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Papers by nicole Naccache
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
Le Journal médical libanais. The Lebanese medical journal
Opioid analgesics are essential for the management of moderate to severe pain. In spite of their ... more Opioid analgesics are essential for the management of moderate to severe pain. In spite of their documented effectiveness, opioids are often underutilized, a factor which has contributed significantly to the undertreatment of pain. Many countries have developed true national policies on cancer pain and palliative care, and in others only guidelines for care have been developed. Ideally, national policies facilitate and legislate not only a patient's right to care, but also the necessary components of education and drug availability which are so critical for the appropriate achievement of public health programs.
Le Journal médical libanais. The Lebanese medical journal
The history of pain is one of the concepts that have divided Cartesian thinkers and mystical phil... more The history of pain is one of the concepts that have divided Cartesian thinkers and mystical philosophers in the Western civilization over centuries. Depending on the historical period, different dogmas and morals intersect, oppose or attempt conciliation. The attitude towards pain evolved with the evolution of mentalities in the broad sense but also by relying on scientific discoveries in the field. Yesterday, pain was accepted or sublimated. Today, taking care of pain is a patient basic right and an obligation for the practitioner.
Le Journal médical libanais. The Lebanese medical journal
Lumbar microdiscectomy surgery is already performed under spinal anesthesia (SA) in many institut... more Lumbar microdiscectomy surgery is already performed under spinal anesthesia (SA) in many institutions. The aim of this study is to compare the quality of analgesia and recovery after SA when compared to general anesthesia (GA) after lumbar microdiscectomy surgery. Following light sedation, SA is performed with the patient in the left lateral decubitus position, one to two levels above the herniated disc level. Isobaric 0.5% bupivacaine 3-3.5 ml was injected intrathecally followed by wound infiltration with 15 ml of bupivacaine with 1/200 000 epinephrine prior to surgical incision. Despite randomization, we found significantly more females in the GA group. Pain scores at 4 and 8 h postoperatively were lower in SA group as well as total analgesic consumption during the first 24 h. Postoperative recovery including time to drinking, eating and walking were more rapid after SA when compared to GA. During the postoperative period, the incidence of urinary retention was comparable between ...
International Journal of Molecular Sciences, 2015
Individualization of acute postoperative pain treatment on an evidence-based decision process is ... more Individualization of acute postoperative pain treatment on an evidence-based decision process is a major health concern. The aim of this study is to investigate the influence of genetic and non-genetic factors on the variability of response to morphine in acute postoperative pain. A group of nighty-five patients undergoing major surgery were included prospectively. At 24 h, a logistic regression model was carried out to determine the factors associated with morphine doses given by a Patient Controlled Analgesia device. The dose of morphine was associated with age (p = 0.011), patient weight (p = 0.025) and the duration of operation (p = 0.030). This dose decreased with patient's age and duration of operation and increased with patient's weight. OPRM1 and ABCB1 polymorphisms were significantly associated with administered dose of morphine (p = 0.038 and 0.012 respectively). Patients with at least one G allele for c.118A>G OPRM1 polymorphism (AG/GG) needed 4 times the dose of morphine of AA patients. Additionally, patients with ABCB1 CT and CC genotypes for c.3435C>T polymorphism were 5.6 to 7.1 times more OPEN ACCESS Int. J. Mol. Sci. 2015, 16 6299 prone to receive higher dose of morphine than TT patients. Our preliminary results support the evidence that OPRM1/ABCB1 genotypes along with age, weight and duration of operation have an impact on morphine consumption for acute postoperative pain treatment.
Lebanese Medical Journal, 2013
Opioids remain essential drugs for the treatment of severe cancerous pain. However, many countrie... more Opioids remain essential drugs for the treatment of severe cancerous pain. However, many countries have developed new regulations and policies for a better availability and accessibility of these drugs. Lebanon is not too far from these advanced strategies. The Ministry of Health and specifically the Narcotic Department have adjusted regulations related to opioid prescriptions and have registered many new opioid drugs in 2012 for a better pain-free life for our patients. However, there is still a lot to do in this field.
Lebanese Medical Journal, 2013
Journal of Hand Surgery (European Volume), 2008
The intention of this prospective study was to evaluate the role of the musculocutaneous and radi... more The intention of this prospective study was to evaluate the role of the musculocutaneous and radial nerves in elbow flexion and forearm supination. The study included 29 patients having loco-regional anaesthesia for minor hand surgery. Elbow flexion and forearm supination forces were evaluated before and after an isolated musculocutaneous nerve block in one group and an isolated radial nerve block in another group. The results showed that the biceps tendon is responsible for 47% of the forearm supination force and the combination of brachioradialis and the supinator for 64% of this force. It showed also that the musculocutaneous and radial nerves contribute by 42% and 27.5%, respectively, to the flexion force of the elbow. These results are intended to help surgeons in decision making when treating chronic biceps tendon rupture, in repair of traumatic brachial plexus neuropathy and in using tendon transfers, such as the Steindler transfer, around the elbow.
Journal of Anesthesia, 2011
In this case series, we present the effectiveness of multilevel nerve stimulator-guided paraverte... more In this case series, we present the effectiveness of multilevel nerve stimulator-guided paravertebral block (PVB) technique in obese women of body mass index ≥30 kg/m(2) undergoing breast cancer surgery with or without axillary dissection. Twenty-six obese women were included in this case series. Block classification, hemodynamics and complication rate, postoperative nausea and vomiting, postoperative analgesic consumption, post-anesthesia care unit (PACU) stay, and hospital stay were recorded. All patients were hemodynamically stable during the operation, and no complications were noted. Patients stayed 69 min on average in the PACU and were discharged within 2 days. Confirmation of the landmark was established from the initial attempt in 61.5%. Surgical PVB was achieved in 76.9% of the patients; the failure rate of the technique was 11.5%. This case series suggested that the multilevel nerve stimulator-guided PVB may be an effective technique for obese patients undergoing breast cancer surgery, although further studies are needed to compare PVB and general anesthesia.
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
Annales Françaises d'Anesthésie et de Réanimation, 2009
Introduction.-La prise en charge de la douleur aiguë postopératoire est un sujet d'intérêt généra... more Introduction.-La prise en charge de la douleur aiguë postopératoire est un sujet d'intérêt général pour la population. Elle est souvent considérée comme encore insuffisamment prise en charge. Type d'étude.-Enquête d'opinion réalisée par la remise d'un questionnaire pendant le Congrès national libanais d'anesthésie-réanimation qui s'est déroulé en mai 2006. Résultats.-Sur 230 questionnaires distribués aux participants venus de tout le Liban, 106 ont été recueillis. La prise en charge de la douleur aiguë postopératoire est différente dans les hôpitaux universitaires et dans les hôpitaux non universitaires. L'information préopératoire et l'évaluation de la douleur postopératoire ne sont réalisées que par 26 % des répondants. Une analgésie multimodale est commencée au bloc opératoire ou en salle de réveil pour 92 % des patients. Seulement 71 % des médecins anesthésistes disposent de pompes pour analgésie autocontrôlée par le patient. Des protocoles écrits d'analgésie postopératoire sont disponibles dans seulement 58 % des centres. Parmi les médecins, seulement 36 % ont une formation initiale et/ou continue sur la prise ne charge de la douleur postopératoire. L'obstacle majeur à l'amélioration de la prise en charge de la douleur reste le coût de ces traitements, qui est supporté par les patients. Conclusion.-Même s'il existe une bonne prise de conscience de l'importance de la prise en charge de la douleur aiguë postopératoire, des efforts importants restent à faire dans ce domaine.
Annales Françaises d'Anesthésie et de Réanimation, 1998
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
Le Journal médical libanais. The Lebanese medical journal
Opioid analgesics are essential for the management of moderate to severe pain. In spite of their ... more Opioid analgesics are essential for the management of moderate to severe pain. In spite of their documented effectiveness, opioids are often underutilized, a factor which has contributed significantly to the undertreatment of pain. Many countries have developed true national policies on cancer pain and palliative care, and in others only guidelines for care have been developed. Ideally, national policies facilitate and legislate not only a patient's right to care, but also the necessary components of education and drug availability which are so critical for the appropriate achievement of public health programs.
Le Journal médical libanais. The Lebanese medical journal
The history of pain is one of the concepts that have divided Cartesian thinkers and mystical phil... more The history of pain is one of the concepts that have divided Cartesian thinkers and mystical philosophers in the Western civilization over centuries. Depending on the historical period, different dogmas and morals intersect, oppose or attempt conciliation. The attitude towards pain evolved with the evolution of mentalities in the broad sense but also by relying on scientific discoveries in the field. Yesterday, pain was accepted or sublimated. Today, taking care of pain is a patient basic right and an obligation for the practitioner.
Le Journal médical libanais. The Lebanese medical journal
Lumbar microdiscectomy surgery is already performed under spinal anesthesia (SA) in many institut... more Lumbar microdiscectomy surgery is already performed under spinal anesthesia (SA) in many institutions. The aim of this study is to compare the quality of analgesia and recovery after SA when compared to general anesthesia (GA) after lumbar microdiscectomy surgery. Following light sedation, SA is performed with the patient in the left lateral decubitus position, one to two levels above the herniated disc level. Isobaric 0.5% bupivacaine 3-3.5 ml was injected intrathecally followed by wound infiltration with 15 ml of bupivacaine with 1/200 000 epinephrine prior to surgical incision. Despite randomization, we found significantly more females in the GA group. Pain scores at 4 and 8 h postoperatively were lower in SA group as well as total analgesic consumption during the first 24 h. Postoperative recovery including time to drinking, eating and walking were more rapid after SA when compared to GA. During the postoperative period, the incidence of urinary retention was comparable between ...
International Journal of Molecular Sciences, 2015
Individualization of acute postoperative pain treatment on an evidence-based decision process is ... more Individualization of acute postoperative pain treatment on an evidence-based decision process is a major health concern. The aim of this study is to investigate the influence of genetic and non-genetic factors on the variability of response to morphine in acute postoperative pain. A group of nighty-five patients undergoing major surgery were included prospectively. At 24 h, a logistic regression model was carried out to determine the factors associated with morphine doses given by a Patient Controlled Analgesia device. The dose of morphine was associated with age (p = 0.011), patient weight (p = 0.025) and the duration of operation (p = 0.030). This dose decreased with patient's age and duration of operation and increased with patient's weight. OPRM1 and ABCB1 polymorphisms were significantly associated with administered dose of morphine (p = 0.038 and 0.012 respectively). Patients with at least one G allele for c.118A>G OPRM1 polymorphism (AG/GG) needed 4 times the dose of morphine of AA patients. Additionally, patients with ABCB1 CT and CC genotypes for c.3435C>T polymorphism were 5.6 to 7.1 times more OPEN ACCESS Int. J. Mol. Sci. 2015, 16 6299 prone to receive higher dose of morphine than TT patients. Our preliminary results support the evidence that OPRM1/ABCB1 genotypes along with age, weight and duration of operation have an impact on morphine consumption for acute postoperative pain treatment.
Lebanese Medical Journal, 2013
Opioids remain essential drugs for the treatment of severe cancerous pain. However, many countrie... more Opioids remain essential drugs for the treatment of severe cancerous pain. However, many countries have developed new regulations and policies for a better availability and accessibility of these drugs. Lebanon is not too far from these advanced strategies. The Ministry of Health and specifically the Narcotic Department have adjusted regulations related to opioid prescriptions and have registered many new opioid drugs in 2012 for a better pain-free life for our patients. However, there is still a lot to do in this field.
Lebanese Medical Journal, 2013
Journal of Hand Surgery (European Volume), 2008
The intention of this prospective study was to evaluate the role of the musculocutaneous and radi... more The intention of this prospective study was to evaluate the role of the musculocutaneous and radial nerves in elbow flexion and forearm supination. The study included 29 patients having loco-regional anaesthesia for minor hand surgery. Elbow flexion and forearm supination forces were evaluated before and after an isolated musculocutaneous nerve block in one group and an isolated radial nerve block in another group. The results showed that the biceps tendon is responsible for 47% of the forearm supination force and the combination of brachioradialis and the supinator for 64% of this force. It showed also that the musculocutaneous and radial nerves contribute by 42% and 27.5%, respectively, to the flexion force of the elbow. These results are intended to help surgeons in decision making when treating chronic biceps tendon rupture, in repair of traumatic brachial plexus neuropathy and in using tendon transfers, such as the Steindler transfer, around the elbow.
Journal of Anesthesia, 2011
In this case series, we present the effectiveness of multilevel nerve stimulator-guided paraverte... more In this case series, we present the effectiveness of multilevel nerve stimulator-guided paravertebral block (PVB) technique in obese women of body mass index ≥30 kg/m(2) undergoing breast cancer surgery with or without axillary dissection. Twenty-six obese women were included in this case series. Block classification, hemodynamics and complication rate, postoperative nausea and vomiting, postoperative analgesic consumption, post-anesthesia care unit (PACU) stay, and hospital stay were recorded. All patients were hemodynamically stable during the operation, and no complications were noted. Patients stayed 69 min on average in the PACU and were discharged within 2 days. Confirmation of the landmark was established from the initial attempt in 61.5%. Surgical PVB was achieved in 76.9% of the patients; the failure rate of the technique was 11.5%. This case series suggested that the multilevel nerve stimulator-guided PVB may be an effective technique for obese patients undergoing breast cancer surgery, although further studies are needed to compare PVB and general anesthesia.
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
Annales Françaises d'Anesthésie et de Réanimation, 2009
Introduction.-La prise en charge de la douleur aiguë postopératoire est un sujet d'intérêt généra... more Introduction.-La prise en charge de la douleur aiguë postopératoire est un sujet d'intérêt général pour la population. Elle est souvent considérée comme encore insuffisamment prise en charge. Type d'étude.-Enquête d'opinion réalisée par la remise d'un questionnaire pendant le Congrès national libanais d'anesthésie-réanimation qui s'est déroulé en mai 2006. Résultats.-Sur 230 questionnaires distribués aux participants venus de tout le Liban, 106 ont été recueillis. La prise en charge de la douleur aiguë postopératoire est différente dans les hôpitaux universitaires et dans les hôpitaux non universitaires. L'information préopératoire et l'évaluation de la douleur postopératoire ne sont réalisées que par 26 % des répondants. Une analgésie multimodale est commencée au bloc opératoire ou en salle de réveil pour 92 % des patients. Seulement 71 % des médecins anesthésistes disposent de pompes pour analgésie autocontrôlée par le patient. Des protocoles écrits d'analgésie postopératoire sont disponibles dans seulement 58 % des centres. Parmi les médecins, seulement 36 % ont une formation initiale et/ou continue sur la prise ne charge de la douleur postopératoire. L'obstacle majeur à l'amélioration de la prise en charge de la douleur reste le coût de ces traitements, qui est supporté par les patients. Conclusion.-Même s'il existe une bonne prise de conscience de l'importance de la prise en charge de la douleur aiguë postopératoire, des efforts importants restent à faire dans ce domaine.
Annales Françaises d'Anesthésie et de Réanimation, 1998