[Possibilites of application of traditional Chinese medicine - acupuncture - in the perioperative period.]

Chinese medicine is a holistic method of therapy with thousands of years of history. There are more assumptions regarding the mechanism of action, nevertheless, several studies have demonstrated its therapeutic effect. Nowadays, patients and physicians have become open to complementary medicine, but acupuncture used in the perioperative period has not yet widespread in Hungary. The aim of the article is to describe traditional Chinese medicine, primarily the effect of acupuncture and laser acupuncture on patients undergoing surgery. Relieving anxiety before surgery, alleviating pain, nausea and vomiting during and after surgery is a basic anesthesiology task, however, the drug therapy can be supplemented with any technique of acupuncture. Based on numerous studies, acupuncture effectively reduces the incidence of postoperative nausea, has an anxiolytic and analgesic effect, and also has an anti-inflammatory effect caused by surgical stress. There are rarely contraindications to its application, accurate knowledge of the rules of point selection and with proper technique acupuncture is a low-risk, pain-free procedure that can be performed by inducing a mild needling sensation. Based on all this, it can become a part of multimodal therapy. Orv Hetil. 2023; 164(30): 1187-1193.

Pain symptoms and pain management options in SARS-CoV-2 environment

Összefoglaló. Az új koronavírusként megismert SARS-CoV-2-fertőzés legsúlyosabb szövődményeként a gyulladásos folyamatok jelátvivő molekuláinak elszabadulása - az ún. citokinvihar - kritikus légzési elégtelenséggel társuló akut respirációs diszfunkciós szindrómát vagy többszervi gyulladásos szindrómát okoz. Mostanáig igazolódott, hogy a fertőzések legnagyobb részben tünetmentesen vagy enyhe tünetekkel zajlanak. A betegség minden szakaszában előfordulhat enyhe vagy középsúlyos, ritkábban intenzív fájdalom, melyek enyhítésére számos fájdalomcsillapítási lehetőség áll rendelkezésre. A pandémia kezdete óta foglalkoznunk kell a tünetek enyhítésével, akár infektológiai osztályon, akár műtéti ellátás alkalmával. A betegek hazaengedését követően figyelmet kell fordítanunk az intenzív osztályos ellátás utáni és a COVID-19-et követő tünetek és fájdalmak értékelésére. Időszerű átfogó összefoglalónkban hangsúlyozzuk a különböző fájdalomcsillapítók szerepét a COVID-19-fertőzéssel összefüggő fájdalommal járó folyamatokban. Orv Hetil. 2021; 162(38): 1511-1519. Summary. As the most severe consequence of the new coronavirus SARS-CoV-2 infection, the cytokine storm - caused by the liberalization of several inflammatory mediators - engenders critical respiratory dysfunction syndrome or multisystem inflammatory syndrome. The most proportion of infections has proven symptomless or with very mild signs of disease so far. Mild, moderate, or rarely intense pain can occur in every phase of the disease, for the treatment of which more than a few analgesic possibilities are readily available. From the start of the pandemic, we have been concerning to ameliorate the symptoms, in either the department of infectology, or operating suites. The post-intensive care pain and post-COVID symptoms should be evaluated and treated after discharge. In this timely and comprehensive article, the role and importance of different analgesics are articulated regarding the COVID-associated painful conditions. Orv Hetil. 2021; 162(38): 1511-1519.

[Non-steroidal anti-inflammatory drugs for relieving pain in musculoskeletal disorders]

Pain control in musculoskeletal disorders is still a challenging task. The most effective treatment of pain in autoimmune and immune-mediated diseases is the treatment of the disease itself. Analgesics, non-steroidal anti-inflammatory drugs and opioids are used to relieve pain. Analgesia is the central intervention of degenerative disorders. The most effective analgesic compounds are the non-steroidal anti-inflammatory drugs (NSAIDs). Concerns are raised regarding the safety of NSAIDs. There is not any organ which is not involved in adverse reactions, but the damage of the gastrointestinal system has been considered the most serious one for a long time. In the 21st century, the recognition of cardiovascular complications led to the re-evaluation of the role of these drugs in analgesia. Orv Hetil. 2019; 160(22): 855-860.

[Complex supportive care of patients with breast cancer. The preliminary results of a psychological intervention study]

Introduction: Interdisciplinary studies confirm that the traumatic nature of cancer diagnosis and the long course of treatment may often lead to a series of emotional problems among cancer patients, this way precluding physical and psychological recovery. Aim: The aim of the study was to create a complex psychosocial intervention program for breast cancer patients and to present our preliminary results. Method: In our 6 week long study, 50 breast cancer patients were assessed. The intervention group comprised of 20 patients, the control group comprised of 30 patients. Measurements included the Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI), the Surgical Fear Questionnaire (SFQ), the Visual Analogue Scale (VAS), the Functional Assessment of Cancer Therapy - Breast (FACT-B) and the Breast-Impact of Treatment Scale (BITS). Therapeutic tools used were the PRISM-D and the Body-Sculpture Test. Results: Our results indicate that the psychological interventions may have an instant stress-relieving and calming effect on our patients, this way providing social support. The type of surgery significantly influenced the levels of body change stress. Conclusion: Our results highlight the importance of early psychological screening among breast cancer patients before and after surgery as well. Orv Hetil. 2019; 160(18): 700-709.

[Effects of therapeutic suggestions on the recovery of patients undergoing major orthopaedic surgery]

INTRODUCTION AND AIM

Hip and knee replacement surgery is very demanding for patients. Medication consumption is further increased by perioperative anxiety. Besides pain killer and anxiolytic medications, patients' recovery can be enhanced by applying therapeutic suggestions, which are easily applicable during the patient-physician communication.

METHOD

In our prospective, randomized, controlled study we examined the effects of positive suggestions on patients undergoing hip or knee arthroplasty in spinal anaesthesia. Members of the suggestion group received the therapeutic suggestions during a pre-surgery physician visit, and by listening to an audio recording during surgery.

RESULTS

Compared to the control group (n = 50), in the suggestion group (n = 45) the need of medication (pain killer and adjuvant pain medication) during the surgery was lower (p = 0.037), the mean change from baseline in the well-being of the patients was better on the 2nd [1.31 (0.57; 2.04); p<0.001] and 4th [0.97 (0.23; 1.7); p = 0.011] postoperative day and less transfusion had to be administered (OR: 2.37; p = 0.004). However, there was no difference between the two groups in the postoperative need of medications, in the length of hospitalisation and in the frequency of complications. Conslusion: Our results indicate that the administration of therapeutic suggestions in the perioperative period may be beneficial for orthopaedic surgery patients. Orv Hetil. 2018; 159(48): 2011-2020.

[The reliability and validity of the Hungarian version of the Surgical Fear Questionnaire]

INTRODUCTION

Interdisciplinary studies confirm that surgical fear experienced by patients can have a substantial effect on the outcome of the surgery and the healing process after surgery.

AIM

The aim of this study was to assess the reliability and validity of the Hungarian version of the Surgical Fear Questionnaire in cancer patients.

METHOD

149 patients were assessed using the Spielberger Anxiety Inventory, the Beck Depression Inventory, the Visual Analogue Scale and the Surgical Fear Questionnaire.

RESULTS

The scale showed excellent internal consistency (Cronbach-alfa = 0.878; 0.885). The Surgical Fear Questionnaire scores moderately correlated with anxiety, depression and anticipated pain after surgery.

CONCLUSION

The reliability and validity of the Hungarian version of the Surgical Fear Questionnaire in the sample were excellent. The questionnaire turned out to be a useful psychometric tool in the measurement of surgical fear. Orv Hetil. 2018; 159(47): 1988-1993.

[Preemptive and preventive analgesia - an important element in perioperative pain management]

In this review, the definition and history of preemptive analgesia and the progress of its conception will be summarized. In the physiology-pathophysiology chapter, central sensitization, the key component of the evolution of postoperative pain, and the neurochemical processes in its background will be explored. Tissue damage caused by surgical incision consists of mechanical and inflammatory components, and it has high importance in the postoperative pain management. The preemptive approach of pain management means more than just preincisional analgesia, it includes the application of multifactious synergistic medication at the same time accordingly. All of these knowledges finally became complete in the conception of the perioperative approach of preventive pain management, which covers the premedication and mental support of a patient in the preoperative setting, furthermore consumes the whole armamentarium of the preemptive (preoperative), intraoperative and postoperative analgesia regimen as well. In practice, procedure-specific pain management should be highlighted, since it is based on the different extents and types of tissue trauma caused by various operations. Orv Hetil. 2018; 159(17): 655-660.