kaouras E, Kaplan LJ, Kara Y, Karamagioli E, Karamarkovia A, Katsaros I, Kavalakat AJ, Kechagias A, Kenig J, Kessel BJ, Khan JS, Khokha V, Kim JI, Kirkpatrick AW, Klappenbach R, Kobe Y, Lymperis EK, Kok KYY, Kong V, Korkolis DP, Koukoulis G, Kovacevic B, Kruger VF, Kryvoruchko IA, Kurihara H, Kuriyama A, Landaluce-Olavarria A, Lapolla P, Licari L, Lisi G, Litvin A, Lizarazu A, Bayo HL, Lohsiriwat V, Moreira CCL, Lostoridis E, Luna AT, Luppi D, V. GMM, Maegele M, Maggiore D, Magnone S, Maier RV, Maier RV, Major P, Manangi M, manetti A, Mantoglu B, Marafante C, Mariani F, Marinis A, Mariot ES, Marseglia GR, Martãnez-Pãrez A, Martines G, Perez AM, Martino C, Mascagni P, Massalou D, Matãas-Garcãa B, Mazzarella G, Mazzarolo G, Melo RB, Mendoza-Moreno F, Meric S, Meyer J, Miceli L, Michalopoulos NV, Milana F, Mingoli A, Mishra TS, Mohamed M, Mohamed MIEA, Mohamedahmed AY, Mohammed MJS, Mohan R, Moore EE, Morales-Garcia D, Muhrbeck M, Mulita F, Mustafa SMS, Muttillo EM, Naimzada MD, Navsaria PH, Negoi I, Nespoli L, Nguyen C, Nidaw MK, Nigri G, Nikolopoulos I, O’Connor DB, Ogundipe HD, Oliveri C, Olmi S, Ong ECW, Orecchia L, Osipov AV, Othman MF, Pace M, Pacilli M, Pagani L, Palomba G, Pantalone D, Panyko A, Paolillo C, Papa MV, Papaconstantinou D, Papadoliopoulou M, Papadopoulos A, Papis D, Pararas N, Parreira JG, Parry NG, Pata F, Patel T, Paterson-Brown S, Pavone G, Pecchini F, Pellino G, Pelloni M, Peloso A, del Pozo EP, Pereira RG, Pereira BM, perez AL, Perra T, Perrone G, Pesce A, Petagna L, Petracca G, Phupong V, Picardi B, Picciariello A, Piccoli M, Piccolo D, Picetti E, Pikoulis Pikoulis E, Pintar T, Pirozzolo G, Piscioneri F, Podda M, Porcu A, Privitera F, Punzo C, Quaresima S, Quiodettis MA, Qvist N, Rahim R, de Almeida FR, Ramely RB, Rasa HK, Reichert M, Reinisch-Liese A, Renne A, Riccetti C, Rodriguez-Luna MR, Roizblatt D, Romanzi A, Romeo L, Roscio FPM, Rosnelifaizur RB, Rossi S, Rubiano AM, Ruiz-Úcar E, Sakakushev BE, Salamea JC, Sall I, Samarakoon LB, Sammartano F, Arteaga AS, Sanchez-Cordero S, Santoanastaso DPM, Sasia D, Sato N, Savchuk A, Sawyer RG, Scaioli G, Schizas D, Sebastiani S, Seeliger B, Lohse HAS, Seretis C, Sermonesi G, Serradilla-Martin M, Shelat VG, Shlyapnikov S, Sidiropoulos T, Simoes RL, Siragusa L, Siribumrungwong B, Slavchev M, Solaini L, soldini G, Sopuev A, Soreide K, Sovatzidis A, Stahel PF, Strickland M, Sultan MAH, Sydorchuk R, Sydorchuk L, Syed SMAM, Syed AM, Tallon-Aguilar L, Tamburini AM, Tamini N, Tan ECTH, Tan JH, Tarasconi A, Tartaglia N, Tartaglia G, Tartaglia D, Taylor JV, Tebala GD, Gonsaga RAT, Teuben M, Theodorou A, Tolonen M, Tomasicchio G, Toro A, Torre B, Triantafyllou T, Trigiante Trigiante G, Tripepi M, Trostchansky J, Tsekouras K, Turrado-Rodriguez V, Tutino R, Uccelli M, Uchikov PA, Ugarte-Sierra B, Ukkonen MT, Vailas M, Vassiliu PG, Vazquez AG, Vazquez RG, Verde JE, Verde JM, Veroux M, Viganò J, Vilallonga R, Visconti D, Vittori A, Waledziak M, Wannatoop T, Widmer LW, Wilson MSJ, Wong TH, Xenaki S, Yu B, Yule S, Zachariah SK, Zacharis G, Zaghi C, Zakaria AD, Zambrano DA, Zampitis N, Zampogna B, Zanghã S, Zapsalis K, Zattoni F, Zese M, Farre SP, Atanasov BT, Pegoraro V, Zantedeschi M, Reitano E, Pizzocaro E. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J Emerg Surg 2023; 18:14. [PMID: 36803568 PMCID: PMC9936681 DOI: 10.1186/s13017-022-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy.
| | - Francesca Dal Mas
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, PV Italy ,grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Walter Biffl
- grid.415402.60000 0004 0449 3295Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Giovanni Butturini
- grid.513352.3Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Stefano Campostrini
- grid.7240.10000 0004 1763 0578Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Stefano Denicolai
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Jacopo Martellucci
- grid.24704.350000 0004 1759 9494Department of Surgery, Careggi University Hospital, Florence, Italy
| | - Maurizio Massaro
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Pietro Previtali
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | - Alessandro Venturi
- grid.8982.b0000 0004 1762 5736Department of Political and Social Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sarah Woltz
- grid.416219.90000 0004 0568 6419Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Haytham M. Kaafarani
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - Tyler J. Loftus
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, Gainesville, FL USA
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Vittori A, Cascella M, Petrucci E, Cortegiani A, Bignami EG, Innamorato MA, Cuomo A, Torrano V, Petrini F, Giarratano A, Natoli S, Marinangeli F. Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists. Pain Pract 2023. [PMID: 36690597 DOI: 10.1111/papr.13207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. METHODS SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5-point Likert-type scale. RESULTS Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31-40 years). Regarding cancer and chronic noncancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential. CONCLUSION This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Marco Cascella
- Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.,Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | | | | | - Arturo Cuomo
- Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Vito Torrano
- Department of Anesthesia, Critical Care and Pain Medicine, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Flavia Petrini
- Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), President 2019-2021, Rome, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.,Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Maugeri, Pavia, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Monaco F, Coluccia S, Cuomo A, Nocerino D, Schiavo D, Pasta G, Bifulco F, Buonanno P, Riccio V, Leonardi M, Perri F, Ottaiano A, Sabbatino F, Vittori A, Cascella M. Bibliometric and Visual Analysis of the Scientific Literature on Percutaneous Electrical Nerve Stimulation (PENS) for Pain Treatment. Applied Sciences 2023; 13:636. [DOI: 10.3390/app13010636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background: Percutaneous electrical nerve stimulation (PENS) is a minimally invasive peripheral neuromodulation approach implemented against chronic neuropathic and mixed pain. This bibliometric study aims to quantitatively evaluate the output of PENS for pain treatment in the scientific literature. The main purpose is to stimulate research in the field and bridge potential scientific gaps. Methods: Articles were retrieved from the Web of Science (WOS) database. The search key term was “percutaneous electrical nerve stimulation (All Fields) and pain (All Fields)”. Year of publication, journal metrics (impact factor and quartile, Q), title, document type, topic, and citations were extracted. The join-point regression was implemented to assess differences in time points for the publication output. The software tool VOSviewer (version 1.6.17) was used for the visual analysis. Results: One thousand three hundred and eighteen articles were included in the knowledge visualization process. A linear upward trend for annual new publications was found. Almost two-thirds of the documents were published in top-ranked journals (Q1 and Q2). The topic “efficacy” was prevalent (12.81%). Concerning article type, the search strategy yielded 307 clinical investigations (23.3%). Articles were cited 36,610 times with a mean of 42.4 citations per article. Approximately one-half of the articles were cited less than 23 times in a range of 21 years. The semantic network analysis for keywords found eight clusters. The analysis of collaborative efforts among researchers showed five thematic clusters including 102 authors with a minimum of five documents produced in collaborations. Most partnerships involved the United States, England, and Germany. Conclusions: despite the upward trend in the number of publications on the subject and the publication of articles in top-ranked journals, there is a need to increase scientific collaborations between researchers and institutions from different countries.
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Natoli S, Vittori A, Cascella M, Innamorato M, Finco G, Giarratano A, Marinangeli F, Cuomo A. Raising Awareness on the Clinical and Social Relevance of Adequate Chronic Pain Care. Int J Environ Res Public Health 2022; 20:551. [PMID: 36612872 PMCID: PMC9819839 DOI: 10.3390/ijerph20010551] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Appropriate pain care should be regarded as a right and effectively guaranteed to people with chronic pain (CP). Law 38, enacted in Italy in 2010, establishes the citizen's right not to suffer. Twelve years later, such right appears still disregarded in Italy and the current access to adequate pain care reveals significant shortcomings. In addition, a mismatch between CP-associated burden and the available healthcare resources in the framework of our national health system has been observed. This article gathers the perspectives of a Board of Italian anesthesiologists on the state of the art of CP management in Italy and aims at strengthening the scientific rationale and clinical relevance of pursuing the enforceability of the right not to suffer and at promoting widespread multidisciplinary care of patients with CP.
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Affiliation(s)
- Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Roma, Italy
- IRCCS Maugeri, 27100 Pavia, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Massimo Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gabriele Finco
- Intensive Care Unit, Azienda Ospedaliero Universitaria Cagliari, 09042 Monserrato, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological, and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, 67100 L’Aquila, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80131 Naples, Italy
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Innamorato MA, Cascella M, Bignami EG, Perna P, Petrucci E, Marinangeli F, Vittori A. Neurostimulation for Chronic Low Back Pain during Pregnancy: Implications for Child and Mother Safety. Int J Environ Res Public Health 2022; 19:15488. [PMID: 36497567 PMCID: PMC9741143 DOI: 10.3390/ijerph192315488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
Pain therapy for low back pain in pregnancy is a very topical issue. In fact, it is necessary to balance the patient's needs to control pain with the need to manage a pregnancy without negative effects on the fetus. We report a case of a 37-year-old woman with low back pain treated with neurostimulation before pregnancy. She described severe chronic low back pain unresponsive to pharmacologic treatments. We first implanted a subcutaneous stimulator into the patient, and then a definitive stimulator resulting in excellent pain control. The improvement in her quality of life allowed the woman to become pregnant. We decided to stop neurostimulation with the patient during pregnancy. The patient completed her pregnancy without complications and the baby was born healthy. During the pregnancy, the woman took only paracetamol when needed. However, this painful symptomatology, completely anecdotal, is not attributable solely to the previous spine problem but probably also to the changes occurring during pregnancy. At the end of pregnancy, the neurostimulator was reactivated without any discomfort for the patient, who is now pain free. This case report provides a first line of evidence of a possible treatment of low back pain in women intending to become pregnant, with risk-free management for both the patient and the child.
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Affiliation(s)
- Massimo Antonio Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, Via Mariano Semmola 53, 80131 Naples, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Paolo Perna
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, Via Vetoio 48, 67100 L’Aquila, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
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Petrucci E, Cofini V, Pizzi B, Cascella M, Marrocco G, Ceccaroni G, Necozione S, Vittori A, Marinangeli F. Pain in critically ill COVID-19 patients: An Italian retrospective study. Open Med (Wars) 2022; 17:1803-1810. [PMID: 36447524 PMCID: PMC9673487 DOI: 10.1515/med-2022-0600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 08/26/2023] Open
Abstract
We retrospectively analyzed the data from patients admitted to the intensive care unit (ICU) of the Hospital of L'Aquila during the first and second waves of pandemic to identify pain related to COVID-19. Pain was evaluated by using the Numerical Rating Scale, and the assessment for neuropathic disturbances of pain was performed with von Frey's hair and Lindblom tests. Pain increased significantly during hospitalization (from 48% at hospital admission to 94.3% at ICU discharge). Female patients were affected by somatic pain in 32.8% of the cases and by somatic pain and pain with neuropathic features (NFs) in 23.5% of the cases, during the ICU stay. Somatic pain and pain with NFs affected more frequently patients with cardiological and respiratory comorbidities. Patients treated with continuous positive airway pressure via helmet had a higher frequency of somatic pain and pain with neuropathic disturbances (84 and 74%, respectively). The frequency of somatic pain and pain with neuropathic disturbances was lower in patients sedated with propofol combined with ketamine. Females have been associated with a higher risk of somatic pain and pain with NFs. Patients with cardiological and respiratory comorbidities undergoing noninvasive ventilation had higher levels of pain. As conclusion, ketamine may reduce the promotion or the worsening of pain in COVID-19 patients.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100, L’Aquila, Italy
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100, L’Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, 67051, Avezzano, L’Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, 80131, Naples, Italy
| | - Gioele Marrocco
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
| | - Gianmaria Ceccaroni
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100, L’Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
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Gawronski O, Thekkan KR, Genna C, Egman S, Sansone V, Erba I, Vittori A, Varano C, Dall’Oglio I, Tiozzo E, Chiusolo F. Instruments to evaluate non-technical skills during high fidelity simulation: A systematic review. Front Med (Lausanne) 2022; 9:986296. [PMID: 36405618 PMCID: PMC9669714 DOI: 10.3389/fmed.2022.986296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/11/2022] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION High Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers' (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS. METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS A total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom (n = 13; 50%), North America/Australia (n = 12; 46%) and Thailand (n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence. CONCLUSION Among a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Kiara R. Thekkan
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Catia Genna
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Sabrina Egman
- Clinical Risk, Innovation and Integration of Care Services, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Vincenza Sansone
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Ilaria Erba
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Carmelita Varano
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
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Petrucci E, Cofini V, Pizzi B, Cascella M, Sollima L, Calvisi G, Gentili L, Marrocco G, Vittori A, Necozione S, Marinangeli F. Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies. Minerva Anestesiol 2022; 88:918-927. [PMID: 36367410 DOI: 10.23736/s0375-9393.22.16434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Non-invasive ventilation may alter the morphology and histology of the upper airway mucosa. This study aimed to investigate the alterations of hypopharynx and oropharynx mucosa, identified during oro-tracheal intubation procedure via video-assisted laryngoscopy, in severe acute respiratory syndrome Coronavirus 2 related, treated by non-invasive ventilation via full-face mask or helmet. METHODS Data of patients affected by Coronavirus 2 admitted to COVID Hospital of L'Aquila (Italy), presenting hypopharynx and oropharynx morphology alterations, requiring oro-tracheal intubation for invasive ventilation and initially treated with non-invasive ventilation were included in the study. The study aimed to investigate the upper airway mucosa alterations using oropharyngeal and hypopharyngeal images and biopsies taken during video-assisted-laryngoscopy. Data from the hypopharynx and oropharynx morphology and histology alterations between non-invasive ventilation via a full-face mask or helmet used during hospitalization were compared. RESULTS From 220 data recorded, 60 patients were included in the study and classified into non-invasive ventilation full-face mask group (30/60) and via helmet group. Comparing data between groups, significant differences were found with respect to hyperemia (77% vs. 20%), laryngeal bleeding ulcerations (87% vs. 13%), and vocal cord edema with >50% narrowing of the tracheal lumen (73% vs. 7%), respectively. The histology examination revealed fibrin-necrotic exudate with extensive necrotic degenerative changes in the sample tissue of the groups. There were not any differences in the duration time of non-invasive ventilation, time from hospitalization and the start of ventilation between groups. CONCLUSIONS The data from this research suggested that there were differences in airway mucosa damages among patients treated with a full-face mask or helmet. Further studies should be planned to understand which non-invasive ventilation support may mitigate upper airway mucosa damages when oro-tracheal intubation is requested for invasive respiratory support.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy -
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Naples, Italy
| | - Laura Sollima
- Department of Anatomopathology, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Giuseppe Calvisi
- Department of Anatomopathology, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Luca Gentili
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gioele Marrocco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Bambino Gesù IRCCS Children Hospital, Rome, Italy
| | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Polati E, Nizzero M, Rama J, Martini A, Gottin L, Donadello K, Del Balzo G, Varrassi G, Marinangeli F, Vittori A, Secchettin E, Schweiger V. Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up. Int J Environ Res Public Health 2022; 19:13354. [PMID: 36293936 PMCID: PMC9603806 DOI: 10.3390/ijerph192013354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Chronic low back pain (CLBP) due to osteoarthritis represents a therapeutic challenge worldwide. Opioids are extensively used to treat such pain, but the development of tolerance, i.e., less susceptibility to the effects of the opioid, which can result in a need for higher doses to achieve the same analgesic effect, may limit their use. Animal models suggest that ultra-low doses of opioid antagonists combined with opioid agonists can decrease or block the development of opioid tolerance. In this retrospective study, we tested this hypothesis in humans. In 2019, 53 patients suffering from CLBP were treated with either Oxycodone and Naloxone Prolonged Release (27 patients, OXN patients) or Oxycodone Controlled Release (26 patients, OXY patients). The follow-up period lasted 2 years, during which 10 patients discontinued the treatment, 5 out of each group. The remaining 43 patients reached and maintained the targeted pain relief, but at 18 and 24 months, the OXY patients showed a significantly higher oxycodone consumption than OXN patients to reach the same level of pain relief. No cases of respiratory depression or opioid abuse were reported. There were no significant differences in the incidence of adverse effects between the two treatments, except for constipation, more common in OXY patients. From our results, we can affirm that a long-term opioid treatment with oxycodone-naloxone combination, when compared with oxycodone only, may significantly hinder the development of opioid tolerance. We were also able to confirm, in our cohort, the well known positive effect of naloxone in terms of opioid-induced bowel dysfunction incidence reduction.
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Affiliation(s)
- Enrico Polati
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
| | - Marta Nizzero
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
| | - Jacopo Rama
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
| | - Alvise Martini
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
| | - Leonardo Gottin
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
| | - Katia Donadello
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
| | - Giovanna Del Balzo
- Department of Medicine and Public Health, Section of Forensic Medicine, University of Verona, 37124 Verona, Italy
| | | | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Rome, Italy
| | - Erica Secchettin
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
| | - Vittorio Schweiger
- Anesthesiology, Intensive Care and Pain Therapy Centre, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37124 Verona, Italy
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31
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Ciccozzi A, Pizzi B, Vittori A, Piroli A, Marrocco G, Della Vecchia F, Cascella M, Petrucci E, Marinangeli F. The Perioperative Anesthetic Management of the Pediatric Patient with Special Needs: An Overview of Literature. Children (Basel) 2022; 9:children9101438. [PMID: 36291372 PMCID: PMC9600107 DOI: 10.3390/children9101438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 06/01/2023]
Abstract
The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible. This article reports an overview of the anesthetic management of non-cooperative patients between 6 and 14 years old. The pathologies most frequently responsible for psycho-physical disorders can be summarized into three groups: (1) collaboration difficulties (autism spectrum disorders, intellectual impairment, phobia); (2) motor dysfunction (cerebral palsy, epilepsy, other brain pathologies, neuromuscular disorders), and (3) craniofacial anomalies (Down syndrome, other genetic syndromes). Anesthesia can be performed safely and successfully due to careful management of all specific problems of these patients, such as a difficult preoperative evaluation (medical history, physical examination, blood sampling, evaluation of vital parameters and predictive indices of difficult airway) and the inapplicability of a "standard" perioperative path (timing and length of the hospitalization, anesthetic premedication, postoperative management). It is necessary to ensure a dedicated perioperative process that is safe, comfortable, tailored to specific needs, and as less traumatic as possible. At the same time, all necessary precautions must be taken to minimize possible complications.
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Affiliation(s)
- Alessandra Ciccozzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, 67051 L’Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Rome, Italy
| | - Alba Piroli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Gioele Marrocco
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Federica Della Vecchia
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Biancuzzi H, Dal Mas F, Brescia V, Campostrini S, Cascella M, Cuomo A, Cobianchi L, Dorken-Gallastegi A, Gebran A, Kaafarani HM, Marinangeli F, Massaro M, Renne A, Scaioli G, Bednarova R, Vittori A, Miceli L. Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies. Int J Environ Res Public Health 2022; 19:ijerph191811754. [PMID: 36142028 PMCID: PMC9517221 DOI: 10.3390/ijerph191811754] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 05/23/2023]
Abstract
In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse.
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Affiliation(s)
- Helena Biancuzzi
- Department of Clinical and Experimental Pain Medicine, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Centro di Riferimento Oncologico—CRO of Aviano, 33081 Aviano, Italy
| | - Francesca Dal Mas
- Department of Management, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Valerio Brescia
- Department of Management, University of Turin, 10134 Turin, Italy
- Department of Finance, Wrocław University of Economics and Business, 53-345 Wrocław, Poland
| | - Stefano Campostrini
- Department of Economics, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- General Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Ander Dorken-Gallastegi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anthony Gebran
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Haytham M. Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Maurizio Massaro
- Department of Management, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Angela Renne
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Giacomo Scaioli
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Rym Bednarova
- Department of Pain Medicine, Hospital of Latisana, 33053 Latisana, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 00165 Rome, Italy
| | - Luca Miceli
- Department of Clinical and Experimental Pain Medicine, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Centro di Riferimento Oncologico—CRO of Aviano, 33081 Aviano, Italy
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Cuomo A, Cascella M, Vittori A, Baciarello M, Badino M, Bignami E. Telemedicine for Managing Cancer Pain. A Great Opportunity to be Exploited for Clinical and Research Purposes. Pain Physician 2022; 25:E886-E888. [PMID: 36122279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Arturo Cuomo
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Badino
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Vittori A, Marinangeli F, Bignami EG, Simonini A, Vergallo A, Fiore G, Petrucci E, Cascella M, Pedone R. Analysis on Burnout, Job Conditions, Alexithymia, and Other Psychological Symptoms in a Sample of Italian Anesthesiologists and Intensivists, Assessed Just before the COVID-19 Pandemic: An AAROI-EMAC Study. Healthcare (Basel) 2022; 10:healthcare10081370. [PMID: 35893193 PMCID: PMC9394278 DOI: 10.3390/healthcare10081370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/30/2022] Open
Abstract
Background. It was previously reported that health care professionals working in the fields of anesthesiology and emergency are at higher risk of burnout. However, the correlations between burnout, alexithymia, and other psychological symptoms are poorly investigated. Furthermore, there is a lack of evidence on which risk factors, specific to the work of anesthetists and intensivists, can increase the risk of burnout, and which are useful for developing remedial health policies. Methods. This cross-sectional study was conducted in 2020 on a sample of 300 professionals recruited from AAROI-EMAC subscribers in Italy. Data collection instruments were a questionnaire on demographic, education, job characteristics and well-being, the Maslach Burnout Inventory Tool, the Toronto Alexithymia Scale, the Symptom Checklist-90-R, and the Rosenberg Self-Esteem Scale administered during refresher courses in anesthesiology. Correlations between burnout and physical and psychological symptoms were searched. Results. With respect to burnout, 29% of individuals scored at high risk on emotional exhaustion, followed by 36% at moderate–high risk. Depersonalization high and moderate–high risk were scored by 18.7% and 34.3% of individuals, respectively. Burnout personal accomplishment was scored by 34.7% of respondents. The highest mean scores of burnout dimensions were related to dissatisfaction with one’s career, conflicting relationships with surgeons, and, finally, difficulty in explaining one’s work to patients. Conclusions. Burnout rates in Italian anesthesiologists and intensivists have been worrying since before the COVID-19 pandemic. Anesthesiologists with higher levels of alexithymia are more at risk for burnout. It is therefore necessary to take urgent health policy measures.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-06-68592397
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, 67100 L’Aquila, Italy;
- Simulearn, Simulation Center of AAROI-EMAC, 40121 Bologna, Italy;
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60121 Ancona, Italy;
| | - Alessandro Vergallo
- Simulearn, Simulation Center of AAROI-EMAC, 40121 Bologna, Italy;
- Department of Anesthesia and Intensive Care, Spedali Civili di Brescia, 25121 Brescia, Italy
| | - Gilberto Fiore
- Department of Anesthesia and Intensive Care, Hospital of Santa Croce di Moncalieri, 10024 Turin, Italy;
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80131 Naples, Italy;
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, 8100 Caserta, Italy;
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Simonini A, Brogi E, Cascella M, Vittori A. Advantages of ketamine in pediatric anesthesia. Open Med (Wars) 2022; 17:1134-1147. [PMID: 35859796 PMCID: PMC9263896 DOI: 10.1515/med-2022-0509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/29/2022] Open
Abstract
Although ketamine is primarily used for induction and maintenance of general anesthesia, it also presents sedative, amnestic, anesthetics, analgesic, antihyperalgesia, neuroprotective, anti-inflammatory, immunomodulant, and antidepressant effects. Its unique pharmacodynamics and pharmacokinetic properties allow the use of ketamine in various clinical settings including sedation, ambulatory anesthesia, and intensive care practices. It has also adopted to manage acute and chronic pain management. Clinically, ketamine produces dissociative sedation, analgesia, and amnesia while maintaining laryngeal reflexes, with respiratory and cardiovascular stability. Notably, it does not cause respiratory depression, maintaining both the hypercapnic reflex and the residual functional capacity with a moderate bronchodilation effect. In the pediatric population, ketamine can be administered through practically all routes, making it an advantageous drug for the sedation required setting such as placement of difficult vascular access and in uncooperative and oppositional children. Consequently, ketamine is indicated in prehospital induction of anesthesia, induction of anesthesia in potentially hemodynamic unstable patients, and in patients at risk of bronchospasm. Even more, ketamine does not increase intracranial pressure, and it can be safely used also in patients with traumatic brain injuries. This article is aimed to provide a brief and practical summary of the role of ketamine in the pediatric field.
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Affiliation(s)
- Alessandro Simonini
- Department of Pediatric Anaesthesia and Intensive Care, S.C. SOD Anestesia e Rianimazione Pediatrica, Ospedale G. Salesi , Ancona , 60123 , Italy
| | - Etrusca Brogi
- Department Anesthesia and Intensive Care, University of Pisa , Pisa , 56126 , Italy
| | - Marco Cascella
- Department of Supportive Care, Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale , Naples , 80100 , Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4 , 00165 , Rome , Italy
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Zec T, Di Napoli R, Fievez L, Ben Aziz M, Ottaiano A, Vittori A, Perri F, Cascella M. Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research. J Multidiscip Healthc 2022; 15:1427-1444. [PMID: 35818514 PMCID: PMC9270886 DOI: 10.2147/jmdh.s337250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
In cancer patients undergoing surgery, tumor biology and anticancer treatments can increase the risk of perioperative bleeding and blood transfusions. Notably, blood transfusions can be potentially associated with an increased risk of life-threatening immune responses, acute lung injury, postoperative infections, and thromboembolism. Moreover, the link between perioperative transfusion and increased risk of cancer recurrence cannot be excluded. On the other hand, cancer patients have an increased risk of thromboembolism due to cancer itself and antineoplastic systemic treatments including chemotherapy and anti-angiogenic drugs. In this complex scenario, effective and safe strategies aimed at the prevention of blood transfusions are warranted. This narrative review addresses the efficacy, and the safety of the synthetic antifibrinolytic agent tranexamic acid (TXA) when used perioperatively in cancer surgery. Although in not oncologic surgery the use of TXA has been extensively studied, in the setting of cancer patients requiring surgery, the evidence is scarce. An overview of the ongoing clinical research is also provided.
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Affiliation(s)
- Tamara Zec
- Department of Anesthesiology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, 1000, Belgium
| | - Raffaela Di Napoli
- Department of Anesthesiology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, 1000, Belgium
| | - Lydwine Fievez
- Department of Anesthesiology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, 1000, Belgium
| | - Mohamed Ben Aziz
- Department of Anesthesiology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, 1000, Belgium
| | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80100, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, Rome, 00165, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, 80100, Italy
- Correspondence: Francesco Perri, Email
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80100, Italy
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Cascella M, Monaco F, Nocerino D, Chinè E, Carpenedo R, Picerno P, Migliaccio L, Armignacco A, Franceschini G, Coluccia S, Gennaro PD, Tracey MC, Forte CA, Tafuri M, Crispo A, Cutugno F, Vittori A, Natoli S, Cuomo A. Bibliometric Network Analysis on Rapid-Onset Opioids for Breakthrough Cancer Pain Treatment. J Pain Symptom Manage 2022; 63:1041-1050. [PMID: 35151801 DOI: 10.1016/j.jpainsymman.2022.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Proper breakthrough cancer pain (BTcP) management is of pivotal importance. Although rapid-acting, oral and nasal transmucosal, fentanyl formulations (rapid-onset opioids, ROOs) are licensed for BTcP treatment, not all guidelines recommend their use. Presumably, some research gaps need to be bridged to produce solid evidence. We present a bibliometric network analysis on ROOs for BTcP treatment. METHODS Documents were retrieved from the Web of Science (WOS) online database. The string was "rapid onset opioids" or "transmucosal fentanyl" and "breakthrough cancer pain". Year of publication, journal metrics (impact factor and quartile), title, document type, topic, and clinical setting (in-patients, outpatients, and palliative care) were extracted. The software tool VOSviewer (version 1.6.17) was used to analyze the semantic network analyzes, bibliographic coupling, journals analysis, and research networks. RESULTS 502 articles were found in WOS. A declining trend in published articles from 2014 to 2021 was observed. Approximately 50% of documents regard top quartile (Q1) journals. Most articles focused on ROOs efficacy, but abuse and misuse issues are poorly addressed. With respect to article type, we calculated 132 clinical investigations. The semantic network analysis found interconnections between the terms "breakthrough cancer pain," "opioids," and "cancers." The top co-cited article was published in 2000 and addressed pain assessment. The largest number of partnerships regarded the United States, Italy, and England. CONCLUSION In this research area, most articles are published in top-ranked journals. Nevertheless, paramount topics should be better addressed, and the implementation of research networks is needed.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy; Department of Electrical Engineering and Information Technologies (M.C., F.C.), Università di Napoli "Federico II", 80100 Napoli, Italy.
| | - Federica Monaco
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Davide Nocerino
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Elisabetta Chinè
- Unit of Pain Therapy (E.C., R.C., S.N.), Polyclinic of Tor Vergata, Rome, Italy
| | - Roberta Carpenedo
- Unit of Pain Therapy (E.C., R.C., S.N.), Polyclinic of Tor Vergata, Rome, Italy
| | - Paola Picerno
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Laura Migliaccio
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Angela Armignacco
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Giulia Franceschini
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Maura C Tracey
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Cira A Forte
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Mariangela Tafuri
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Francesco Cutugno
- Department of Electrical Engineering and Information Technologies (M.C., F.C.), Università di Napoli "Federico II", 80100 Napoli, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care (A.V.), ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Silvia Natoli
- Unit of Pain Therapy (E.C., R.C., S.N.), Polyclinic of Tor Vergata, Rome, Italy; Department of Clinical Science and Translational Medicine University of Rome (S.N.), Tor Vergata, Rome, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
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Petrucci E, Marinangeli F, Pizzi B, Sciorio F, Marrocco G, Innamorato MA, Cascella M, Vittori A. A Modified Approach for Ultrasound-Guided Thoracic Paravertebral Block via Thoracic Intervertebral Foramen in an Adolescent Patient: A Case Report. J Clin Med 2022; 11:jcm11092646. [PMID: 35566772 PMCID: PMC9105263 DOI: 10.3390/jcm11092646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
This case report describes a modified approach for a thoracic paravertebral block by performing a bilateral ultrasound-assisted injection of 12 mL of 0.5% levobupivacaine near the thoracic intervertebral foramen, combined with general anesthesia, in a patient who underwent emergent laparotomy for small intestinal volvulus. Two continuous catheter sets were used for a bilateral continuous block with levobupivacaine 0.25% at a rate of 5–8 mL/h. No complications during the execution of the block were recorded. No supplemental opioids were administered and the patient was hemodynamically stable, requiring no pharmacological cardiovascular support during surgery. At the end of the surgical procedure, the patient received a continuous flow of 0.2% levobupivacaine as postoperative analgesia, at a basal flow of 4 mL/h per each side, a bolus of 4 mL, and a lockout time of 60 min was used. The postoperative pain on the Numeric Rating Scale was 2 at rest and it was 4 in motion, without neurological or respiratory sequelae due to block in the first 72 h after surgery.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, Via Vetoio 48, 67100 L’Aquila, Italy
- Correspondence:
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, Coppito, 67100 L’Aquila, Italy; (F.M.); (F.S.); (G.M.)
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, Avezzano, 67051 L’Aquila, Italy;
| | - Francesco Sciorio
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, Coppito, 67100 L’Aquila, Italy; (F.M.); (F.S.); (G.M.)
| | - Gioele Marrocco
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, Coppito, 67100 L’Aquila, Italy; (F.M.); (F.S.); (G.M.)
| | - Massimo Antonio Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Viale Vincenzo Randi 5, 48121 Ravenna, Italy;
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, Via Mariano Semmola 53, 80131 Naples, Italy;
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy;
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Cascella M, Vittori A, Petrucci E, Marinangeli F, Giarratano A, Cacciagrano C, Tizi ES, Miceli L, Natoli S, Cuomo A. Strengths and Weaknesses of Cancer Pain Management in Italy: Findings from a Nationwide SIAARTI Survey. Healthcare (Basel) 2022; 10:healthcare10030441. [PMID: 35326919 PMCID: PMC8951760 DOI: 10.3390/healthcare10030441] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
Objectives: Despite guidelines, a large percentage of cancer patients continue to suffer from ineffectively treated pain. The authors undertook this survey to assess the strengths and weaknesses of cancer pain management in Italy. Design: This was a prospectively administered survey. Participants: The participants were anesthesiologists of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Intervention: A 58-item questionnaire covered the demographics and features of cancer pain management in the Italian context. Results: The authors received responses from 611 pain therapists of 279 centers. Only 22% of physicians are exclusively pain therapists. Seventy-five percent are specialists in anesthesiology, intensive care, and pain medicine. Most pain centers are hospital or university facilities (78%). The strengths of cancer pain management in Italy are the careful opioid prescriptions, the use of strategies for the treatment of neuropathic pain, patient/healthcare provider partnerships, and breakthrough cancer pain management. Weaknesses to be addressed include poor adherence to guidelines, inadequate attention toward the patient’s quality of life, insufficient use of minimally invasive techniques, lack of teamwork approaches, inappropriate timing of pain specialist engagement, and poor telemedicine use. Conclusions: Despite several strengths, further efforts are needed to improve the care of patients suffering from cancer pain in Italy.
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Affiliation(s)
- Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy;
- Correspondence: ; Tel.: +39-0815903221
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy;
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy;
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy;
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | - Cristina Cacciagrano
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), 80100 Rome, Italy; (C.C.); (E.S.T.)
| | - Emiliano Simone Tizi
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), 80100 Rome, Italy; (C.C.); (E.S.T.)
| | - Luca Miceli
- Unit of Pain Medicine, IRCCS Centro di Riferimento Oncologico (CRO), 33081 Aviano, Italy;
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00173 Rome, Italy;
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy;
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Cascella M, Marinangeli F, Vittori A, Scala C, Piccinini M, Braga A, Miceli L, Vellucci R. Open Issues and Practical Suggestions for Telemedicine in Chronic Pain. Int J Environ Res Public Health 2021; 18:ijerph182312416. [PMID: 34886140 PMCID: PMC8656645 DOI: 10.3390/ijerph182312416] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
Telemedicine represents a major opportunity to facilitate continued assistance for patients with chronic pain and improve their access to care. Preliminary data show that an improvement can be expected of the monitoring, treatment adherence, assessment of treatment effect including the emotional distress associated with pain. Moreover, this approach seems to be convenient and cost-effective, and particularly suitable for personalized treatment. Nevertheless, several open issues must be highlighted such as identification of assessment tools, implementation of monitoring instruments, and ability to evaluate personal needs and expectations. Open questions exist, such as how to evaluate the need for medical intervention and interventional procedures, and how to define when a clinical examination is required for certain conditions. In this context, it is necessary to establish dynamic protocols that provide the right balance between face-to-face visits and telemedicine. Useful tips are provided to start an efficient experience. More data are needed to develop precise operating procedures. In the meantime, the first experiences from such settings can pave the way to initiate effective care pathways in chronic pain.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori—IRCCS—Fondazione Pascale, 80131 Napoli, Italy;
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Rome, Italy
- Correspondence: or ; Tel.: +39-06-68592397
| | - Cristina Scala
- UOC Anesthesia, Intensive Care and Pain Therapy, Senigallia Hospital, 60123 Ancona, Italy;
| | - Massimo Piccinini
- Anesthesia, Critical Care, Palliative Medicine and Pain Therapy Service, L’Aquila ASL1 Abruzzo, 67100 L’Aquila, Italy;
| | | | - Luca Miceli
- Department of Clinical and Experimental Pain Medicine, IRCCS CRO of Aviano, 33081 Aviano, Italy;
| | - Renato Vellucci
- Pain and Palliative Care Clinic, University Hospital of Careggi, 50121 Florence, Italy;
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Vittori A, Petrucci E, Cascella M, Innamorato M, Cuomo A, Giarratano A, Petrini F, Marinangeli F. Pursuing the Recovery of Severe Chronic Musculoskeletal Pain in Italy: Clinical and Organizational Perspectives from a SIAARTI Survey. J Pain Res 2021; 14:3401-3410. [PMID: 34744457 PMCID: PMC8565982 DOI: 10.2147/jpr.s328434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Increased attention to the functional impact of chronic pain (CP), as highlighted by the 11th revision of the International Classification of Diseases (ICD-11) and advocated by the International Classification of Functioning, Disability and Health (ICF), is an important step forward for optimizing its management. Evidence about perspectives of Italian physicians on the relevance of musculoskeletal (MSK) pain care to improve patients’ functioning and Quality of Life is scant. The study aimed to investigate the physicians’ perception of the value of functional recovery in severe MSK pain patients, their attitude towards its assessment and achievement in Italy. Methods A survey was conducted in Italy between October 2020 and January 2021. Specialist centers members of the SIAARTI (n = 395) were sent an online questionnaire encompassing the Italian pain therapy network. Participants rated their agreement to questionnaire items according to a 5-point Likert-type scale. Results A total of 305 centers (77%) completed the survey. Most physicians rated the recovery of functioning as very relevant in MSK pain treatment and, when they assessed it, devoted great attention to the ability to perform daily activities, pain, ability to ambulate and sleep quality. Multidimensional questionnaires were less employed in favor of physical examination and pain intensity scales. Pharmacological therapy, rehabilitation and lifestyle changes and/or physical exercise were all rated optimal strategies to pursue the recovery of patients’ functioning. When considering pharmacological therapy, weak and strong opioids, either alone or combined with paracetamol, were the most frequently employed analgesics. Conclusion Clinicians seem to recognize the recovery of functioning as equally important as pain intensity reduction, but there is a need of streamlining available tools to effectively assess both across different MSK pain patients.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Massimo Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- SIAARTI (Italian Society of Anaesthesia, Analgesia, Reanimation and Intensive Care Medicine), Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Cuomo A, Cascella M, Vittori A, Marinangeli F. Chronic low back pain as a biopsychosocial disease: time to change our point of view. J Anesth Analg Crit Care 2021; 1:7. [PMCID: PMC10245422 DOI: 10.1186/s44158-021-00010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 06/17/2023]
Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
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Simonini A, Brogi E, Conti G, Vittori A, Cascella M, Calevo MG. Dexmedetomidine reduced the severity of emergence delirium and respiratory complications, but increased intraoperative hypotension in children underwent tonsillectomy. A retrospective analysis. Minerva Pediatr (Torino) 2021:S2724-5276.21.06330-8. [PMID: 34515441 DOI: 10.23736/s2724-5276.21.06330-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intraoperative dexmedetomidine can be useful for its sedative and analgesic sparing effects, and for the prevention of emergence delirium. Conversely, it can cause hypotension and bradycardia. The aim of this study was to assess the safety and efficacy of dexmedetomidine in pediatric anesthesia. METHODS This is a retrospective cohort study in children who received intravenous dexmedetomidine (Dex group) or opioids (No-Dex group) during general anesthesia for tonsillectomy, between November 2014 and November 2016. From the medical records, data on the intraoperative phase (hemodynamic adverse events, respiratory failure at the emergence, awakening and extubation times, emergence delirium), recovery room (pain, hemodynamic parameters, and desaturation), and ward stay (pain, and nausea and vomiting) were investigated. Time of hospital discharge was calculated. RESULTS Three hundred twenty-eight (Dex group 183; No-Dex group 145) children ranging from 1.5 to 10 years were included. The percentage of intraoperative hypotension was significantly higher in the Dex group (p=0.01). The extubation times were significantly higher in No-Dex group (p=0.0001), although the awakening times were significantly longer with dexmedetomidine (p= 0.0001). Desaturation episodes were higher in the Dex group (p=0.0001). The incidence of emergence delirium was similar in the two groups, but of greater intensity in the No-Dex group. While in the immediate postoperative period there was no difference in pain, after 24 hours, the incidence of pain and vomiting was significantly higher (p=0.003; p=0.0001) in the No-Dex group. CONCLUSIONS Although several outcome parameters showed important advantages of dexmedetomidine over opioid-based regimens in terms of safety and efficacy, issues such as the increased intraoperative hypotension, indicated that it is not possible to draw any definitive conclusions.
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Affiliation(s)
- Alessandro Simonini
- Department of Pediatric, Anaesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy -
| | - Etrusca Brogi
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Naples, Italy
| | - Maria G Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Cascella M, Del Gaudio A, Vittori A, Bimonte S, Del Prete P, Forte CA, Cuomo A, De Blasio E. COVID-Pain: Acute and Late-Onset Painful Clinical Manifestations in COVID-19 - Molecular Mechanisms and Research Perspectives. J Pain Res 2021; 14:2403-2412. [PMID: 34408485 PMCID: PMC8364364 DOI: 10.2147/jpr.s313978] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/01/2021] [Indexed: 01/08/2023] Open
Abstract
Although the respiratory manifestations of COVID-19 are predominant, signs and symptoms of an extra-pulmonary involvement are usually encompassed among the clinical picture of the disease. Several painful manifestations can occur during the acute phase but also as short- or long-term complications. Myalgia, joint pain, sore throat, abdominal pain, chest pain, and headache usually accompany respiratory symptoms, but they can also occur as isolated clinical findings or can be expressed regardless of the severity of COVID-19. On these premises, given the vast spectrum of clinical manifestations and the complexity of their pathogenesis, it would be more appropriate to refer to "COVID-pain", an umbrella term useful for encompassing all these clinical manifestations in a separate chapter of the disease. In this scenario, we addressed the topic from a molecular perspective, trying to provide explanations for the underlying pathophysiological processes. Consequently, this narrative review is aimed at dissecting the mechanisms of acute and chronic painful manifestations, summarizing fundamental concepts on the matter, controversies, current research gaps, and potential developments in this field.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Alfredo Del Gaudio
- DSC Anestesia e Rianimazione 2, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, 71013, FG, Italy
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Paola Del Prete
- Direzione Scientifica, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Elvio De Blasio
- DSC Anestesia e Rianimazione 2, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, 71013, FG, Italy
- Multidisciplinary Emergency Unit for COVID-19 Campania, Naples, 80100, Italy
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45
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Marchetti G, Vittori A, Ferrari F, Francia E, Mascilini I, Petrucci E, Piga S, Pardi V, Cascella M, Contini G, Marinangeli F, Inserra A, Picardo SG. Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients. Children (Basel) 2021; 8:children8080642. [PMID: 34438533 PMCID: PMC8392193 DOI: 10.3390/children8080642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022]
Abstract
We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.
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Affiliation(s)
- Giuliano Marchetti
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
- Correspondence: ; Tel.: +39-06-68592397
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Fabio Ferrari
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, Via Vetoio, 48, 67100 L’Aquila, Italy;
| | - Simone Piga
- Unit of Clinical Epidemiology, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy;
| | - Valerio Pardi
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (V.P.); (G.C.); (A.I.)
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131 Naples, Italy;
| | - Giorgia Contini
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (V.P.); (G.C.); (A.I.)
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi, 1, 67100 Coppito, Italy;
| | - Alessandro Inserra
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (V.P.); (G.C.); (A.I.)
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
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46
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Vittori A, Marchetti G, Francia E, Mascilini I, Picardo SG. Organization of a pediatric acupuncture clinic for pain and enuresis during Covid-19 pandemic in a third level Italian Pediatric Hospital: experience of Ospedale Pediatrico Bambino Gesù. Minerva Pediatr (Torino) 2021; 74:480-481. [PMID: 34184468 DOI: 10.23736/s2724-5276.20.06050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro Vittori
- ARCO Roma, Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy -
| | - Giuliano Marchetti
- ARCO Roma, Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Elisa Francia
- ARCO Roma, Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Ilaria Mascilini
- ARCO Roma, Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Sergio G Picardo
- ARCO Roma, Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
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Vittori A, Marchetti G, Pedone R, Francia E, Mascilini I, Marinangeli F, Picardo SG. COVID-19 pandemic mental health risks among anesthesiologists: it is not only burnout. Braz J Anesthesiol 2021; 71:201-203. [PMID: 33623177 PMCID: PMC7893308 DOI: 10.1016/j.bjane.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/23/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alessandro Vittori
- Ospedale Pediatrico Bambino Gesù IRCCS, Department of Anesthesia and Critical Care, Rome, Italy
| | - Giuliano Marchetti
- Ospedale Pediatrico Bambino Gesù IRCCS, Department of Anesthesia and Critical Care, Rome, Italy
| | - Roberto Pedone
- University of Campania Luigi Vanvitelli, Department of Psychology, Caserta, Italy
| | - Elisa Francia
- Ospedale Pediatrico Bambino Gesù IRCCS, Department of Anesthesia and Critical Care, Rome, Italy
| | - Ilaria Mascilini
- Ospedale Pediatrico Bambino Gesù IRCCS, Department of Anesthesia and Critical Care, Rome, Italy
| | - Franco Marinangeli
- University of L'Aquila, Intensive Care and Pain Treatment, Department of Anesthesiology, Aquila, Italy
| | - Sergio Giuseppe Picardo
- Ospedale Pediatrico Bambino Gesù IRCCS, Department of Anesthesia and Critical Care, Rome, Italy
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48
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Simonini A, Murgia F, Cascella M, Marinangeli F, Vittori A, Calevo MG. Ibuprofen and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy: a systematic review and meta-analysis of randomized clinical trials. Expert Rev Clin Pharmacol 2020; 14:33-45. [PMID: 33306914 DOI: 10.1080/17512433.2021.1863787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Ibuprofen is a drug widely used in children who underwent elective tonsillectomy or adenotonsillectomy because compared to the other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) it is considered a safe drug with a low risk of postoperative bleeding. AREAS COVERED We conducted a systematic review with meta-analysis of randomized clinical trials (RCTs) comparing ibuprofen vs. placebo or not-NSAIDs drugs in children aged up to 17 years of age, who underwent elective tonsillectomy or adenotonsillectomy. We searched in MEDLINE, EMBASE and Cochrane from 1990 through 30 April 2019. We searched www.clinicaltrials.gov for relevant ongoing studies. Our primary outcome was postoperative bleeding requiring surgical intervention. Secondary outcomes were postoperative bleeding not requiring further surgical intervention, the need for blood transfusion, nausea, vomiting, prolonged hospital stay, postoperative pain, and adverse events related to ibuprofen administration. The database search yielded 1227 patients from 7 studies. EXPERT OPINION Given the imprecision of our estimates, the quality of evidence very low/moderate and the few RCTs identified, the results of this analysis were consistent with either a benefit or a detrimental effect of the administration of ibuprofen and do not provide a definitive answer to the review question. Further studies are needed on this important topic.
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Affiliation(s)
- Alessandro Simonini
- Department Pediatric Anaesthesia and Intensive Care, Salesi Children's Hospital , Ancona, Italy
| | - Francesco Murgia
- Department of Anesthesiology and Intensive Care, University of Cagliari
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale , Napoli, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila , Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO. IRCCS Ospedale Pediatrico Bambino Gesù , Rome, Italy
| | - Maria Grazia Calevo
- Department of Epidemiology and Biostatistic, IRCCS Istituto Giannina Gaslini , Genova, Italy
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Cascella M, Vittori A, Miceli L, Bednarova R, Guardamagna VA, Bimonte S, Petrini F, Crispo A, Cuomo A, Marinangeli F. Italian publications on Pain Medicine in 2018. Minerva Anestesiol 2020; 87:250-251. [PMID: 32756547 DOI: 10.23736/s0375-9393.20.15008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Cascella
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy -
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luca Miceli
- Unit of Pain Medicine, IRCCS Centro di Riferimento Oncologico (CRO), Aviano, Pordenone, Italy
| | - Rym Bednarova
- Unit of Anesthesiology, Division of Intensive Care and Pain, Hospital of Latisana, Udine, Italy
| | | | - Sabrina Bimonte
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Flavia Petrini
- Department of Anesthesiology, Resuscitation and Intensive Care, University of Chieti-Pescara, Pescara, Italy
| | - Anna Crispo
- SC of Epidemiology and Biostatistics, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Marchetti G, Vittori A, Mascilini I, Francia E, Picardo SG. Acupuncture for pain management in pediatric psoriatic arthritis: a case report. Acupunct Med 2020; 38:440-442. [PMID: 32370536 DOI: 10.1177/0964528420920281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuliano Marchetti
- Department of Anesthesia and Critical Care ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical Care ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
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