Abstract Background: Patients beginning cancer treatment consistently list chemotherapy- induced nausea and vomiting as one of their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life for patients, increases the use of health care resources and may occasionally compromises adherence to treatment. The goal of this study was to evaluate the effectiveness of gabapentin, in prevention of delayed chemotherapy induced nausea, vomiting and neuropathic pain in cancer patients receiving highly and moderatly emetogenic chemotherapy. Patients and methods: 125 chemotherapy-naive cancer patients, who were scheduled to receive moderately and highly emetogenic chemotherapy were enrolled in the study. Patients were stratified according to gender, age and they were allocated to one of three groups: Group І: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24 mg on day1 and oral gabapentin300mg once daily on day2 through 6 of chemotherapy. Group п: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1, and oral prochlorperazine (Emedrotec) 3mg twice daily on day 2 through 6 of chemotherapy. Group ш: received 20 mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1 and oral ondansetron (Zofran) 8mg daily on day2 through 6. The average severity of nausea and vomiting during days 2 to 6 after chemotherapy was assessed for every patient, using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and this assessment was repeated for every chemotherapy cycle for 6 cycles. Results: The reported average severity of nausea during cycle 1, 2, 3, 6 was lower in patients receiving ondansetron and gabapentin compared to emedrotec (p0.05). As regard average severity of vomiting scores there was significant decrease in vomiting scores in patients received either gabapentin or ondansetrone in cycles 2,3,4,5,6 compared to patients received emedrotec (p0.05). A percentage of patients required rescue medication to alleviate CINV during the study period, 8(19.5%) patients taking ondansetrone compared with 10 (24.3%) patients in the gabapentin group and 17(39.5%) patients in the Emedrotec group. Rescue medication used was ondansetron (zofran) 24 mg IV. Inter groups comparison for the DN4 during the 6 cycles showed significant reduction in the gabapentin group compared to both emedrotec and ondansetrone groups (p0.05). The incidence of neuropathic pain (DN4 ≥ 4) was significantly reduced in gabapantin group in the 3rd cycle compared to emedrotec and ondansetrone groups (p =0.048). Conclusion: Gabapentin is a useful drug for the management of delayed chemotherapy- induced nausea and vomiting and it also reduced incidence of chemotherapy-induced neuropathic pain.

Abstract Background: Patients beginning cancer treatment consistently list chemotherapy- induced nausea and vomiting as one of their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life for patients, increases the use of health care resources and may occasionally compromises adherence to treatment. The goal of this study was to evaluate the effectiveness of gabapentin, in prevention of delayed chemotherapy induced nausea, vomiting and neuropathic pain in cancer patients receiving highly and moderatly emetogenic chemotherapy. Patients and methods: 125 chemotherapy-naive cancer patients, who were scheduled to receive moderately and highly emetogenic chemotherapy were enrolled in the study. Patients were stratified according to gender, age and they were allocated to one of three groups: Group І: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24 mg on day1 and oral gabapentin300mg once daily on day2 through 6 of chemotherapy. Group п: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1, and oral prochlorperazine (Emedrotec) 3mg twice daily on day 2 through 6 of chemotherapy. Group ш: received 20 mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1 and oral ondansetron (Zofran) 8mg daily on day2 through 6. The average severity of nausea and vomiting during days 2 to 6 after chemotherapy was assessed for every patient, using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and this assessment was repeated for every chemotherapy cycle for 6 cycles. Results: The reported average severity of nausea during cycle 1, 2, 3, 6 was lower in patients receiving ondansetron and gabapentin compared to emedrotec (p0.05). As regard average severity of vomiting scores there was significant decrease in vomiting scores in patients received either gabapentin or ondansetrone in cycles 2,3,4,5,6 compared to patients received emedrotec (p0.05). A percentage of patients required rescue medication to alleviate CINV during the study period, 8(19.5%) patients taking ondansetrone compared with 10 (24.3%) patients in the gabapentin group and 17(39.5%) patients in the Emedrotec group. Rescue medication used was ondansetron (zofran) 24 mg IV. Inter groups comparison for the DN4 during the 6 cycles showed significant reduction in the gabapentin group compared to both emedrotec and ondansetrone groups (p0.05). The incidence of neuropathic pain (DN4 ≥ 4) was significantly reduced in gabapantin group in the 3rd cycle compared to emedrotec and ondansetrone groups (p =0.048). Conclusion: Gabapentin is a useful drug for the management of delayed chemotherapy- induced nausea and vomiting and it also reduced incidence of chemotherapy-induced neuropathic pain.

ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine

ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine

ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine

ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine

Abstract Neuraxial opioids provide excellent postoperative analgesia, but their use is associated with a frequent incidence of troublesome side effect such as pruritus, nausea and vomiting. The aim of this study was to evaluate the efficacy of intrathecal nalpuphine alone or combined with magnesium sulphate on postoperative analgesia after major abdominal cancer surgery. Ninety patients randomly assigned into three groups 30 patients each; group control received intrathecal 1ml saline 0.9% , group nalpuphine received intrathecal 0.8 mg nalpuphine and group nalpuphine+ received 0.8 mg nalpuphine + 100 mg magnesium sulphate 10% . Patients were monitored for vital signs ( heart rate, non invasive blood pressure , SaO2 and respiratory rate) , pain severity , sedation score , time to first request of rescue analgesic , total analgesic consumption and incidence of side effects were recorded in the first 24 hours postoperative. The mean VAS scores immediately and at 2,4,6,12 and 18 hours postoperative were significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). The time to first rescue analgesic requirement was significantly prolonged in nalpuphine and nalpuphine+ groups compared to control group (p=0.001). The mean total consumption of tramadole IV rescue analgesia significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). There was no significant difference in the incidence of adverse effect in the three groups. Intrathecal 0.8 mg nalpuphine alone or combined with intrathecal 100 mg magnesium sulphate improved the quality and the duration of post operative analgesia also provide an analgesic sparing effect without increasing the incidence of adverse effects.

Abstract Neuraxial opioids provide excellent postoperative analgesia, but their use is associated with a frequent incidence of troublesome side effect such as pruritus, nausea and vomiting. The aim of this study was to evaluate the efficacy of intrathecal nalpuphine alone or combined with magnesium sulphate on postoperative analgesia after major abdominal cancer surgery. Ninety patients randomly assigned into three groups 30 patients each; group control received intrathecal 1ml saline 0.9% , group nalpuphine received intrathecal 0.8 mg nalpuphine and group nalpuphine+ received 0.8 mg nalpuphine + 100 mg magnesium sulphate 10% . Patients were monitored for vital signs ( heart rate, non invasive blood pressure , SaO2 and respiratory rate) , pain severity , sedation score , time to first request of rescue analgesic , total analgesic consumption and incidence of side effects were recorded in the first 24 hours postoperative. The mean VAS scores immediately and at 2,4,6,12 and 18 hours postoperative were significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). The time to first rescue analgesic requirement was significantly prolonged in nalpuphine and nalpuphine+ groups compared to control group (p=0.001). The mean total consumption of tramadole IV rescue analgesia significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). There was no significant difference in the incidence of adverse effect in the three groups. Intrathecal 0.8 mg nalpuphine alone or combined with intrathecal 100 mg magnesium sulphate improved the quality and the duration of post operative analgesia also provide an analgesic sparing effect without increasing the incidence of adverse effects.

Novelty and Impact: This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed in toxicity and the outcome. Background: The effect of hepatitis C virus (HCV) infection on prognosis and hepatic toxicity in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era is unclear. The treatment and the outcome of patients with DLBCL and HCV infection are still a matter of debate. Methods: We analyzed 137 DLBCL patients positive to HCV, treated with chemotherapy regimens include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) ± rituximab. Survival outcomes and hepatic toxicity were compared in DLBCL patients positive to HCV infection according to CHOP ± rituximab. Result: Our result showed that the group of patients treated with R-CHOP has significant high incidence of hepatic toxicity grade (3–4) (28 vs. 18%, P value 0.001) and worse progression-free survival (55 vs. 80%, P value 0.002) in comparison with the group treated with CHOP, and also there is significant difference between both groups in overall survival. This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed significant differences. Conclusion:We conclude that HCV-positive patients with DLBCL treated with rituximab plus CHOP have high incidence in hepatic toxicity. Specific protocols evaluating antiviral therapy should be designed for these patients

Novelty and Impact: This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed in toxicity and the outcome. Background: The effect of hepatitis C virus (HCV) infection on prognosis and hepatic toxicity in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era is unclear. The treatment and the outcome of patients with DLBCL and HCV infection are still a matter of debate. Methods: We analyzed 137 DLBCL patients positive to HCV, treated with chemotherapy regimens include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) ± rituximab. Survival outcomes and hepatic toxicity were compared in DLBCL patients positive to HCV infection according to CHOP ± rituximab. Result: Our result showed that the group of patients treated with R-CHOP has significant high incidence of hepatic toxicity grade (3–4) (28 vs. 18%, P value 0.001) and worse progression-free survival (55 vs. 80%, P value 0.002) in comparison with the group treated with CHOP, and also there is significant difference between both groups in overall survival. This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed significant differences. Conclusion:We conclude that HCV-positive patients with DLBCL treated with rituximab plus CHOP have high incidence in hepatic toxicity. Specific protocols evaluating antiviral therapy should be designed for these patients