S152 European Journal of Pain 2006, Vol 10 (suppl S1) Abstracts, 5th EFIC Congress, Free Presentations

Results: Patients were evaluated 28 days after IR. Major improvement ofthe range of shoulder motion was observed in 68 patients (56%). Morethan 50% reduction of pain in VAS was observed in 94 patients (78%).In the next four weeks 102 patients were able to return back to work.Pain symptoms worsened in 12 patients (4.8%). No serious complicationsoccurred.Conclusions: Targeted IR enables us to specificaly disrupt painful per-ception and modulate reactivity of sympathetic nerves which supplyconnective tissue. We conclude that IR improves results in non-respondersto conservative kinesiotherapy.

577EFFICACY OF TRANSASCROCOCCYGEAL GANGLION IMPARBLOCKADE IN PERINEAL PAIN FROM CANCER RECTUM

A. Ghoneim°. Anaesthesia and Pain relief, National Cancer Institute –Cairo University, Cairo, Egypt

Background and Aim: The ganglion impar is the lowest ganglion ofthe paravertebral sympathetic chain. Its blockade is indicated in visceralpain syndromes and/or sympathetic pain syndromes of the perineal region.Several approaches to this block have been described, mainly through theanococcygeal or sacrococcygeal ligaments.This study was conducted to evaluate the efficacy of neurolytic transdiscalapproach to ganglion impar in 30 patients suffering from intractableperineal pain from cancer rectum.Methods: Patients were randomly divided into two groups; classic group(group C, n = 15) were treated with the bent needle technique for ganglionimpar block, whereas the ganglion impar blockade for the patients intranssacrococcygeal group (group T, n = 15) had been achieved througha straight spinal needle passed directly through the sacrococcygeal disc.Results The VAS values, morphine consumption and patient satisfactionscores showed significant decrease at 24 h and one month after theblock when compared to those prior the block. There was no significantdifference between both groups at the same studied time period regardingthe VAS and daily morphine consumption. However, the mean patientsatisfaction score at 24 hrs after the block in group T was statisticallysignificant lower than that in group C at the same period, meanwhile,there was no statistically significant difference between both groups atone month after the block.Conclusion: The ganglion impar block through sacrococcygeal junctionappears to be safe and effective procedure in the management of perinealpain related to malignancy.

578FIRST-NEURON BLOCKADE WITH MULTIPLE MEPIVACAINEINFILTRATIONS IN THE TREATMENT OF SEVEREREFRACTORY CHRONIC NON-CANCER PAIN: ARETROSPECTIVE STUDY

J. Hidalgo°, E.P. Calandre, F. Rico-Villademoros, J.M. Garcı́a-Leiva.Instituto De Neurociencias, Universidad De Granada, Granada, Spain

Background and Aims: Refractory non-malignant chronic pain is highlyprevalent and disabling, representing a challenge for the physician. Infil-tration techniques have shown to be useful in the treatment of myofascialpain syndromes. Our objective was to retrospectively evaluate efficacy andtolerability of mepivacaine injections in patients suffering severe treatment-refractory chronic pain, mostly fibromyalgia, temporomandibular disorder,chronic headache, and neuropathic pain.Methods: We evaluated 50 refractory patients referred from other medicalservices. Patients had been treated between May of 1998 and May of 2003receiving a series of 3% mepivacaine infiltrations, in doses ranging from0.4−8 millilitres in a “following the pain” approach until achieving themaximum possible relief. Pharmacological prescribed therapies remainedunchanged. Patients’ assessment was done at least one year after their lastvisit by means of two VAS, recording the difference between initial andcurrent pain level. A Patient Global Improvement Scale (PGI) was usedto asses the overall improvement degree related with injections.

Results: According to PGI, 17 (34%) patients reported very much im-provement due to the infiltrations, 24 (48%) reported much improvement,and 7 (14%) patients reported mild improvement; only 2 (4%) patientsreported no change, and no patient reported worsening. According to theVAS data 41 patients (82%) reported an improvement �50%. Adverseeffects were mild and included post injection pain and soreness, littlehaematoma or reactive muscle contraction.Conclusions: Our data suggest that peripheral infiltration series constitutea valid, safe and long-lasting complementary technique in the managementof severe and treatment-refractory chronic pain.

579GREAT OCCIPITAL NERVE BLOCKADE (GONB) –INFILTRATION OF TRIGGER POINTS (TPS) OF CERVICALMUSCLES IN PATIENTS (PTS) WITH OCCIPITAL NEURALGIA(ON)

I. Kouroukli °, S. Xadjilia, V. Zobolas, T. Papavassilopoulou, A. Papadima,F. Kostopoulou, V. Tsirtsiridou, L. Georgiou. Hippocratio GeneralHospital, Athens, Greece

Aim: To determine the effectiveness of GONB combined with infiltrationof TPs of cervical muscles in pts with ON caused by cervicogenic headacheor tension headache.Materials: 25 pts (16 female-9 male) aged 39−64 years (54±7) withsymptoms of ON over a period of six months. All pts had occasionallyreceived painkillers with partial improvement. Pts were submitted tounilateral blockade of the GON with 10ml ropivacaine 0.75% and 12mgbetamethasone in two weekly sessions and infiltration of TPs of thecervical muscles with procaine 0.5%. Pain inensity was recorded usingVisual Analogue Scale (VAS) before (vasprin), one week (vasmet) andtwo months (vasfin) after completion of the treatment, pts satisfaction(unsatisfied: 1, satisfied: 2, moderately satisfied: 3, very satisfied: 4), theinfluence of the pts age on pain score after the treatment, the consumptionof analgesics before and after completion of the treatment. Paired t-testand one-way ANOVA was used for statistical analysis (p< 0.05).Results: We found a statistical significant reduction in vasmet(1.07±0.688) and vasfin (2.42±1.17) (p< 0.001) in comparison withvasprin (7.73±0.96) but with no significant difference between vasmetand vasfin. All pts were moderately and very satisfied from the treatment.The age of the pts did not seem to influence their response to treatment.Consumption of analgesics significantly decreased after the treatment. Nocomplications were recorded.Conclusions: GONB with simultaneous infiltration of TPs in cervicalmuscles is a safe and effective treatment for dealing with ON.

580LONG-TERM RESULTS OF TREATMENT WITH CONTINUOUSREGIONAL ANALGESIA FOR COMPLEX REGIONAL PAINSYNDROME

K. Margic1 °, J. Pirc2. 1Department of Plastic and ReconstructiveSurgery, 2Department of Anesthesiology and Intensive Care, GeneralHospital, Sempeter pri Gorici, Slovenia

Background: Retrospective analysis to evaluate the long-term results oftreatment of complex regional pain syndrome (CRPS) with continuousregional analgesia (CRA) of brachial plexus.Methods: 23 patients, 5 men and 18 women between 42 and 84 years withthe mean age of 60 suffering from CRPS type I involving upper extremitywere treated with CRA, intensive physiotherapy and local injections intoall painful points. CRA was maintained for seven days with intermittentboluses of bupivacaine. The local anesthetic concentration and volumewere titrated to achieve sensory analgesia and to leave motor functionunaffected. Mean time from injury to treatment was 3.5 (range 1−7)months and mean hospitalization stay was 15 (range 7−30) days. Atfollow-up, ranging from 10 to 72 with the mean of 37 months, pain wasmeasured using numeric pain scale from 0 to 10. Sympathetic activity wasvisually delineated comparing both hands while range of motion (ROM)