Pasquale De Negri - Academia.edu (original) (raw)

Papers by Pasquale De Negri

Anesthesia & Analgesia, Aug 1, 2003

We investigated three different concentrations of levobupivacaine (0.125%, 0.20%, and 0.25%; n 20... more We investigated three different concentrations of levobupivacaine (0.125%, 0.20%, and 0.25%; n 20 in each group) for caudal blockade in a prospective, ran- domized, observer-blinded fashion in children (1-7 yr) undergoing subumbilical surgery. The duration of postoperative analgesia was assessed as the time to first administration of supplemental analgesia (based on a Childrens and Infants Postoperative Pain Scale score of

Regional Anesthesia and Pain Medicine, Mar 1, 2002

Background and Objectives: To compare ropivacaine, levo-bupivacaine, and racemic bupivacaine for ... more Background and Objectives: To compare ropivacaine, levo-bupivacaine, and racemic bupivacaine for caudal blockade in children. Methods: Using a prospective observer blinded design, 60 sevoflurane anesthetized children (1 to 7 years) undergoing minor subumbilical surgery, were randomized to receive a caudal block (1 mL/kg) with either ropivacaine 0.2%, racemic bupivacaine 0.25%, or levo-bupivacaine 0.25%. Postoperative analgesia (number of patients needing supplemental analgesia as defined by an objective pain score [OPS] score of Ն 5; time to first analgesic demand) during the first 24 postoperative hours was chosen as the primary end-point. Early postoperative motor block (3-point scale) was assessed as a secondary end-point. Results: All blocks were judged to be clinically successful based on the presence of adequate intraoperative and early postoperative analgesia. An OPS score Ն 5 was found in 5/20 patients in each study group. No difference regarding the time to first analgesic demand was found between the study groups. The use of ropivacaine (P ϭ .02), but not levo-bupivacaine (P ϭ .18), was found to be associated with less motor block during the first postoperative hour compared with racemic bupivacaine. Conclusion: All 3 investigated local anesthetics were found to be clinically comparable despite the slight reduction of early postoperative motor block associated with the use of ropivacaine.

BJA: British Journal of Anaesthesia, Aug 1, 1998

In a double-blind, multicentre study 245 children aged 1-10 yr undergoing elective minor surgery ... more In a double-blind, multicentre study 245 children aged 1-10 yr undergoing elective minor surgery as inpatients were randomly allocated to receive a single caudal extradural injection of 1 ml kg 91 of either 0.25% bupivacaine or 0.2% ropivacaine after induction of light general anaesthesia. The groups were comparable for age, weight, vital signs and duration of surgery. The onset time was similar for ropivacaine and bupivacaine (9.7 vs 10.4 min). Further analgesia was not required in 40% of children. The mean time to first analgesia in the remainder was 233 min in the bupivacaine group and 271 min in the ropivacaine group. No motor block was measurable in either group. Ropivacaine 2 mg kg 91 was as effective as bupivacaine 2.5 mg kg 91 for caudal analgesia in children. (Br.

DOAJ (DOAJ: Directory of Open Access Journals), Apr 1, 2020

OBJECTIVE SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)-related pneumonia, referre... more OBJECTIVE SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)-related pneumonia, referred to as COVID-19 (Coronavirus Disease 19), is a public health emergency as it carries high morbidity, mortality, and has no approved specific pharmacological treatments. In this case series, we aimed to report preliminary data obtained with anti-complement C5 therapy with eculizumab in COVID-19 patients admitted to intensive care unit (ICU) of ASL Napoli 2 Nord. PATIENTS AND METHODS This is a case series of patients with a confirmed diagnosis of SARS-CoV2 infection and severe pneumonia or ARDS who were treated with up to 4 infusions of eculizumab as an off-label agent. Patients were also treated with anticoagulant therapy with Enoxaparin 4000 IU/day via subcutaneous injection, antiviral therapy with Lopinavir 800 mg/day + Ritonavir 200 mg/day, hydroxychloroquine 400 mg/day, ceftriaxone 2 g/day IV, vitamine C 6 g/day for 4 days, and were on Non-Invasive Ventilation (NIV). RESULTS We treated four COVID-19 patients admitted to the intensive care unit because of severe pneumonia or ARDS. All patients successfully recovered after treatment with eculizumab. Eculizumab induced a drop in inflammatory markers. Mean C Reactive Protein levels dropped from 14.6 mg/dl to 3.5 mg/dl and the mean duration of the disease was 12.8 days. CONCLUSIONS Eculizumab has the potential to be a key player in treatment of severe cases of COVID-19. Our results support eculizumab use as an off-label treatment of COVID-19, pending confirmation from the ongoing SOLID-C19 trial.

The Clinical Journal of Pain, Jun 1, 2007

Objective: Vertebroplasty (PV) and balloon kyphoplasty (KP) are minimally invasive vertebral augm... more Objective: Vertebroplasty (PV) and balloon kyphoplasty (KP) are minimally invasive vertebral augmentation procedures involving injection of polymethyl methacrylate cement under radiologic control into a fractured vertebral body. They strengthen the bone and improve the intense pain caused by fracture secondary to osteoporosis, metastasis, or trauma and refractory to conservative therapies such as analgesic use, bed rest, and bracing. Aim of the study is to investigate and compare safety and efficacy of KP and PV on pain and mobility in patients with vertebral fractures due to osteoporosis or trauma. Methods: Twenty-one patients have been enrolled in a prospective nonrandomized controlled study with painful vertebral compression fractures resistant to common therapies. Patients underwent KP or PV. A Visual Analog Scale has been used to measure pain status at different time up to 6 months; the Oswestry Disability Index (ODI) was chosen to evaluate functional activity before procedure and 6 months later. Results: Mean pain scores decreased significantly from pretreatment to posttreatment with KP and PV as did the ODI scores. No significant differences could be found between both groups for the mean VAS and ODI scores preprocedure and postprocedure. Cement extravasation occurred only during PV. No other adverse events correlated to both techniques have been reported. Discussion: Our results suggest that both PV and KP offer therapeutic benefit significantly reducing pain and improving mobility in patients with vertebral fracture without significant differences between groups in term of quality. The leakage of cement has been observed only during PV.

Journal of Anesthesia and Clinical Research, 2012

ABSTRACT It has been estimated that chronic pain affects 15% of the world population. The high pr... more ABSTRACT It has been estimated that chronic pain affects 15% of the world population. The high prevalence of chronic pain emphasizes the need for effective analgesic therapy: when analgesic efficacy is low or when adverse events are unacceptable, alternative and more invasive therapeutic approaches must be taken into account, such as intrathecal therapy. Intrathecal infusion of drugs at low doses achieves an analgesic effect equivalent (or better) to that of high doses, with a more favorable tolerability profile in some patients. The 2012 Polyanalgesic Consensus Conference defined the intrathecal administration of opioids and ziconotide as first-line therapy for chronic pain. Ziconotide, an N-type calcium channel antagonist, is considered effective for the treatment of neuropathic, nociceptive, and mixed neuropathic/nociceptive pain, as it blocks calcium influx into the presynaptyic nerve terminal, preventing the release of neurotransmitters into the synapse. Italian experts in chronic cancer pain treatment updated theirs algorithms for ziconotide use in intrathecal analgesia for cancer pain relief. The aim of this panel was to determine which patients suffering from cancer pain might be eligible for treatment with ziconotide and to clarify ziconotide titration and its possible combination with opioids in order to obtain adequate pain relief with a low incidence of adverse effects. The statements reported here reflect the opinion of experts based on clinical practice. The proposed indications do not constitute guidelines.

Techniques in Regional Anesthesia and Pain Management, Jul 1, 2002

ABSTRACT Pediatric regional anesthesia is now well-established and has an important place for per... more ABSTRACT Pediatric regional anesthesia is now well-established and has an important place for peri- and postoperative pain control in children. We also need drugs safe and effective for epidural administration; ropivacaine and levobupivacaine seem to offer a wider safety margin in comparison with the old drugs and are able to provide a valid pain control. Various adjuvants can be used in order to potentiate the analgesic duration; clonidine and ketamine are probably among the best drugs. Copyright 2002, Elsevier Science (USA). All rights reserved.

Journal of Thoracic Disease, Aug 1, 2019

Background: One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgica... more Background: One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. Methods: A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. Results: Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult

Anesthesiology and Pain Medicine, Jan 2, 2021

Canadian Journal Of Anesthesia/journal Canadien D'anesthésie, May 1, 1999

Purpose: To assess and compare the onset time and duration of neuroblockade obtained after ropiva... more Purpose: To assess and compare the onset time and duration of neuroblockade obtained after ropivacaine or bupivacaine in infants undergoing major abdominal surgery. We also evaluated the efficacy and safety of employing ropivacaine instead of bupivacaine to provide operative anesthesia and postoperative analgesia. Methods: In a prospective double blind study 28 infants, aged I-12 months, undergoing elective major abdominal surgery, were randomly allocated to receive, after induction of general anesthesia, either 0.7 ml.kg-' bupivacaine 0.25% (group B) or ropivacaine 0.2% (group R) via lumbar epidural block. The onset time, total surgical time and duration of analgesia were recorded. Results: No differences were noted in demographic data, hemodynamic variables or duration of surgery. The onset time for sensory blockade was 13. I min _+ 2. I (group B) and I 1.7-+ 2.4 min (group R). The duration of analgesia was 491 +__ 291 (group R) and 456 min + 247 (group B). Eight patients in group B and six in group R needed codeine and acetaminophen rescue on at least one occasion during the 24 hr study period. No major side effects were noted in either groups. Conclusions: In infants undergoing major abdominal surgery under combined epidural/light general anesthesia, ropivacaine 0.2% produces sensory and motor blockade similar in onset, duration of action and efficacy to that obtained from an equal volume, 0.7 ml.kg <, of bupivacaine 0.25%.

Pediatric Anesthesia, Mar 1, 1996

In a double-blind study, 42 children, aged 1-10, undergoing general subumbilical surgery, were ra... more In a double-blind study, 42 children, aged 1-10, undergoing general subumbilical surgery, were randomly allocated to two groups; they received, via caudal extradural, 1% mepivacaine 7 mg.kg-1 and normal saline 1 ml (Group 1) and a mixture of 1% mepivacaine 7 mg.kg-1 plus clonidine 2 micrograms.kg-1 and normal saline up to 1 ml (Group 2) respectively. No significant difference was noticed in age, weight, duration of surgery and onset time of anaesthesia, blood pressure, heart rate and oxygen saturation. Mean duration of analgesia (evaluated with 'Broadman objective pain scale') was 143 min for Group 1 and 218 min for Group 2 (P < 0.05); the time of sedation (evaluated with a sedation score) was statistically longer in Group 2 (172 min vs 89 min in Group 1). This longer sedation is due both to the longer analgesia and partially to a side effect of clonidine. In conclusion the addition of 2 micrograms.kg-1 of clonidine to mepivacaine prolongs the duration of caudal analgesia in children.

Pediatric Anesthesia, Oct 1, 2002

Background: The adjunctive use of clonidine to local anaesthetics has been reported to enhance an... more Background: The adjunctive use of clonidine to local anaesthetics has been reported to enhance analgesia both after spinal and peripheral administration. However, no attempt has been made to compare spinal and peripheral application of clonidine in the same surgical context in order to further explore the mechanism for the analgesic action of clonidine when administered together with local anaesthetics. Methods: Using a prospective, randomized, observer-blinded study design, 40 patients, aged 1-7 years, who were undergoing elective surgery for inguinal hernia repair or orchidopexy, were randomly allocated to receive either a caudal block (group C: n ¼ 20; ropivacaine 0.2%, 1 mlAEkg)1 + clonidine 2 lgAEkg)1) or an ilioinguinal-iliohypogastric nerve block (group I: n ¼ 20; ropivacaine 0.2%, 0.4 mlAEkg)1 + clonidine 2 lgAEkg)1) following the induction of a standardized sevoflurane based anaesthetic. Postoperative analgesia [maximum Objective Pain Scale (OPS) score and requirement for supplemental analgesia] and sedation (three-point scale) were assessed at predetermined intervals during the first 24 h postoperatively. Results: Fourteen children in group I and nine children in group C did not require rescue analgesia (P ¼ 0.17). No difference in maximum OPS scores could be detected between the two study groups. The mean time to full recovery regarding sedation was 149 min and 153 min in groups C and I, respectively. Conclusions: This pilot study demonstrates a trend for better postoperative analgesia following peripheral administration of clonidine compared with central application. However, the main mechanism for the adjunct analgesic effect of clonidine when administered together with local anaesthetics requires further study.

Anesthesia & Analgesia, Oct 1, 2002

1). As available commercial products do not offer many of the perceived necessary management func... more 1). As available commercial products do not offer many of the perceived necessary management functions, facilities may develop their own homegrown systems. Some of these functions, such as staff scheduling (2), block time allocation (3), and patient instructions (4) have been analyzed and could be implemented in the next generation of OR Mgt Info Systems. Return on this investment may come from lost supply charges recovered, savings on inventory carrying cost by increasing inventory turns per year, and increase in revenue from better case scheduling and OR efficiency. The editorial by Weinger et al. prompted us to report the results of our survey regarding the impressions of OR managers as to the key features of an OR Mgt Info System and unrealized opportunities to design and successfully implement new management technology in the surgical suite.

Regional Anesthesia and Pain Medicine, Jun 1, 1999

Anesthesia & Analgesia, Dec 1, 2012

Open colorectal cancer (CRC) surgery induces severe and prolonged postoperative pain. The optimal... more Open colorectal cancer (CRC) surgery induces severe and prolonged postoperative pain. The optimal method of postoperative analgesia in CRC surgery has not been established. We evaluated the efficacy of preperitoneal continuous wound infusion (CWI) of ropivacaine for postoperative analgesia after open CRC surgery in a multicenter randomized controlled trial. Candidates for open CRC surgery randomly received preperitoneal CWI analgesia or continuous epidural infusion (CEI) analgesia with ropivacaine 0.2% 10 mL/h for 48 hours after surgery. Fifty-three patients were allocated to each group. All patients received patient-controlled IV morphine analgesia. Over the 72-hour period after the end of surgery, CWI analgesia was not inferior to CEI analgesia. The difference of the mean visual analog scale score between CEI and CWI patients was 1.89 (97.5% confidence interval = -0.42, 4.19) at rest and 2.76 (97.5% confidence interval = -2.28, 7.80) after coughing. Secondary end points, morphine consumption and rescue analgesia, did not differ between groups. Time to first flatus was 3.06 ± 0.77 days in the CWI group and 3.61 ± 1.41 days in the CEI group (P = 0.002). Time to first stool was shorter in the CWI than the CEI group (4.49 ± 0.99 vs 5.29 ± 1.62 days; P = 0.001). Mean time to hospital discharge was shorter in the CWI group than in the CEI group (7.4 ± 0.41 and 8.0 ± 0.38 days, respectively). More patients in the CWI group reported excellent quality of postoperative pain control (45.3% vs 7.6%). Quality of night sleep was better with CWI analgesia, particularly at the postoperative 72-hour evaluation (P = 0.009). Postoperative nausea and vomiting was significantly less frequent with CWI analgesia at 24 hours (P = 0.02), 48 hours (P = 0.01), and 72 hours (P = 0.007) after surgery evaluations. Preperitoneal CWI analgesia with ropivacaine 0.2% continuous infusion at 10 mL/h during 48 hours after open CRC surgery provided effective postoperative pain relief not inferior to CEI analgesia.

InTech eBooks, Feb 24, 2012

Gestures rather harmless at first sight like weight-lifting , a sudden movement, sometimes only r... more Gestures rather harmless at first sight like weight-lifting , a sudden movement, sometimes only remaking the bed in the morning could cause, in susceptible individuals, the failure and collapse of the vertebral body. Painful fractures, which cause changes in appearance and posture, persistent back pain, limited mobility and a general decay in the affected individuals, most often even unaware of the cause of their evil (Eastell et al., 1991). One of the most frequent causes of fractures of the vertebral body is osteoporosis (Dempster, 2011; Haczynski, 2001), relentless and "silent" disease spread rapidly, due to an aging world population. Vertebral fractures can also be the result of a traumatic event, of hematologic malignancies(multiple myeloma, leukemia), solid tumor metastases to the spine (Bouvard et al., 2011) or long-term steroid therapy(treatment of rheumatoid arthritis, post-transplant patients)(Naganathan et al., 2000). Despite the persistent pain and a more accentuated thoracic and lumbar deformities, those affected often find it hard to realize it , confusing the symptoms with a simple back pain. A compression fracture of the vertebral body not properly treated, increases by 5 times the risk of further fractures, with all that entails in terms of quality of life of the patient and health and social costs (Oleksik et al., 2000). Usually, in case of spinal pain from vertebral fracture, the patient underwent conservative treatment, covering the prescription of a rigid bust, prolonged immobilization and antiinflammatory medication and painkillers (Prather et al.,2007). A similar solution, however, may not always be sufficient to solve the problem, because the pain can persist for several months and, above all, the patient does not recover the correct posture with increased comorbidity (Cauley et al., 2000) Currently there are minimally invasive methods, such as balloon kyphoplasty, vertebroplasty, and other percutaneous techniques for stabilization, inherently safe for characteristics and dynamics of action, allowing an immediate relief of the pain, and ensuring a good recovery of the statics of the spine (Frank, 2003). 2. Spine anatomy The spine consists of 33 vertebrae, including 7 cervical, 12 thoracic, 5 lumbar, 5 sacral segments often fused together, and finally 4 coccygeal segments (Gray, 1973). These segments are spaced by the intervertebral discs and structurally connected by ligaments and muscles. Observed in the lateral projection, a normal spine shows lordosis at the cervical www.intechopen.com Osteoporosis 650 and lumbar regions and a mild kyphosis at the thoracic and sacral regions. These variations in the curvature are important because they are responsible for the orientation of the single vertebra and important components such as the vertebral pedicles, which are the main access route of percutaneous stabilization techniques which will be discussed later(Ortiz & Deramond, 2001). The size of the vertebrae gradually increase from cervical to lumbar tract with variability dependent on the size of the individual. Theoretically there is an increase in volume ranging from 7.2 ml of the cervical area to 22.4 ml of the lumbar spine. In the thoracic area vertebrae are connected bilaterally with the ribs by ligaments that go from the head of the rib to the vertebral body and then from the rib to the vertebral transverse process. The pedicles of the lower thoracic are relatively large and oriented in an anteriorposterior direction. Heading toward the upper tract, we observe a progressive reduction in the size of the pedicles whose orientation becomes more oblique. In the lumbar tract, we observe larger vertebrae and the orientation of the pedicles is different as we go from L1 to L5. The pedicles of the lumbar spine than have a straight anterior-posterior direction similar to that of the lower thoracic. The pedicles tend therefore to be more oblique in the lower lumbar vertebrae reaching their maximum inclination at L5 (fig. n. 1).

Brain and behavior, Mar 1, 2021

This article summarizes recommendations made by six pain specialists who discussed the rationale ... more This article summarizes recommendations made by six pain specialists who discussed the rationale for ziconotide intrathecal analgesia (ITA) and the requirement for evidence‐based guidance on its use, from a European perspective. Riemser Pharma GmbH (Greifswald, Germany), which holds the European marketing authorization for ziconotide, hosted the meeting. The group agreed that ITA is under‐used in Europe, adding that ziconotide ITA has potential to be a first‐line alternative to morphine; both are already first‐line options in the USA. Ziconotide ITA (initiated using a low‐dose, slow‐titration approach) is suitable for many patients with noncancer‐ or cancer‐related chronic refractory pain and no history of psychosis. Adopting ziconotide as first‐line ITA could reduce opioid usage in these patient populations. The group advocated a risk‐reduction strategy for all candidate patients, including compulsory prescreening for neuropsychosis, and requested US–European alignment of the licensed starting dose for ziconotide: the low‐and‐slow approach practiced in the USA has a better tolerability profile than the fixed high starting dose licensed in Europe. Of note, an update to the European Summary of Product Characteristics is anticipated in early 2021. The group acknowledged that the Polyanalgesic Consensus Conference (PACC) treatment algorithms for ziconotide ITA provide useful guidance, but recommendations tailored specifically for European settings are required. Before a consensus process can formally begin, the group called for additional European prospective studies to investigate ziconotide in low‐and‐slow dosing strategies, in different patient settings. Such data would enable European guidance to have the most appropriate evidence at its core.

Pediatric Anesthesia, Nov 1, 2001

The aim of the study was to determine whether caudal S-ketamine or clonidine prolonged analgesia ... more The aim of the study was to determine whether caudal S-ketamine or clonidine prolonged analgesia together with ropivacaine. Sixty-three boys, aged 1-5 years, who were undergoing minor surgery, were allocated in order to receive one of three solutions for caudal anaesthesia. Group R received 2 mg x kg(-1) 0.2% ropivacaine; group C, 2 mg x kg(-1) 0.2% ropivacaine + clonidine 2 microg x kg(-1); and group K, 2 mg x kg(-1) 0.2% ropivacaine + S-ketamine 0.5 mg x kg(-1). Postoperative analgesia assessed by CHEOPS lasted 701 min in group K (P &amp;amp;amp;amp;amp;amp;amp;lt; 0.05) compared with 492 min in group C and 291 min in group R. There were no significant differences between the groups for incidence of haemodynamic and respiratory alterations, motor block or sedation. This study demonstrates that S-ketamine 0.5 mg x kg(-1) when added to 0.2% caudal ropivacaine provides better postoperative analgesia than clonidine without any clinically significant side-effect.