Topic H: ETHICAL, LEGAL FINANCIAL & EDUCATION S255

H03 ETHICS – ANIMAL/HUMAN RESEARCH & CLINICAL PRACTICE

985EVERY LITTLE COUNTS! DIFFERENCES BETWEENSTANDARDIZED AND INDIVIDUAL TREATMENT TARGETS OFANALGESICS IN CLINICAL TRIALS AND DAILY PRACTICE

M.A. Ueberall1 °, G. Mueller-Schwefe2. 1IFNAP, Institute forNeurological Sciences, Nuernberg, 2DGS, Interdisciplinary Pain Center,Goeppingen, Germany

Background and Aims: For registration purposes of analgesic drugs,standardized treatment targets (STTs) are given, which have to be metin controlled clinical trials (e.g. 30−50% reduction of the baseline painintensity (PI)). In contrast to that, pain management in daily practice(especially in patients suffering from chronic pain) focused on different –more individual – treatment targets (associated with a QoL-improvement asdefined by the patient concerned), not necessarily congruent with STTs. Inan attempt to evaluate these differences we performed a study addressingpatient-defined individual treatment targets (ITTs) as part of a shared-decision-making program of the German Pain Society.Methods: Prospective open non-interventional survey focusing on PI, ITTs[both given/defined by the patient on a 100mm visual analogue scale(VAS)] and STTs (calculated as a 30/50% reduction of the PI).Results: 5163 chronic pain patients (62.2% female, age: 53.5±16.8 yrs),suffering from chronic pain with a duration of at least 6mo par-ticipated. Mean PI was 61.5±20.1mm VAS, mean STT (−30/50%)was 43.1±14.0/30.8±10.0mm VAS, mean absolute (relative) ITT was21.0±12.4mm VAS (−67.1±16.2%) following an exponential trajectory(Y=−8.5413Ln(X)+24.135 (R2 = 0.0389, with X=PI and Y= ITT). Over-all, STTs were only in 0.6% (−30%) and 27.3% (−50%) sufficient to meetITTs and to fulfil individual expectancies associated with the use of apotent analgesic.Conclusions: STTs are important tools for scientific purposes, but usuallyfail to address the efficacy of novel analgesics under daily life conditions,where individual expectations and treatment targets are of utmost impor-tance.

986COMPARISON OF THE MATERNAL AND NEONATAL EFFECTSOF COMBINED SPINAL-EPIDURAL BLOCK AND SPINALBLOCK FOR CESAREAN SECTION

E. Uysallar, S. Karaman, I. Gunusen, M. Uyar °, V. Firat. Department ofAnaesthesiology and Reanimation, Ege University Faculty of Medicine,Izmir, Turkey

Background: Combined spinal-epidural block (CSEB) has gained increas-ing interest as it combines the reliability of a spinal block (SB) and theflexibility of an epidural block. We have investigated maternal and fetaleffect of CSEB against SB in cesarean operation.Methods: Forty pregnant woman at full term were randomized into twogroups. Patients in the CSEB and SB groups were given 1.5mL and 2.5mLof 0.5% hyperbaric bupivacaine intrathecally, respectively. If sensorialblock did not reach T4 within 10 min, supplemental bupivacaine wasinjected epidurally 2mL per unblocked segment in CSEB group. Thequality and side effects of surgical anesthesia, hemodynamic parameters,apgar scores, NACS and postoperative duration of pain were comparedbetween the two groups.Results: The time for the block to rich T4 level was significantly lowerin SB group (P< 0.05). More patients in the SB group achieved completemotor blockade sooner than in the CSEB group (P< 0.05). Mean arterialpressure and heart rate were lower in SB group (P< 0.05). There wereno significant differences between the groups in the incidences of apgarscores, cord blood gases, and NACS and adverse effects such as nauseaand vomiting.Conclusion: Finally, both spinal and CSE block provide good surgicalanalgesia for cesarean section. Maternal hypotension is a risk with bothtechnigues, but it occurs earlier and more higher with spinal block. There is

no difference in neonatal outcome, provided that maternal blood pressureis cautiously monitored and hypotension promptly treated.

H04 HISTORY OF PAIN

987THE ART OF ALLEVIATING PAIN IN GREEK MYTHOLOGY

H. Ture1 °, U. Ture2, F.Y. Gogus3, A. Valavanis4, M.G. Yasargil5.1Department of Anesthesiology, 2Department of Neurosurgery,3Department of Anesthesiology, Marmara University School of Medicine,Istanbul, Turkey, 4Institute of Neuroradiology, University of Zurich,Zurich, Switzerland, 5Department of Neurosurgery, University ofArkansas for Medical Sciences, Little Rock, AR, USA

Sedare dolorem opus divinum est – an old Latin inscription – means“alleviating pain is the work of the divine”. This inscription is oftenattributed to either Hippocrates of Kos or Galen of Pergamum, but itis most likely an anonymous proverb. Relieving pain has indeed been oneof the most important tasks since humankind’s first steps into the worldof medicine. Nevertheless, there has probably always been a gap betweenthe ideal relief of pain and the clinical reality of pain management. Sincethen, the rapid increase in the use of anesthesia has embraced many facets,including acute and chronic pain. In addition to protecting our bodies andmental health, the ability to treat or kill pain has allowed us to developsurgical approaches to treat particular diseases, thus contributing to thequality of life.We reviewed many of the essential Greek myths to identify the methodsused at that time to relieve the pain of both illness and surgery, and wediscovered many pioneering methods. Both gods and demigods imple-mented these methods to ease pain, conduct surgery, and, on occasion,kill mythological beings. The myths describe the three most commoncomponents of anesthesia: hypnosis, amnesia, and algesia. Drugs andmusic-aided hypnosis were two of the most common methods use totreat emotional and surgical pain. This article identifies highlights in thedevelopment of concepts to treat pain in Greek mythology. The examplesfound in the Greek myths remind us of the historical significance of paintreatment.

H06 IMPEDIMENTS TO OPIOID USE

988DIFFERENCES IN IMPEDIMENTS TO CHRONIC OPIOIDPRESCRIPTION IN CHRONIC LOW BACK PATIENTSBETWEEN UNIVERSITY VERSUS NON UNIVERSITYPRACTIONERS

J.E. Devulder °. Department of Anesthesia, Section Pain Clinic, GhentUniversity Hospital, Ghent, Belgium

Background and Aims: Chronic low back pain is a burden for society.Opioids can relief efficiently chronic back pain. However, many physiciansare still reluctant to prescribe them. Physicians’ knowledge, attitudes andbeliefs about opioid treatment for those patients was examined. Threegroups of physicians were created: general practitioners (GP’s); specialistin regional hospitals and at the University Hospital.Methods: A cross-sectional study examined in the Ghent region (Belgium)100 GP’s, 100 regional specialists and 50 Ghent University physicians.They were selected ad random by telephone until attaining their quantum.They answered a 13 item multiple choice questionnaire looking at theirknowledge, attitude and beliefs about opioids. Results were statisticalexamined by SPSS..Results: No statistically significant differences were found between the3 groups in opioid knowledge, although GP’s tended to have a betterknowledge (p = 0.16). The overall value was rather poor (median: 7 on a 14point score). GP’s seemed more refrained prescribing opioids than special-ists (p = 0.285). University physicians were the least refrained (p = 0.002).Fear for addiction and tolerance remain the principal reasons to withholdopioids (GP’s: 47%, regional specialist 38%, university physicians 34%).Physicians experienced in prescribing opioids are less refrained than others(p< 0.001).