E-Posters

E-POSTERS SESSION I ACUTE PAIN I P 01 COMPARISON OF ACUPUNCTURE AND PEROS TRAMADOL IN THE RELIEF OF POSTOPERATIVE PAIN IN SURGICAL DENTISTRY G. Papakitsos, A. Kapsali, E. Papakitsou.

Anaesthetic Department, General Hospital Arta, Greece.

Background: Tramadol is a racemic mixture. R-isomer has activity at the Îź receptor. Recently published guidelines support the use of acupuncture for treating postoperative pain in surgical dentistry.

Aim: To compare the efficacy and safety of acupuncture and peros Tramadol in the postoperative pain relief in a clinical setting. Patients were treated at private clinic.

Methods: A double-blind randomized trial involving 67 patients undergoing surgical removal of a single mandibular third molar. Those who developed moderate pain within 4h of the procedure were allocated to: acupuncture (Group A, n=22), peros Tramadol 100mg (Group T, n=24), or placebo (Group P, n=21). Participants monitored pain intensity for 24h using visual analogue scales. Paracetamol 500mg peros was used as the rescue analgesic. Statistical analysis was based on the intention-to-treat analysis. Acupuncture applied from a rehabilitation specialist.

Results: Both groups were significantly better compared with placebo, over the 0-24h period.

Rescue analgesia was required by only 2 out of 22 subjects in Group A, 1 out of 24 subjects in Group T and 18 out of 21 in Group P. The median times to use of rescue medication were 20h (Group A-VAS=3), 21h (Group T-VAS=2) and 2h (Group P-VAS=8). There were no important adverse events. Results, which achieved due to the protocol mentioned above are comparable to those mentioned in international literature.

Conclusions: A has a shorter duration of action, but gave adequate analgesia in comparison with T. Patients in Group A needed more rescue analgesia than Group T. This study provides some evidence to support acupuncture as more effective, than no treatment, but no conclusions can be drawn about its effectiveness over other treatment modalities as the evidence is conflicting.

P 02 EFFECT OF PELVIC TILT BY USING BIRTH BALL ON ACTIVE PHASE OF PHYSIOLOGIC LABOR: A RANDOMIZED CONTROL TRIAL STUDY Taavoni S. 1,2, Abdolahian S.1, Haghani H.1 1.

Tehran University of Medical Sciences 2.

Member of Research Institute for Islamic & Complementary Medicine (RICM, TUMS) Labor pain management is intrapartum care major goal and by some of complementary therapy could manage it.

Aims: To evaluate the effect of pelvic tilt by using birth ball on Physiologic labor pain.

Materials & Methods: In this randomized control trial study, which had done in one of the large public hospitals of Tehran University of Medical Sciences (TUMS) and approved by ethics Committee of TUMS (Year 2009- 2010), 60 healthy volunteer 18- 35 years old primiparas after signing informed consent, randomly divided into two groups: 1) Pelvic tilt by using Birth ball, 2) Control group, whom received routine care of Physiologic labor/ delivery during active phase. Tool had three main parts of personal characterizes, check list of

national labor control and Pain Visual Analog Scale (VAS). Description and inferential statistical test were used.

Results: Equality of age, educational level, having job, planned pregnancy and duration of pregnancy in two groups were checked and there were no significant differences. Pain score during active phase in the birth ball group after 30, 60, 90 and 120 minutes, were significantly less than control group. (P≤0.001) Conclusions: Although pelvic tilt by using birth ball had no significant effect on duration of active phase, duration of uterine contractions, or the interval between contractions, but using this complementary treatment significantly reduce the intensity of pain during the active phase of labor after half an hour intervention. It is recommended to study the effects of combining of this method, with other complementary and comparing results.

Acknowledgment: Received grants from the Research Department of TUMS and approved by research Ethics committee of TUMS (2009-2010), Registered in IRCT. * Research group want to appreciate for kind help of Ching-Yi Chang for sending his articles.

Key words: Physiologic labor pain management, Pelvic tilts, Birth ball.

P 03 CATHETER-RELATED BLADDER DISCOMFORT (CRBD) AFTER RADICAL PROSTATECTOMY Mouriki M, Patili E, Tsismalidis K, Makaroni M, Gavra Ai, Papatsoris A Sismanoglio General Hospital, Athens-Greece Background Postoperative pain after radical prostatectomy is derived from two mechanisms. Pain from the surgical wound and pain from the indwelling bladder catheter due to bladder contractions mediated by stimulation of the muscarinic receptors.

Aim The aim of this study is to evaluate the incidence and severity of catheter related bladder discomfort (CRBD) in patients after radical prostatectomy for localized prostate cancer.

Methods Thirty male patients (50-75yr), were studied for postoperative pain at 1, 2 and 6 hours after radical prostatectomy. Intraoperatively, catheterization took place with a 20Fr couvelairecatheter. All patients received 45-30 min before completion of surgery 1000 mg paracetamol, lernoxicam, 0,8-1 mg/kg morphine IV and incisional infiltration with ropivacaine 0,75% for postoperative analgesia. Pain was assessed with the VAS score (0-10) and patients were asked to clarify whether the pain was related to the surgical wound (i.e discomfort in the suprapubic region) or to the bladder catheter (i.e urgency to void). Severity of CRBD was graded as none (not complain), mild (only on questioning), moderate (without questioning) or severe (accompanied by behavioral responses). The data were analyzed using Descriptive Statistics in a nomimal variable and calculating the tables of frequencies (%).

Results

% 36,92% 17,95% 12,31% 30,77%

VAS Patients Pain range 9 7 6 5

1st/2nd Hr CRBD Patients Pain % range 46,34% severe 53,66% moderate 0,00% mild 0,00% none

Pain from surgical wound Patients Pain % range 0,00% pain 100,00% No pain

2,05%

% 0,00% 33,33% 17,86% 41,67% 7,14%

4 VAS Patients Pain range 9 7 6 5 4

6th Hr CRBD Patients Pain % range 21,15% severe 61,54% moderate 17,31% mild 0,00% none

Pain from surgical wound Patients Pain % range 11,11% pain 88,89% No pain

Conclusions The incidence and severity of CRBD are considerably high after radical prostatectomy, exacerbates postoperative pain and is resistant to multimodal analgesia.

P 04 EFFECT OF INTRAVENOUS LIDOCAINE IN TRIGEMINAL NEURALGIA E.Stavropoulou1, E.Argyra2, A.Vadalouka2, C.Isaia2, A.Karra2, N.Bernali3, I.Siafaka2 1.

General Hospital of Athens “Elpis�, 2. Outpatient Pain Centre- Aretaieion Hospital-National & Kapodistrian University of Athens 3. General Hospital of Thivae Background: Trigeminal Neuralgia (TGN) is the most common neuralgia. Its therapeutic approach is challenging as the first line treatment often does not help or causes intolerable side effects. The current study examines whether intravenous lidocaine as additive treatment affects the spontaneous and evoked pain (allodynia/hyperalgesia) of TGN. Methods: Twenty patients suffering from TGN were enrolled to a randomized double- blind crossover trial. Each patient underwent two active and two placebo infusions of 5 mg/kgr lidocaine in 250 ml serum normal (S/N) ) 0.9% or SN 0,9% alone, over 60 minutes. At baseline, immediately and the next morning after the infusion we assessed spontaneous pain using visual analog scale (VAS) and evoked pain and hyperalgesia by thermal, cold, pressure application and pinprick tests. For the Quantitative Sensory Testing the Neurometer R-CPT(NEUROTRON Inc) was used. We documented the side effects of the treatment during the infusion and for 24 hours. STATA version 11.0 was used for the statistical analysis.

Results: Both lidocaine and placebo reduced VAS score at the end and until the next morning of the infusion (p<0,001) although lidocaine was superior to placebo. The side effects of lidocaine (mild confusion, somnolence, dry mouth) were mild, not especially troubling, thus we did not have any drop outs. Clinical tests showed that lidocaine reduced mechanical, thermal and cold allodynia more than placebo, while placebo reduced only mechanical and thermal, but not cold allodynia, in a lesser degree than lidocaine (p<0.05).

Concerning evoked pain the values received by the R-CPT were increased at baseline, both at the painful and at the contra lateral side at 5, 250, 2000 Hz before treatment, and got higher at 5 and 250 Hz after the lidocaine infusion at the painful side, whereas after placebo they were reduced (p<0,001).

Conclusion: Lidocaine ameliorated spontaneous and evoked pain of TN more than placebo for almost 24 hours, without serious side effects, suggesting that it could offer an extra and safe therapeutic option as an add on therapy in intractable TNG pain P 05 THE INFLAMMATORY RESPONSE TO THREE TYPES OF REGIONAL ANAESTHESIA AND ANALGESIA OF PATIENTS OPERATED FOR OSTEOARTHRITIS OF THE KNEE WITH TOTAL KNEE

ARTHROPLASTY Pelagia-Paraskevi Chloropoulou1, Theodosia Vogiatzaki1, Savvas Eleftheriadis1, Konstantinos Kazakos2, Christos Iatrou1 1 Department of Anaesthesiology, Democritus University of Thrace, 2 Department of Orthopaedics, Democritus University of Thrace Background: Anaesthesia and inflammatory response have been studied in major abdominal and thoracic surgical procedures, but not as extensively in major orthopaedic reconstructive procedures such as total knee arthroplasty. Most studies have compared general anaesthesia with epidural anaesthesia, but none has compared spinal with epidural or with combined spinal and epidural.

Aim: The aim of this study was to investigate the inflammatory response of patients who were submitted to total knee arhtroplasty for osteoarthritis of the knee through three different techniques of regional anaesthesia and analgesia.

Methods: In a prospective randomized study three groups of patients scheduled for total knee arthroplasty for osteoarthritis, were evaluated regarding the inflammatory response to three types of regional anaesthesia. In 30 patients (Group A) with spinal anaesthesia followed by intravenous morphine analgesia, in 24 patients (Group B) with epidural anaesthesia followed by epidural analgesia and in 23 patients (Group C) with combined spinal and epidural anaesthesia followed by epidural analgesia, the inflammatory response was assessed through the calculation of leukocyte concentration (WBC), C- reactive protein (CRP), monocyte chemotactic protein 1 (MCP-1), interleukins ( IL-1, IL-6, IL-10, IL-18) , TNF-a, and leukocyte activation molecules CD11b and CD62L , in three blood samples (immediately before induction to anaesthesia, immediately after closure of the operative wound and at 24 hours post-operatively).

Results: The MCP-1 values showed a statistically significant increase (p<0.02) in the group of patients with spinal anaesthesia. Of the leukocyte activation molecules a high statistically significant increase was noticed in the expression of CD11b on monocytes in the sample taken 24 hours post-operatively, in the patients of group A. Similarly, CD62L expression on neutrophils showed a high statistically significant reduction in the sample taken 24 hours post-operatively in the group of patients with spinal anaesthesia compared to the group of patients with epidural anaesthesia and combined spinal with epidural anaesthesia.

Conclusions: Our results show that epidural anaesthesia followed by epidural analgesia produced less inflammatory response compared with spinal anesthesia followed by intravenous morphine analgesia or with combined spinal with epidural anaesthesia in patients operated with total knee arthoplasty, and that the most sensitive markers, of those investigated, were the CD11b and CD62L leukocyte activation molecules.

P 06 SAFETY STANDARDS FOR ASLEEP THORACIC EPIDURAL FOR PAIN MANAGEMENT AFTER BILATERAL SEQUENTIAL LUNG TRANSPLANT (BSSLTX). A RETROSPECTIVE REVIEW Sarridou DG , Fonteyne IAN, Walker CPR, Cox F, Mitchell JB, Lees NJ, Farrimond JG Department of Anaesthesia, Critical Care & Pain Management, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, UK Background: Pain following BSSLTx (especially if a clamshell incision) significantly slows recovery, mobilization, rehabilitation and may prolong ICU stay. Pulmonary complications are more frequent in addition to the psychological and emotional impact of pain per se.

Thoracic epidural infusion for postoperative analgesia is a recognized and established technique but safeguards are necessary and more so for sedated patients in intensive care.

In our centre we performed 46 BSSLTx last calendar year. The routine practice for lung transplants is to insert an epidural catheter 12-24/h postoperatively, a few hours before the

patient is ready to wake so to establish adequate sensory block and analgesia.

Aim: To review retrospectively the incidence of major complications (epidural haematoma, CNS infection and neurological deficits) after asleep thoracic epidural catheter placement in lateral position in ICU according to strict selection criteria.

Methods: We included 12 patients undergoing BSSLTx in the last year. Patients were excluded according to criteria such as active bleeding, coagulation disorders, use of systemic anticoagulation e.g. for haemofiltration. Patients with SIRS or elevated WBC count. Full blood count, clotting screen and thomboelastogram (TEG) were deemed necessary investigations.

Platelets and fresh frozen plasma were transfused if the above investigations were abnormal.

The blood tests were then repeated.

Once normal values for platelet count, clotting profile and TEG were achieved patients were positioned laterally whilst sedated with continuous remifentanil and propofol infusions. The epidural catheter was placed under routine sterile conditions after preparing the skin with 2% chlorhexidine in alcohol. All of the anaesthetists were consultant or senior registrar grade.

Results: No major complications such as epidural haematoma or abscess, or permanent nerve damage occurred. One patient developed a cutaneous infection which resolved with appropriate antibiotic treatment.

Conclusion: Asleep lateral thoracic epidural catheter placement can provide safe central neuraxial analgesia in experienced hands when safety protocols targeted at preventing complications are in place and adhered to.

E-POSTERS SESSION II CHRONIC PAIN I P 07 CASE REPORT: EFFICACY OF CAUDAL EPIDURAL INJECTIONS FOR LOW BACK PAIN IN A CHILD Papantonaki Sofia, Andreadaki E.,Christofaki M.,Antonoglou F.,Havaki D.,Psomopoulos Ch. Department of Anesthesiology ,General Hospital of Agios Nikolaos, Lassithi, Creta Introduction: Caudal Epidural Injections (CEI) of local anesthetics with or without steroids,is one of the commonest interventions in managing chronic low back pain. However ,there is a lack of experience to determine the efficacy of CEI in children.

Objective : To demonstrate the effectiveness of CEI for low back pain in a child.

Method: A 15 years- old boy with severe low back pain (VAS score 10/10) caused from disc herniation at the L4-L5 level compromising the spinal cord and poor response to analgesic agents was presented. Pain was interfered with child's activities resulting to severe disability for over a month. It was described as "electric shock", radiating to the legs mainly to the left side. Abnormal sensation, numbness and sensation of needles was reported and the straight leg raising test was positive.

Because of the severity of pain ,we decided to perform CEI with Ropivacaine 7,5% (2 ml), Fentanyl 50 μγ, Betamethasone 4 mg, Clonidine 30 μγ, Hyaluronidase 1500 IU. They were repeated four times in a period of 50 days.

Results: After the first CEI the VAS score was 0/10 at rest, 3/10 at movement and intense physical therapy was started. The analgesic agents was stopped and the boy got back to his normal daily activities until today, nine months later.

Conclusion: The CEI are effective at managing low back pain and sciatica in children.

P 08 THORACIC SPINAL CORD STIMULATION FOR LOW BACK PAIN IN A PATIENT WITH PERMANENT PACEMAKER Vassilakos D1, Fyntanidou B1, Grosomanidis V1, Al-Kaisy A2 1 Department of Anesthesiology and Intensive Care Medicine, AHEPA University Hospital, Thessaloniki, Greece 2 Pain Management and Neuromodulation Centre, Guyâ&#x20AC;&#x2122;s & St Thomas NHS Trust, London, UK Background: Spinal Cord Stimulation (SCS) has been proposed many years ago as a minimally invasive treatment method for resistant chronic back and leg pain. However, in patients with permanent cardiac pacemaker (PPM), there is a theoretical risk of device interference after SCS implantation.

Aim: We report the case of a 52yrs old female patient with a PPM (Medtronic Inc, MN, USA), who has been suffering severe chronic refractory low-back pain for more than 10 years, to whom all oral analgesics and other non-invasive treatment methods were ineffective.

Methods: After her condition has deteriorated extremely, SCS implantation was applied to her under ECG careful monitoring and under supervision of a Medtronic technician for the whole perioperative period.

Result: There was no interference documented between the two devices. After SCS implantation, the patient experienced gradually improved pain relief documented by significant enhancement in her VAS scores. Furthermore, improvement of patientâ&#x20AC;&#x2122;s ability to perform basic movements at the bedside has been documented according to the appropriate scoring scale, which altered from 9/30 preoperatively to 15/30, 19/30, 21/30 and 22/30 at 1, 3, 6 and 12months respectively. Similarly, quality of life score changed from 7/40 preoperatively to 21/49, 26/49, 30/49 and 33/40 at 1, 3, 6 and 12months respectively Conclusion: According to this case report, SCS and PPM can be used simultaneously with safety and effectiveness. Nevertheless, individual testing under careful monitoring is mandatory in every case during and after implantation and after any reprogramming of any device parameter.

P 09 EPIDURAL INJECTION AND ENDOSCOPIC LYSIS OF ADHESIONS, DURING EPIDUROSCOPY IN PATIENTS WITH DEGENERATIVE DISEASE OF SPINE G. Papakitsos, A. Kapsali, E. Papakitsou, A. Roimba Anaesthetic Department, General Hospital Arta, General Hospital Mesologi, St Paul General Hospital Thessaloniki, Greece.

BACKGROUND: It is used a relatively new minimally invasive diagnostic and therapeutic procedure, epiduroscopy to study the pathology of the degenerative lumbar spine with the use of a flexible endoscope.

OBJECTIVES: For the pain relief of the patients, we performed targeted epidural injection of steroids/local anaesthetic/adhesiolytic agents in combination with endoscopic adhesiolysis.

It was investigated the immediate, long-term results and epiduroscopic findings.

METHODS: Indication has had patients with disc herniation, spinal, foraminal stenosis and failed back surgery syndrome (FBSS). Contraindications were patients with coagulopathies, severe renal failure, pregnancy and patients under treatment with anticoagulants. The surgical technique included the introduction of a flexible endoscope to the epidural space via the sacral hiatus, under local anaesthesia, sedation and fluoroscopy. Mechanical adhesiolysis

was performed with an endoscope and the infusion of N/S 0,9%. At the end, in the epidural space were targeted injected steroids/local anaesthetic/adhesiolytic agents.

RESULTS: From January 2008 until July 2010 was studied 210 patients (55 have had FBSS, 26 foraminal stenosis, 69 spinal stenosis and 60 disc herniation) median age 71 years old. The decision for the further treatment was based to the epiduroscopic findings. In all cases we observed immediate relief to the symptoms after epiduroscopy for a variable period of time, 67% of the patients were relieved from their symptoms 4 months to 2,5 years. 3 patients were further treated surgically.

CONCLUSIONS: Epiduroscopy is a safe diagnostic method and it can be used as a therapeutic treatment option if conservative treatment fails and before we proceed to other more invasive procedures. Our findings of epiduroscopy corresponded to the symptoms of the patients. Especially in elderly patients and patients who can’t be operated is a good alternative.

P 10 INTERSCALENE NERVE BLOCK AND CATHETER ANALGESIA FOR THE TREATMENT OF FROZEN SHOULDER Roumelioti Ch., Xarchoulakos D, Padopoulos D, Kotouzas A, Fandridis E, Mavrommati R, Gampopoulou Z. General Hospital of Athens “KAT” BACKGROUND: Though Frozen shoulder is a common problem ,it is still difficult to relieve the pain and actually to treat. Patients suffer from severe pain and progressive loss of movement and function of the shoulder joint.

AIM: The aim of our study was to evaluate the effectiveness of continuous interscalene brachial plexus block via catheter in patients with frozen shoulder in pain relief, according to pain levels and improvement of movements.

METHOD: Fifteen (15) patients, one male aged 61 years old and fourteen females aged 38-61 years old ,diagnosed with frozen shoulder were studied. All patients were with loss of external rotation and affected internal rotation, abduction and inability to use the affected arm for daily activities. The mean duration of pain prior to this treatment was 9 months All interscalene nerve blocks , clinical /movement examination and Pain scores(before and after the specific rehabilitation sessions) were made by the same three doctors. All the patients were premedicated with midazolam i.v.for sedation. Interscalene nerve block was performed using the same nerve stimulator and 30 ml of ropivacaine 0.2% were injected bolus.

Continious infusion with ropivacaine 0.2% 5-7 ml/h was introduced for 24 hours.

RESULTS: All patients were recruited over 72 hours and no patient was withdrawn . All patients had pain relief according to pain scores and active and passive range of motion showed improvement. Transient local tenderness to the site of injection was observed to one patient which was resolved spontaneously but no more side effects .

CONCLUSIONS: Although our study has limitation the small number of patients, interscalene nerve block provides effective analgesia in patients with frozen shoulder and contributes to a safe treatment.

P 11 Α 25 CONSECUTIVE CASES SERIES STUDY OF SUCCESSFUL RADIOFREQUENCY THERMOCOAGULATION FOR THE TREATMENT OF TRIGEMINAL NEURALGIA: USE OF A NEW ELECTRODE AND AN ADVANCED COMBUSTION PROTOCOL N.Maratheftis1, E.Stavropoulou2, M.Sarridou1, H.Sourtzis1

1.

General Hospital of Athens “Euroclinic”, 2. General Hospital of Athens “Elpis”

Introduction: The success rate of radiofrequency thermocoagulation for treatment of trigeminal neuralgia refractory to medical treatment is 92.5%, according to literature. The aim of this study is to present a series of 25 consecutive patients who underwent radiofrequency coagulation by a special protocol and had a success rate of 100% after one year of follow up.

Materials-Methods: In this study 25 patients were enrolled retrospectively. They all suffered from intractable trigeminal neuralgia and had radiofrequency coagulation of the gasserion gagglion or/and three branches under local anesthesia and sedation. The foramen ovale was approached under CT-guidance. We used a 15-mm electrode with a sharp, curved tip. Active surface of the electrode was 5 mm. The duration of the thermocoagulation was 2 minutes, maximum temperature of the application was 80 0C for first time treatments, and the minimum time of attainment of temperature (ramp time) was 45 sec.

Results: We confirmed correct position of the electrode in all the patients with a CT scan.

Suitable temperature was achieved at the tip of the electrode by fusiform diffusion. The curved edge of the needle was rotated if necessary, offering flexibility of the combustion beam for better anatomical orientation. Mean hospital stay was 2.3 hours. There were no significant adverse effects, including causalgia. All patients had >50% reduction of their pain intensity. Four out of 25 patients had to continue their medical treatment, fully or partially.

One year later, only one patient needed to repeat thermocoagulation treatment.

Conclusion: The electrode and the modified protocol seem to improve the radiofrequency coagulation success rate. The method is safe and offers excellent results to patients with refractory trigeminal neuralgia that are not candidates for surgical treatment.

E-POSTERS SESSION III CHRONIC PAIN II P 12 INCIDENCE OF CHRONIC POSTSURGICAL PAIN (CPSP) AFTER COLON SURGERY ̇ CHARACTERISTICS AND RELATED FACTORS Macheridou A., Giannopoulou A.,Grigoratou M., Michaloliakou M., Pagoulatou A., Ivanova E., Papadopoulou T., Afouxenidou E., Kalantzi N., Michaloliakou Chr. Department of Anaesthesiology and Chronic Pain Clinic, Metaxa Cancer Hospital, Piraeus, Greece Background:In our knowledge, few studies have analyzed CPSP for 1,5 years after surgery.1 Many factors have been described in relation to development of CPSP.2 Aim:Our aim was to determine incidence,characteristics and factors related to the appearance of CPSP, after colon surgery with midline laparotomy approach.

Methods:Retrospective review of patients(pts) after colon surgery operations, between June 2011-December 2012, through standardized telephone questionnaire,call between 3-18 months after surgery. Pts were asked about presence of CPSP,characteristics,intensity (Numerical Rating Scale-NRS,0-10,Neuropathic Pain Diagnosting,DN4 test) and analgesic treatment efficacy.

We analyzed possible predisposing factors to the development of CPSP like gender,surgery type (hemicolectomy,sigmoidectomy,rectal resection),type of anaesthesia (total intravenous,combined or balanced anaesthesia),surgeons(4 different),postop. pain control (NRS 0-10 maximum during first 48h),duration of surgery, necessity of chemotherapy or reoperation,using Pearson’s x2 test and bevariate analysis.

Results:Included 165 pts:116 respondents(70,3%),29 not located,20 died. Incidence of CPSP:19,8%. Characteristics of CPSP:mild-moderate intensity(NRS median 4{range 3-6}).

Burning was the most frequent symptom 82,6%,stubbing pain 60,8%,electric shocks 17,3%.

DN4≥4 between pts with CPSP was 52,2%.The 43,5% treated with paracetamol with little pain relief. Factors associated with the appearance of CPSP statistically significant were:poor control of postop. pain(p<0,001) and necessity of chemotherapy.Pts who underwent chemotherapy referred chronic pain in 33,3% vs those who didn’t (6,8%), p<0,001.The remaining factors didn’t achieve statistically significant differences.

Summary/Conclusions:Chronic pain after midline surgery is common.Pain is mild to moderate with neuropathic characteristics and responds poorly to analgesic drugs. The poor control of postop. pain and the chemotherapy are the factors related to the appearance of CPSP. References 1. Dworkin et al. Anesth 2010;112:516-8.

2. Katz et al.Review. Expert Rev Neurother. 2009;9(5):723-744.

P 13 GABAPENTIN WITHDRAWAL SYMPTOMS Frantzeskos G, Arhontaki V, Lefaki T Heraklio University Hospital, Crete -Pain Clinic Aims: Gabapentin (GBP) is an antiepileptic drug, indicated for neuropathic pain, with very low potential for abuse.

Methods: We reviewed one patient who showed unexpected symptoms after discontinuation of GBP. Results: A 78- year-old- woman with lumbar spinal stenosis , who suffered from low back pain , right ischialgia and mainly neuropathic pain, was taking Pregabalin (PGB) 150mg / day, and a mixture of Paracetamol 500mg plus Codeine 30mg (Lonalgal) three times/day, but the pain was strong (VAS score between 6– 8). She increased the PGB dosage to 300 mg , but shortly afterwards discontinued it, because of nausea and ankles oedema. We changed the PGB dose gradually to GBP 1200mg /day. Also Tramadol drops 75mg was added for the paroxysmal pain. The pain was successfully controlled (VAS score 1 -3) for three months. The patient felt very confident and discontinued the GBP, abruptly on her own accord, and developed mainly at night, hyperactivity and nightmares. Interestingly there was no pain increase. She restarted the GBP 400mg, only at night and the symptoms disappeared. When attempting to discontinue again the GBP 400mg the symptoms reappeared, when she informed us about what has happened. We changed GBP to PGB 25mg twice daily, plus Bromazepam 1.5mg for 7 days. The symptoms were controlled successfully. PGB was stopped first, and after seven days the Bromazepam.

Conclusions: GBP withdrawal symptoms although rare, exists and needs careful steps to stop it.

P 14 DIAGNOSIS AND TREATMENT OF CHRONIC PERIPHERAL NEUROPATHIC PAIN IN EVERYDAY PRACTICE Spyrakopoulou G.,1 Tzanetakou M.,1 Skianni Α.,1 Georgiadis Α. 2 1.

Astellas Pharmaceuticals, 2. Center of Musculoskeletal Diseases, Lito Hospital, Athens.

Background According to statistics, Chronic Peripheral Neuropathic Pain (CPNP) is the most common type of chronic pain in everyday practice, but is not nosologically well defined and difficult to treat.

Aim Investigation of the methods used by Greek private doctors dealing with CPNP, aiming to

their information about new diagnostic tools and treatments.

Methods After an extensive presentation of the methods used internationally for the diagnosis and treatment of CPNP, we asked 180 doctors to fill a protocol concerning:1) The evaluation of their cases of CPNP for the next 3 months, according to DN4 and pain VAS (Visual Analog Scale) questionnaire. 2) Treatment before and after the presentation and 3) The VAS results after 3 months of treatment. For the analysis we have used the Clinical Trial Agency MediMark.

Results 1) 105 doctors analyzed 1109 patients with CPNP according DN4 and measured their pain by VAS. 2) After the initial presentation all the doctors changed their treatment (doses and/or drugs). 3) The mean VAS result was, at the beginning 6,1 and three months later 3,6, i.e. an amelioration of 59,01%. 4) 79% of the doctors found DN4 a very useful tool for their practice while 83% of them had the same opinion about pain VAS. 5) The most successful treatment was the association of a per os NSAID with topical Capsaicin Patch 8%.

Conclusion Our data show that Greek doctors of private sector are in great need of training on CPNP. P 15 ANALGESIC TREATMENT OF TRIGEMINAL NEURALGIA WITH CAPSAICIN PATCH 8%.

PRELIMINARY RESULTS Doskas T. Neurological Clinic. Naval Hospital of Athens Background and aim Trigeminal Neuralgia (TN) is a chronic peripheral neuropathic pain condition. In 80-90% of cases, the pain is caused by pressure on the trigeminal nerve. Up to present, all the medication used provides temporary relief, but it also causes serious side effects (ADRs).

Capsaicin patch 8% (Qutenza) has proved to be effective for many conditions with chronic peripheral neuropathic pain (PNP) without causing systemic ADRs. Methods We studied 8 patients, 4 men and 4 women, mean age 66,8 years, suffering from Trigeminal Neuralgia, to whom usual treatments (carbamazepine, tramadol, pregabaline) had provided partial relief of pain. We identified the neuropathic origin of TN of our patients with DN4 questionnaire. In all patients, the patch was applied for 1 hour at the most painful areas of the face. Patients continued to receive their usual per os analgesic treatment. We have evaluated the pain intensity with VAS (Visual Analogue Scale) before the patch application and 1 month later.

Results Our results showed that: 1) The DN4 questionnaire was positive for all cases. 2) The mean VAS score of the treated patients was 6,8 before treatment and 2,1 one month later (mean improvement 69,2%. 3). No serious ADRs were detected.

Conclusions The application of Capsaicin 8% patch in patients with severe Trigeminal Neuralgia improves by 69,2 % the peripheral neuropathic pain without causing any systemic ADRs.

P 16 BURNING MOUTH SYNDROME M.Kokolaki, A.Bairaktari*, P.Kamperi, K.Tsismalidis, M.Vafiadou

Department of Anaesthesiology and Pain Clinic, Sismanoglion General Hospital Athens * Department of Anaesthesiology and Pain Clinic, G.O.H.K. <<Agioi Anargyroi>> Background The complaint of a burning pain in the mouth can be a symptom of other diseases or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used.

Aim of the study was to estimate the effectiveness of drugs used in neuropathic pain for relief of symptoms in BMS Methods We studied 4 patients , 3 women and 1 man , who visited the pain clinic between January 2012 and June 2013.Their main symptom was burning pain in the mouth and tongue with Visual Analogue Scale (VAS) score >7 .Patients have been evaluated by doctors of different specialities and other possible causes for symptoms have been ruled out. Patients received pregabalin 300-600 mg /d ,duloxetin 60-120 mg/d ,tab zaldiar (1x3 or 1x4 ),vitamin B .They were studied for 3 months.

Results Three patients after 6 weeks treatment had VAS< 4.One patient continued to have pain (VAS >8) and received cognitive behavioural therapy(VAS=5) .

Conclusion It is important for the clinicial to recognize the BMS. Different treatments have been tried but treatments proposed for neuropathic pain may be beneficial in helping to relief symptoms.

E-POSTERS SESSION IV BASIC SCIENCE P 17 THE INTERACTION OF SEVERAL ANTIDEPRESSANT DRUGS WITH ACUTE AND CHRONIC METHADON IN MICE AND POSSIBLE CLINICAL IMPLICATIONS Heiman A. 2, Schreiber, S.1, Hostovsky, A.2, Barak, Y. 2, Rubovitch, V. 2, and Pick, C.G.2*, 1Department of Psychiatry, Tel Aviv Sourasky Medical Center & Tel Aviv University Sackler Faculty of Medicine; 2Department of Anatomy, Tel-Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel; Background: Depression is highly prevalent among chronic-pain patients and methadone maintenance treatment (MMT) patients. Controversy regarding effective antidepressant treatment for these patients persists.

Objective: Assessing the two models in mice, using the hotplate assay.

Methods: In the model of depressed pain patients, the impact of low, sub-threshold doses of 6 antidepressants with different mechanisms of action (fluvoxamine, escitalopram, reboxetine, venlafaxine, desipramine, clomipramine) on the antinociceptive properties of a single (acute) dose of methadone. In the model of depressed MMT patients, the impact of low, sub-threshold doses of 3 antidepressant drugs with different mechanisms of action (escitalopram, desipramine, clomipramine) on the antinociceptive properties of chronic treatment with methadone.

Results: Following injection, acute methadone elicited analgesia in a dose-dependent manner. Fluvoxamine and desipramine, each at a sub-threshold dose induced a synergistic effect with methadone. Escitalopram, reboxetine venlafaxine and clomipramine given separately at a sub threshold dose induced no interaction. Following two weeks of methadone administration (through an implanted mini-pump, i.p.) injection of escitalopram

did not elicit any analgesic effect, desipramine augmented the analgesic effect of methadone, while clomipramine reduced it notably.

Conclusion: Possible clinical implications are that while escitalopram, reboxetine, venlafaxine and clomipramine do not affect acute methadoneâ&#x20AC;&#x2122;s antinociception in mice and are safe to be given together with methadone, fluvoxamine and desipramine notably augment methadone induced antinociceptive effects and should be avoided due to the risk of inducing opiate-overdose. Possible clinical implications of chronic methadone remain to be determined as tricyclic antidepressants' cardiac effects may prevent their use in MMT patients.

P 18 THE ANTIOXIDANT RESPONSE IN THE SKIN INCISION INJURY MODEL OF NEUROPATHIC PAIN. A PROSPECTIVE, EXPERIMENTAL STUDY G. Papakitsos, A. Kapsali, E. Papakitsou Anaesthetic Department, General Hospital Arta, Greece.

BACKGROUND: In the skin incision injury model of pig neuropathic pain, oxidative stress as well as total antioxidant capacity (TAC) and total oxidant capacity (TOC) are important determinants of neuropathological consequences. Surgical trauma induces an early inflammatory response and release of cytokines.

OBJECTIVES: We investigated the level of oxidative stress and antioxidant enzymes in plasma at 3rd day after injury.

METHODS: In this study were included 38 Landrace pigs, 20+/- 1kg, undergoing median subumbilican incision. The pigs were randomized into two groups and received general anesthesia. The first (SI: 20) was the skin-injured pigs, while the second (C: 18) was the control. The level of TOC was determined as a measure of oxidative stress, while TAC determined as measures of overall antioxidant activity. TOC and overall antioxidant activity were measured in plasma at 3rd day after skin injury and determined using ELISA. RESULTS: Total operative time varied between groups. The SI and C groups required 12,2 and 4,6 min of mean operative time, respectively (p < 0.05). The plasma level (jugular vein) of TOC observed no statistical significant difference between nerve-injured and control pigs. In the plasma, the increase of the level of TAC was statistical significant higher (p=0,026) in skininjured pigs, than in controls.

CONCLUSIONS: This study shows, that at 3rd day after nerve injury, oxidative stress-induced changes are present in the plasma of the pigs. Our findings of a decreased level of TOC in combination with an increased level of the TAC suggest, that an overshoot of antioxidant activity overrules initial oxidative stress in the skin incision injury model of pig neuropathic pain.

P 19 ZINC HOMEOSTASIS AND PAIN SIGNALING ARE HSP70 â&#x20AC;&#x201C; MODULATED, IN MICE DRG NEURONS Deligiannis I. 1, Lekkas P. 1 , Kontargiris E. 1, Angelidis Ch. 2, Vezyraki P. 1 , Evangelou A.1, Vadalouka A.3 Kalfakakou V. 1 1 Physiology Lab, Medical School,University of Ioannina,Greece 2 Biology Lab., Medical School,University of Ioannina,Greece 3 Anesthesiology Clinic, Medical School,University of Athens,Greece Background: Zinc (Zn) is a potent neuro-modulator and nerve-cell protecting agent at normal concentrations. Heat shock proteins (HSPs) are critical regulators in physiological nerve cell

function and upon stress signaling.

Aim: To study the protective role of Hsp70s against sub-lethal Zn concs, in primary afferent neuronal cells (DRGs), isolated from hHsp70 overexpressing transgenic mice .

Methods : Embryonic wild-type DRG cells isolated from…..mice, and exposed to Zn were proceeded for MTT assays and flow cytometry, to study apoptosis/necrosis in response to increasing concentrations of the metal. Immunofluorescent assays for the imaging of MT3 and ZnT7, key proteins in cellular zinc homeostasis and CGRP markers, representing pain modulating DRG neurons, were performed. Over-expressing hHSP70 transgenic mice, exposed to Zn-excess, were subjected to Tail Flick Test to test their response to pain Results:Wild type DRG cells exposed to Zn developed, at 30 uM Zn alterations in the expression of the cGRP marker, indicating possible effects in pain sensation. maintenance.

Hsp70 overexpression improved cell viability and reduced apoptosis in DRG cells. Pain induction in vivo, in hHSP70 overexpressing mice, was decreased compared to control mice.

Increased expression of hHsp70, affected MT3 and ZnT7 suggesting that Hsp70’s protective role could be driven by Zn homeostasis Conclusion: Using a humanized transgenic mice model we showed that the multifunctional chaperone Hsp70 protects against zinc toxic effects in DGR cells by affecting the expression of key proteins involved in zinc homeostasis and that Hsp70 overexpression lowers pain sensation in vivo.

P 20 TREATING-TO-TARGET FOR PAIN RELIEF: THE SATISFACTION CRITERION (SACR) Raptis E.1, Vadalouca A.2, Stavropoulou E. 2, Argyra E. 2, Siafaka I.2 1 Pfizer Hellas, 2 Pain Relief & Palliative Care Center, Α΄ Anesthesiology Department, Aretaieion Hospital, University of Athens The concept of treat-to-target has been incorporated in the management of several diseases, such as rheumatoid arthritis and diabetes. Such a concept is not yet routinely used for pain treatment and relevant data is lacking. As pain is a complex phenomenon involving sensory, emotional, cognitive and other parameters, defining a clear target may be particularly difficult.

Here we propose the use of a simple target measure, called the Satisfaction Criterion (SaCr) which can be used for titration or comparative efficacy purposes in clinical practice and/or clinical trials. This bi-dimensional target measure takes into account the decrease in pain intensity using % change and absolute pain intensity score, as well as patient-reported satisfaction with achieved pain reduction. Criteria below are based on a numeric rating scale (NRS) of 11 points (1-10) but can be easily modified for a NRS of 0-100.

Criterion Score if criterion is achieved* a.

VASn ≤ 0.7 X VASb or VASn ≤ 0.5 X VASb* 1.5 or 3 (respectively) b.

VASn ≤ 4 2.5 c.

PS 1 VASn: current VAS score; VASb: baseline VAS score; PS: patient declaring satisfied with overall pain treatment outcome *Score = 0 if criterion is not achieved; **If 0.5 X VASb is achieved, this should be used instead of 0.7 X VASb SaCr = a + b + c Target: score ≥ 5; Partial Target: score ≥ 3.5; Fail: score < 3.5

Based on this target measure, individual scores are added-up; a score of ≥ 5 signifies achievement of target; a score of ≥ 3.5 a partially met target, and a score of < 3.5 a target not

met. The rationale for choosing the individual score weight is that for high baseline values, a 30% or 50% pain reduction may still lead to moderate pain severity; on the other hand, for low baseline pain scores, a VAS of 4 following treatment may not correspond to a significant pain reduction; third, patient satisfaction with treatment may involve emotional, cognitive and subjective components which may vary from patient-to-patient. Each measure alone would not suffice to show satisfactory pain management, whereas achieving all of them may not be feasible in daily practice. To this effect, the proposed target measure combines these parameters to depict when pain control is satisfactory, somewhat satisfactory or not satisfactory. Although empirical, the individual score weight has been chosen so that a meaningful pain relief can be targeted in most instances. Ranging from 0 â&#x20AC;&#x201C; 6.5 (with higher scores signifying better pain relief), this score can also be used for comparative efficacy purposes.

Concluding, treating-to-target for pain management is a concept that needs to be addressed in well-designed, future studies. Using a simple formula such as the SaCr may have a practical value, allowing for a more objective titration and eliminating relevant bias (especially in open-label studies), while allowing for a bi-dimensional, albeit more stringent, approach to measured efficacy.

P 21 VALIDATION OF THE GREEK VERSION OF THE DN4 DIAGNOSTIC QUESTIONNAIRE FOR NEUROPATHIC PAIN; PRELIMINARY RESULTS Zis P1, Sykioti P2, Stavropoulou E2, Argyra E2, Siafaka I2, Vadalouca A2, Karandreas N3 1 Department of Neurology, Evangelismos General Hospital, Athens, Greece 2 1st Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Greece 3 st 1 Department of Neurology, University of Athens, Greece Background The Douleur Neuropathique 4 questionnaire (DN4) was developed by the French Neuropathic Pain Group and is a simple and objective tool, with the ability to distinguish nociceptive from neuropathic pain.

Aims The aim of our study was to validate the DN4 in the Geeek language.

Methods The study was set up as a prospective observational study. Two pain specialists examined independently the patients and diagnosed them with neuropathic, nociceptive or mixed pain. A third physician has administered the DN4 questionnaire to the patients.

Results So far, 181 patients have met our inclusion criteria. Out of the 153 patients who had identical diagnoses regarding the type of pain, 84 were diagnosed with neuropathic, 32 with nociceptive and 37 with mixed pain.

Among patients with identical diagnoses of neuropathic or nociceptive pain, using a receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.92. A cutoff point of 4 resulted in a sensitivity of 95% and a specificity of 72%, while a cutoff point of 5 resulted in a sensitivity of 85% and a specificity of 78%.

Among patients suffering from pain with neuropathic element (neuropathic or mixed pain) or pain with no neuropathic element (nociceptive pain), using a ROC curve analysis, the AUC was 0.87. A cutoff point of 4 resulted in a sensitivity of 89% and a specificity of 72%, while a cutoff point of 5 resulted in a sensitivity of 76% and a specificity of 78%.

Conclusion The Greek version of DN4 is a valid tool for discriminating between neuropathic and nociceptive pain conditions in daily practice.

E-POSTERS SESSION V CHRONIC PAIN III P 22 ANALGESIC EFFICACY OF PREGABALIN IN PATIENS WITH CHRONIC LOW BACK PAIN Isaia E.C, Stavropoulou E,Raptis E, Siafaka I, Argyra E, Vadalouka A Pain and Palliative Care Center,Aretaeon Hospital ,University of Athens Objective: Chronic low back pain(CLBP) is a disease that occurs at a rate of over 50% in the Greek population.It is well known that CLBP has a neuropathic component in up to 37% of patients The aim of this study is to evaluate the therapeutic use of pregabalin in patients that suffer from chronic back pain with neuropathic origin.

Method:160 patients suffering from CLBP were included in this retrospective study .All patients were evaluated with clinical examination and the linguistic validated greek version of DN4 questionaire in order to identify the neuropathic componentWe treated patients with definite neuropathic pain according to Treede classification 59 of them,12 men and 47 women had CLBP with a neuropathic origin.The average age was 65,8 y.o.. Pain intensity was assesed with the Visual Analogue Scale and the health-status with the EQ-VAS. The study included patients who reported pain greater than VAS = 4 at the time of examination The patients had received Cox-2 inhibitors, combination of paracetamol with tramadol and PPI with insufficient analgesic results Pregabalin was added in a dose 75-300mg and was given by careful titration in order to avoid side effects. Monitoring of the patients was done over the first and second week of treatment as well as recording of results was completed after the first month of treatment.

Results: As primary endpoint result was the reduction of pain intensity by a percentage of 30%.39(66,1%) of our patients reached the primary endpoint within the first week , while an improvement of 60% was recorded within the first month of using pregabalin. The side effects reported were evaluated as light to moderate and were limited after the first 2 to 3 days. Important was the reported improvement in sleep quality in 90% of the cases while there was a general improvement in the evaluation of health status in all the patients.

Conclusion: By adding pregabalin to patients with chronic low back pain with neuropathic component, we can improve the analgesic effect and contribute to patient satisfaction considering the improvement in their health status P 23 ALKAPTONURIA AS A CAUSE OF CHRONIC PAIN. A CASE REPORT Siafaka I., Foradi E., Vadalouka A., Argyra E. Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece CASE REPORT A 74 years old female, was referred to our Pain and Palliative care center for evaluation and management of long-standing, severe and generalized joint pain, especially pain in her knees, shoulders and lower back. The pain was previously treated with non-steroidal anti-inflammatory drugs, which brought no substantial relief.

The patient was diagnosed with alkaptonuria (AKU) after an aortic valve replacement due to aortic stenosis, four years before visiting our center. The diagnosis was suspected from the intraoperative findings of the aortic valve. Prior to that the patient underwent bilateral total hip replacement and although both femoral heads had the pathognomonic findings of the disease â&#x20AC;&#x201C; black pigmented cartilages- AKU remained unrecognized. She was also presented with renal lithiasis, experienced several episodes of renal colic, hear loss and lower extremity venous insufficiency.

The physical examination revealed the typical grey-bluish pigmentation of the concha, anthelix

and helix of the ear, bluish sclera pigment and grey fingernail patches, along with limited range of motion in the large joints and the spine, decreased and painful lumbar flexion, spasm of the paravetebral muscles and stiffness.

Treatment was aiming at reducing the pain, maintaining mobility, minimizing disability, while not compromising the renal function: our initial prescription was tramadol, codeine and paracetamol per os and local application of lidocaine 5% patches. The results were partially effective, so we added transdermal fentanyl in an initial dose of 12μgr/h, which brought some relief. We also suggested reduction of joint loading, acupuncture, and shiatsu massage.

Alkaptonuria is a rare autosomal recessive disorder with a frequency of 1in 250 000-1000000 caused by a deficiency of homogentisic acid oxidase and resulting in accumulation of homogentisic acid in collagenous structures. Treatment of AKU is palliative and unsatisfactory.

Thus, palliative pain management is a crucial issue in AKU. CONCLUSION Considering the facts above and the possibility that AKU may go unrecognized until middle life when degenerative arthritis develops, we report this case in order to alert clinicians involved in the care of musculoskeletal problems, to suspect this rare metabolic disorder by the skin signs and other concurrent medical problems, as early detection and focused screening extended to all family members may have therapeutic implications and prevent the complications in vital organs.

P 24 ALTERNATIVE HEALING METHOD FOR LOW BACK PAIN: SPINE WORKS MANUAL THERAPY. A CASE STUDY Papanikolaou Fotini, Adapted Physical Educator, Manual Therapist Spine Worker The aim of this study is to present an alternative healing method assessing chronic pain in individuals with low back pain. Good health is determined by a healthy nervous system, particularly a healthy spinal column. Occasionally, vertebrae become misaligned and place pressure on the nerves exiting the spinal cord.

We will display a case study referring to a woman aged 38 with chronic pain in lumbar, after an accident, caused severe pain in L5 S1 and disc herniation. The technique we used to cope with the upper problem was the Manual Therapy Spine works. Spine works is an alternative therapeutic method manual handling of the musculoskeletal system and the spinal column through neuromuscular – peritoneal approach. Special exercises and pieces of the Mulligan technique were adapted to mobilize the lumpar region.We worked in the spinous and transverse extraction of vertebrae by releasing soft tissues around L5 and S1 in order to restore the vertebrae to their original position, to align the spine. We focused relaxing Psoas and Piriformis responsible in our case for muscle tension and reflections in legs.

The treatment lasted for six months and every session repeated once a week for 45 minutes.

During sessions and as long these lasted no particular medication had been taken. The client exhibited significantly improved results of pain. She became more actively and started training, by running every day 5 miles.

As a result we could say that the therapy provided sufficiently in this case and helped to restore the patient near the previous state.

Key words: spine works, low back pain, manual therapy, chronic pain P 25 MEDICAL UNDERGRADUATE’s AWARENESS, BELIEFS AND ATTITUDES TOWARDS CHRONIC PAIN Argyra E.1, Theodoraki K. 1, Moutzouri A.2, Papadopoulos D.2, Rekatsina M.2, Vadalouka A.1, Siafaka I.1

1.

Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA) Medical School, Greece 2.

Medical Students, NKUOA Medical School

Background: Previous studies suggest that teaching of pain related topics in medical schools is fragmented, while lack of knowledge and opiophobia of health professionals is a main barrier in pain management.

Aim: To assess the knowledge, attitudes and beliefs of medical undergraduates about chronic pain and its management.

Methods: After a pilot study, an electronic questionnaire with six demographic and 21 painrelated items exploring awareness on the definition, types, treatment of chronic cancer and non cancer pain, use and likelihood of addiction to opioids and medical school curriculum courses providing relevant knowledge, was uploaded on Survey Monkey, open to medical students of all years, of all Greek Universities for one month. Reminders, through electronic social media (facebook), invited students to participate in the survey once a week.

Results: 321 students answered the questionnaire, in their 2nd -6th year of studies, 78.0% from the medical school of the NKUOA. According to responses students seem to be familiar with the definition and types of pain, although 49,2% believe that chronic pain can be a psychiatric disorder. Almost half have lived though the experience of chronic or cancer pain of relatives and friends. 97.5% consider that chronic pain should be treated as a human right, and due to multiple problems it creates to patient and family.

Students respond that pain in cancer is due to cancer and its treatment, chronic pain should be treated by specialists (94.2%), although only 56.2% are informed that pain clinics exist.

They believe that the best judge of the intensity of cancer pain is the patient himself (87.4%), and that chronic pain patients are undertreated (64.4%).

Students seem aware of drugs and modalities used in pain management, but only 40.1% believe that opioids should be given on a regular basis in cancer pain and 49.1% consider addiction as the main problem in prescribing opioids for cancer pain. Only 33.9% know that non malignant chronic pain can be treated with opioids. Knowledge on pain was acquired through Physiology, Pharmacology, Pain therapy and Palliative care of cancer and not cancer patients and Neurology courses.

Conclusion: The results of this survey suggest that medical students have fair knowledge of the definition and consequences of pain, and appreciate that pain should be treated as a human right by specialists, but information on pain clinics is still low. Students are aware of pain treatment modalities, although knowledge on the use of opioids in cancer and non malignant chronic pain is lacking. Addiction to opioids remains a main concern even in the treatment of cancer pain, calling for urgent improvement in the medical school curriculums.

E-POSTERS SESSION VI CHRONIC PAIN VI

P 26 THE EFFECTIVENESS OF CAPSAICIN PATCH 8% (QUTENZA) IN PATIENTS WITH CHRONIC LOW BACK PAIN Krokos A., Georgiadis A. Center of Musculoskeletal Diseases, Lito Hospital, Athens, Greece Background According to epidemiological studies, chronic low back pain (CLBP) has a neuropathic origin in 37% of patients. The effectiveness of Capsaicin patch 8% is documented by many clinical studies in patients with Chronic Peripheral Neuropathic Pain (CPNP).

Aim Ιnvestigation of the effectiveness of Capsaicin Patch 8% in patients with CPNP caused by CLBP. Methods We studied 60 patients (27 men and 33 women (mean age 69, 3 yrs) with CLBP. All patients had already received different kinds of treatments without result. After an extensive physical examination followed by x-rays, EMG, CT or MRI, as appropriate, we evaluated the pain of each patient using Pain-Detect (PD-Q), 10 point pain Visual Analogue Scale (VAS) and SF-36 questionnaires. Then we applied the Capsaicin 8% Patch at the low back region. We repeated the application at 3, 6 and 9 months and we reevaluated the pain before each application and after 12 months.

Results According to the PD-Q, all patients had CPNP. The average VAS number before the beginning of treatment was 7,6; before the 2nd application 2,85; before the 3rd 2,94; before the 4th 1,97; and 1,87 in 12 months. In 40% of patients, Pregabaline 75mg/d was used as cotreatment if needed. 90% of the patients presented redness and causalgia at the region of application, which ceased to exist completely after three days.

Conclusion The Capsaicin patch 8% (Qutenza) is a very effective (≥ 60%) and safe treatment for patients suffering from CPNP caused by CLBP. 6 patients to 60, 10 to 50 and 7 to 28 didn’t continue the treatment after 1st, 2nd and 3rd application respectively

P 27 ΤHE USE OF 8% CAPSAICIN PATCH FOR TREATMENT OF CHRONIC LOW BACK NEUROPATHIC PAIN Bernali N., Tambakis P., Venetsanou F., Deli M. Pain center of Thives General Hospital Background and aims: The Chronic Low Back Pain(CLBP) has a 37% pain with neuropathic origin The aim of the study is to establish the effectiveness of 8% capsaicin patch in peripheral neuropathic pain and especially in localised chronic low back neuropathic pain.

Methods: Prospective, observational study of 40 patients (men-women) aged 40-75 years with low back pain during the period 1/9/12 - 30/3/13. Pain intensity using NPRS, DN4 questionnaire, side effects, level of patient satisfaction, number of patients that were retreated after week twelve and safety and tolerability of treatment were registered. The procedure of administrating the capsaicin 8% patch has been detailed elsewhere (REF No 1).

Patients were treated with a topical anaesthetic cream for 60 min prior to application of the capsaicin 8% patch Results- Mean Baseline values: NPRS: 6, 9+-1, 6 DN4:≥6, 9+-1, 3 At the follow up: NPRS: 3, 2+-1, 5.

85% (34 patients) of patients present reduction of pain ≥3 points

10% (4 patients) of patiens present reduction â&#x2030;¤3 points 5% (2 patients) were lost to follow up Duration of effectiveness: The capsaicin 8% patch provided a quick reduction on average NPRS scores which were sustained for over 12 weeks. By week 2 there was a decrease in Mean NPRS score of 80% compared to the Baseline which was sustained over 12 weeks.

Re- treatment with the capsaicin 8% patch : 13/40 patients were re-treated Tolerability: the capsaicin patch was well tolerated. All patients completed 100% of the intended capsaicin 8% patch application time.

The most common side effects were erythema and local site burning sensation lasting up to 24 hours after application. As far as patient satisfaction 34 patients were totally satisfied, 4 patients were satisfied and 2 patients were lost to follow up.

Conclusion: 8% Capsaicin patch was useful in the treatment of chronic low back neuropathic pain observing a reduction in pain intensity, no severe side effects and a high degree of satisfaction to the patients.

P 28 ACUPUNCTURE AS AN ADD ON THERAPY IN CHRONIC PAIN Chairetakis N.1, Papakosta L.1, Argyra E.2 1.

Acupuncture Physicians 2. Physician Coordinator in Pain department Pain and Palliative Care Center, Aretaieion Hospital, National and Kapodistrian University of Athens Aim: To evaluate the impact of acupuncture as an add on therapy in Chronic Pain management Methods: The present paper summarizes the results of a series of patients who took part in an acupuncture protocol. The data retrieved relate to the operation of the Outpatient Clinic, every Wednesday from September 2011 up to July 2013.

Results: 97 patients underwent 120 therapy cycles receiving 1043 acupuncture sessions in total, as an add-on treatment to their pain management plan. The number of sessions was personalized, to match the needs of each patient.

The cases that we dealt with were suffering from: - Headaches (Migraine, tension type, Cluster) (N:11) - Lumbar back pain (N:19), Sciatica (Nr:16), Neurologic Intermittent Claudication(N:11), Cervical radiculopathy(N:3) - Peripheral neuropathy (Postherpetic neuralgia (N:3), Trigeminal neuralgia (N:2)) - Myofascial pain syndrome with trigger points (N:7) - Periarthritis (N:5) - Osteoarthritis (N:8) - Complex regional pain syndrome (CRPS) (N:2) - Chronic pain syndrome with central sensitization (fibromyalgia (N:10)) - Other pain diagnoses (N:7) Myosceletal pain concerned the 2/3 of the diagnoses, with Low back pain and Sciatica more prevalent in half the cases. 90% regarded chronic pain and 10% acute incidents Of this cohort, 12 patients gave up or did not complete the treatment, while 85 completed at least one cycle of acupuncture and evaluated its result. Following relapse of the symptoms 13 patients repeated the protocol at least once.

The results are summarized as follows: 12% did not complete the therapy, thus we cannot value the result of acupuncture

13% had non-satisfactory results, although they completed a cycle of sessions 15% evaluated the acupuncture positively, but mentioned small amelioration of their symptoms (up to 30% reduction of pain in VAS scale) 22% reported improvement of pain (40-50% in VAS scale) 24% had significantly positive results (60-70% improvement in VAS scale) 15% had total symptom relief (more than 80% improvement in VAS scale) Conclusion Overall 59% of patients experienced more than 40% reduction of VAS score. The acceptance of the method even from patients who did not experience the longed for therapeutic benefit, the trust and the pursuit to repeat sessions in case of relapse, and finally, its holistic action render acupuncture into a precious non-pharmaceutical ally in the management of elected cases of chronic pain.

P 29 TREATMENT OF STUMP PAIN IN A PATIENT WITH REPEATED CAPSAICIN 8% PATCH USE - A CASE REPORT Tsirogianni A., Veliki P., Aslanidis D., Kostikou M. Pain Unit, General Hospital of Katerini Background: Up to 80% of all amputees experience neuropathic pain (phantom and/or stump pain) in an absent body part and both peripheral and central factors seam to be responsible and determine its severity. Capsaicin 8% patch is a choice in the treatment of neuropathic pain.

Material & Methods: A retrospective case report was performed for our patient seen at our Pain Center.

Case Report: The patient is a 63-year-old male, underwent an amputation of his left leg, due to a car accident injury 24 years ago. Our patient â&#x20AC;&#x201C;soon after amputationcomplained for continuous pain at the stump, painful and painless sensations at the amputated limb, worsening at night. He was on pharmaceutical treatment with pregabalin, bromazepam and opioids, without great efficiency, but he refused any interventional technique. There were four applications of capsaicin 8% patch on the stump during a year.

Results: The patient reported slight stump pain reduction by ~ 10% after the first application, but with significant reduction in the frequency of exacerbations (worsening with weather changes), about 50 - 60% reduction of the original pain after the second patch use, three months later, and 100% after the third capsaicin patch the next quarter, although there was no improvement after a forth application, after patientâ&#x20AC;&#x2122;s request, hoping in phantom pain improvement. Breakthrough phantom pain still remains, but with the electric sensation frequency and painless sensations reduced. He is satisfied with a better quality of life, continuing pregabalin and bromazepam, and opioids for BTP. Conclusions: Capsaicin is a hopeful solution in the treatment of stump pain.

(2nd, 3rd , 4th application)

P 30 EFFECTS OF SHIATSU IN PATIENTS WITH CHRONIC NON-MALIGNANT PAIN Lazana M., Tchagoshvili K., Stroggyloudis K., Polychroni-Giannino P., Kokkori M., Konstantinidou E. Pain and Palliative Care Center- Aretaieion Hospital-National & Kapodistrian University of Athens Background: Shiatsu, one of the Complementary and Alternative Medicine (CAM) methods, is offered to chronic pain patients in the Pain and Palliative Care Center of Aretaieion University Hospital of Athens since 2008, with good results. The aim of this study is to investigate the outcomes of the application of Shiatsu to patients who are not given standard medication.

Methods: We studied retrospectively the results of the application of Shiatsu in 22 patients (age: 22-76 years old, 2 male, 20 female) who were treated in our Pain Centre for several non-malignant chronic pain conditions. All patients were not given or discontinued standard pain medication because of pregnancy planning, poor therapeutic outcome or intolerable side effects of first line treatment; painkillers and/or anti-inflammatory drugs were used however to manage flair-ups. All patients had co-morbid conditions such as sleep disorders, mood disorders or depression, asthma, endocrinological and autoimmune diseases.

We examined the pain charts of the patients and we recorded: 1. the pain score (using the VAS scale 0-10) before the initial session and at the end of the course of treatment 2. the total number of Shiatsu sessions 3. how many patients had at least 50% reduction or no pain at the end of the course of treatment and 4. the percentage of patients reporting a beneficial effect on sleep quality and other co-morbidities.

Results: The mean VAS score before the initial session was 5,8Âą1,7 and 3,4Âą2,6 at the end of treatment. The total number of sessions was 10-53. Five patients reported no pain and 12 patients had 50% reduction of pain at the end of treatment. 90% of patients had a beneficial effect on sleep quality and 65% reported improvement of other co-morbidities.

Conclusion: Shiatsu seems to be a CAM method with positive effect on patients with chronic pain of several etiologies who are not able to use medication. Moreover, it improves many other co-morbidities.

E-POSTERS SESSION VII ACUTE PAIN II P 31 THORACIC EPIDURAL ANALGESIA RELATED COMPLICATIONS: A LARGE RETROSPECTIVE DUAL CENTER REVIEW Sarridou D.G., Cox F., Mitchell J.B., Walker C.P.R., Wright J., Wright I.G., Royston D., Hall D., Harris P. Department of Anaesthesia, Critical Care & Pain Management, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, UK Introduction: The Trust is formed from two of the largest cardiothoracic centres in UK and based in the Greater London area. 1100 thoracic epidurals were placed over the last 2 years primarily for lung resection surgery. The establishment of a specific pathway allows complications and critical incidents to be identified early. They can be reported and treated sooner and this supports the process of continuously improving the quality of patient care.

Aim: To review and classify adverse events associated with thoracic epidural placement and management in the last two calendar years.

Methods: A review of all patients who underwent major thoracic surgery and had a thoracic epidural catheter inserted for postoperative pain management. Tools used for the follow up of

patients and the recording of complications and critical incidents included the Trust epidural and analgesia prescription chart for assessing vital signs, urine output and neurological status, the internal electronic reporting of incidents system(IERIS) and the Risk Rating Matrix with colour coded levels of risk (green, yellow, amber, red).

Results: 19 of 1100 patients were referred via the above pathways for further investigation.

Administration:  epidural dislodged/disconnected accidentally n=4 (includes 1 x confused patient pulled hers out - yellow)  skin blistering under insertion site dressing n=1 (amber)  skin burn from hot pack use on shoulder n=2 (yellow)  paravertebral catheter mislabelled as epidural n=1  transfer of patient from level 1 to level 2 care facility because of oliguria requiring inotropic therapy n=1 (yellow) Inappropriate strong opioid co-administration  strong oral or intravenous opioids administered concurrently with opioid containing thoracic epidural analgesia (TEA) n=5  plain local anaesthetic infusion prescribed but opioid containing TEA infusion used n=1 Medicines management/communication/patient care/other  failure to discard opioid containing TEA infusion once disconnected from patient n=1  lack of patient observations after premature cessation of TEA infusion as dysaesthesia in legs resolved upon TEA catheter removal n=1 (yellow)  failure by anaesthetists to hand over presence of TEA catheter to PACU staff =1  no TEA infusion device available so PCA pump used (yellow) n=1

Conclusion: The number of complications and critical incidents was small relative to the large number of thoracic epidurals placed within the Trust (0.02%). An established system of early recognition and reporting of adverse events contributes to the above.

P 32 ANALGESIC EFFECT OF DROPERIDOL IN EMERGENCY DEPARTMENT PATIENTS Papakitsos G., Kapsali A., Papakitsou E. Anaesthetic Department, General Hospital Arta, Greece BACKGROUND: Droperidol has myriad pharmacologic properties that may explain its efficacy as an analgesic. It is used also for treatment of nausea/vomiting.

OBJECTIVES: To determine if there is a difference in pain relief or frequency of side effects in emergency department (ED).

METHODS: This is a prospective, randomized clinical trial of ED patients undergoing treatment for agitation. Consenting patients were randomized to receive either droperidol 5 mg IV or a saline solution (control) bolus and asked to complete a 100-mm (VAS) describing their pain, their level of nausea 30 and 60 minutes after medication administration and a 4point verbal rating scale (VRS) describing their pain as none, mild, moderate, or severe.

Descriptive statistics were used as appropriate. Pain relief was compared both in terms of the decrease in VAS scores and in the proportion of patients who reported moderate or severe pain whose report later changed to mild or no pain.

RESULTS: 49 patients were enrolled. 25 patients received droperidol and 24 received saline.

In the droperidol group, 96% patients who had reported moderate or severe pain at baseline reported mild pain at 60 minutes. In the saline group, 8.3% reported this change (p = 0.015).

The mean percent change from baseline VAS pain score at 60 minutes was -37% for droperidol and -16% for saline (p = 0.008). The mean percent change from baseline for the VAS nausea score was -59% for droperidol and -21% for saline (p = 0.023).

CONCLUSIONS: Droperidol tended to act faster and no clinically important cardiac side effects were reported. Because it acts rapidly and is safe to use in patients with high (co) morbidity, it is still in favour with many health professionals.

P 33 VACCINATION PAIN MANAGEMENT: EFFECT OF BREAST FEEDING ON INFANT'S BEHAVIORAL PAIN SCALE, A RANDOMIZED CONTROL TRIAL STUDY Taavoni S.¹ ², ShahAli Sh.¹, Haghani H. ¹ 1 Tehran University of Medical Sciences, 2 Member of Research Institute for Islamic & Complementary Medicine (RICM, TUMS) Neonates have higher pain sensitivity in comparison of childhood and adults, and its management has become crucial part of neonatal care and cure.

Aim: To evaluate pain relieving effect of breast feeding during DPT vaccination in healthy neonates.

Materials and Methods: 76 healthy 2- 4 months years old term infants, which had been brought by their mothers to the health centers of Tehran University of Medical Sciences (TUMS) in West of Tehran for DPT vaccination, after their parents signed informed consent was involved in this randomized controlled trial study. (Year 2008-2009, approved by ethics Committee of TUMS) By randomized collection one group were breast-fed, 2 minutes before, during, and 15 seconds after the DPT vaccination, and second group according to routine of clinic lied on the examining table during vaccination. Objective changes in appearance of Neonates were assessed by Modified Behavioral Pain Scale (MBPS) during 5 second before immunization till 15 second after it. Description and inferential statistical test were used.

Results: According to age, gender and time of feeding prior to vaccination, equality of two groups were checked and there were no significant difference between them. There were significant differences in MBPS include: facial expression (4 items), cry (5 items), and movements (6 items). (P < 0.0001) Conclusion: Referring to significant difference in all domain of behavioral of Pain scale in two groups, it is suggested that, with simple and safe intervention of straight breast feeding, health care workers, and physicians reduce pain during vaccination and muscular injections too.

Acknowledgment: Received grants from the Research Department of TUMS and approved by research Ethics committee of TUMS (2008-2009), Registered in IRCT. Key Words: Breast Feeding, Pain Management, DPT Vaccination, Modified Behavioral Pain Scale (MBPS).

P 34 COMBINATION OF TRAMADOL WITH MORPHINE FOR THE TREATMENT OF ACUTE POSTOPERATIVE PAIN Bairaktari A.1, Kokolaki M., Gianniri M., Triantafillou O. 1, Vafiadou M. Department of Anaesthesiology and Pain Clinic, Sismanoglion General Hospital, Athens 1 Department of Anaesthesiology and Pain Clinic,G.O.H.K. “Agioi Anargyroi”, Athens Aim of the study was to evaluate if the addition of tramadol to morphine for the treatment

of acute postoperative pain improves subjective analgesic efficacy and has a morphine sparing effect Methods 29 patients, male ,40 -65 years old ,ASA Ι-ΙΙ, scheduled for elective thoracotomy were enrolled. They were randomly divided into two groups: group M(N=14) and group MT(N=15).All patients received general anaesthesia with propofol, remifentanil, cis-atracurium or rocuronium. Propofol or sevoflurane was used for maintenance of anaesthesia .They also received paracetamol 1 g, parecoxib 40 mg and infiltration of the intercostal nervs was done .30 min before the end of the operation, morphine 0.1 mg/kg (group M) or morphine 0.1 mg/kg and tramadol 100 mg (group M-T) were given. In the postanaesthesia care unit additional doses of morphine were given according to the pain intensity in the movement.PCA with morphine was started in the wards . The total dose of morphine that was given in the postanaesthesia care unit was estimated in both groups. T- test was used for statistical analysis Results the total dose of morphine in group M was 15,71± 2,64 and in group M-T was 13,6 ± 2,20(p=0,026) Conclusions it seems that the concomitant use of tramadol and morphine may provide a synergistic useful effect advisable in the treatment of severe postoperative pain P 35 PREGABALIN FOR CHRONIC PAIN IN END STAGE RESPIRATORY FAILURE PATIENTS AWAITING LUNG TRANSPLANT FROM VENO-VENOUS ECMO SUPPORT Sarridou D.G. ,Walker C.P.R., Cox F., Mitchell J.B., Farrimond J.G., Wright I.G., McGovern I., Mohite P. Department of Anaesthesia, Critical Care & Pain Management, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, UK Introduction: End stage lung disease patients requiring veno-venous ECMO as a bridge to lung transplant have prolonged ITU stay which may last months. Reduced mobility is unavoidable to ensure adequate flow in ECMO lines and reduce the risk of dislodgement.

Neuropathic pain and polyneuropathy are not uncommon in this unique group of patients.

Many complain of severe anxiety and depression with disrupted sleep patterns. Pregabalin is licensed for chronic neuropathic pain and generalized anxiety disorder (GAD).

Aim: We reviewed the use of pregabalin in this patient group.

Methods: Seven patients on v-v ECMO awaiting lung transplant aged 21 to 54 years old.

Median ITU stay was 45±27 days (one 2+ 8 weeks ). All were awake in ITU, 3 had tracheostomies and required continuous ventilatory support. Patients received morphine PCA and one with ITU polyneuropathy required a continuous morphine infusion. Pregabalin 50 mg BD was initiated in all patients and the dose escalated to 75 to 100 mg BD as needed.

Patients were asked to evaluate their pain daily using VAS scale from 0-10 and asked how many hours of undisturbed sleep in the previous 24 hours. A simple four scale anxiety evaluating inventory was used. The presence of side effects (dizziness, drowsiness, blurred vision) was recorded.

Results: All patients (100%) reported significant analgesic effect after the start of the treatment. Mean VAS scores were reduced from 6±2 to 3±1. Duration of good quality sleep increased from 5±1.5 hours in 24 hours before pregabalin to 8±2 hours. All of the patients except one reported reduced anxiety of at least 2±1 scale improvement.

Conclusion: Pregabalin may be an effective analgesic with accompanying anxiolytic activity in this particular group of patients with increased analgesic requirements and exacerbated

psychological and emotional stress.

P 36 ANALGESIC, OPIOID-SPARING, AND FAST-TRACKING PROPERTIES OF a2-ADRENERGIC AGONISTS IN CABG PATIENTS: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED COMPARATIVE AND COST-ANALYSIS STUDY OF DEXMEDETOMIDINE AND CLONIDINE EFFICACY Moka E.1, Boufidis S.1, Markantoni S.1, Mathioudakis E.2, Zografistos N.2, Xenikakis T.3, Manousakis E.3, Mehlhorn U.3 1 Anaesthesiology Department, Creta InterClinic Hospital, Heraklion, Crete, Greece 2 Intensive Care Unit (ICU), Creta InterClinic Hospital, Heraklion, Crete, Greece 3 Cardiac Surgery Department, Creta InterClinic Hospital, Heraklion, Crete, Greece Background Clonidine has been widely used as part of fast-track cardiac surgery protocols.

Dexmedetomidine, a highly-selective/potent a2-adrenoreceptor agonist, was recently introduced into cardiac anaesthesia practice, due to its beneficial profile. However, two-drug direct comparisons are sparse in literature, especially in the cardiovascular surgery environment.

Aim A Prospective/Observational/Single-Centre/Randomized/Double-Blind/Placebo-Controlled Study was designed to compare the aforementioned a2-agonists opioid-sparing effects, during CABG procedures, and to investigate whether Dexmedetomidine offers any analgesic/fast-tracking advantages over Clonidine.

Methods 105 ASA II-IV, CABG patients, were allocated into three Groups (n=35/group): Groups I&II received an iv loading dose/15min of either Dexmedetomidine or Clonidine (1&1.6 mcg/kg respectively), before anaesthesia induction, followed by infusion at 0.5 or 0.3 mcg/kg/h (Dexmedetomidine/Clonidine respectively), for 12h post-ICU admission.

Clonidine/Dexmedetomidine dosage-schemes were intended to be equipotent. Group III received a similar placebo volume-matched loading dose/infusion. A standard anaesthesia protocol was followed in all patients, utilizing midazolam/etomidate/fentanyl for induction and propofol/remifentanil maintenance iv infusions, guided by BIS values (35-40) and titrated to the lowest possible rates necessary to keep BP&HR within 10% of pre-induction baseline levels. Hypertensive responses were initially treated with propofol and/or fentanyl boluses, followed by NTL administartion if propofol/fentanyl were ineffective. Hypotensive episodes were managed with iv phenylephrine. Postoperative analgesia was provided with morphine iv infusion, initiated 1h post-ICU admission. VAS (0-10) was recorded for 20h postextubation/2h, until ICU discharge. Haemodynamics were continuously monitored and recorded, throughout study period. Primary Outcomes: Comparison of a2-agonists effects on opioid/anaesthetic drugs requirements, Mechanical Ventilation Length, ICU LOS and ICU VAS Scores. Secondary Endpoints: Haemodynamic Responses Differences, Vasoactive Drugs Use, Side-Effects and Analgesia/Sedation-Related Costs Determination. Statistical Analysis: ANOVA/ANCOVA/Chi-Square Test, where appropriate (p<0.05: statistically significant).

Results All Groups were similar in demographics/operative/haemodynamic data. Dexmedetomidine was well tolerated, without bradycardia or AF/AVB incidents. Mechanical Ventilation Duration was lower in patients receiving a2-agonists compared to placebo (p<0.05), with Dexmedetomidine presenting faster Extubation-Times compared to Clonidine (p=0.039). ICU LOS did not differ between Groups. Consumed Anaesthetics and Opioids were lower in Groups I&II. Dexmedetomidine resulted in decrease of Propofol/Remifentanil/Fentanyl

requirements over placebo (52.71/37.91/24.51%), whereas Clonidine in a 23.51%/20.84%/10.33% reduction, respectively (p<0.05). Cumulative Reduction of ICU Morphine Utilization over placebo was higher in Dexmedetomidine versus Clonidine patients (36.16&24.01%, p=0.026). Pain scores were similar in Groups I&II, at all time-points, but significantly lower versus placebo the first 12h post-extubation. Dexmedetomidine Opioids/Sedatives related cost was lower versus placebo (p=0.022), with insignificant differences from Clonidine.

Conclusions Both a2-agonists exerted anaesthetic/opioids-sparing effects. Dexmedetomidine efficacy was highly pronounced in CABG patients. Its utilization during cardiac surgery represents a safe alternative and a useful adjuvant, with profound analgesic efficacy, fast-tracking properties and potentially cost-effective benefits, in carefully selected patients.