1,721,006 research outputs found
Response to Fu-Shan Xue's letter to the editor
No full textSerratus anterior plane block has been proposed to reduce opioid requirements after minimally invasive cardiac surgery, but high-quality evidence is lacking.The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors
Reply to: importance of accounting for repeated measure designs when evaluating treatment effects at multiple postoperative days
No full textEditor, We thank Huber M. and Wuetrhich P. (1) for their interest in our study (2) and we are happy to respond to their concerns. Patients in our study reported pain at rest and movement after ambulatory arthroscopic shoulder surgery in the group treated with metamizole, ibuprofen, and paracetamol (MIP) or in the group treated with ibuprofen and paracetamol, which was indeed evaluated at multiple time points i.e. the PACU and on postoperative days (POD) 1-4, 7, 14, 28 and 3 months after the surgery. We acknowledge the fact that the original analyses did not take into account the repeated measures and the longitudinal nature of the data. To address this issue, we have reanalyzed the data using a marginal mixed model for repeated measures (MMRM). This model incorporates treatment group, timepoint, and a treatment-by-timepoint interaction as fixed effects, with timepoint treated as a categorical variable. This approach allows us to model unstructured group-specific trends over time. We employed an unstructured variance-covariance matrix to account for the correlation between repeated measurements on the same patient. The assumptions of the model were assessed through residual and QQ plots, confirming that the model fits were satisfactory. Regarding statistical significance and methods of inference, we utilized the MMRM to estimate the least square mean differences between the Metamizole and Control group at each time point, accompanied by 95% confidence intervals and two-sided p-values for evaluating the null hypothesis of no treatment effect (Table 1). The primary outcome of this trial was the difference in pain scores at movement measured by an 11-point NRS (where 0=no pain and 10= worst imaginable pain) on POD1 between both groups. In the article, the following result was reported: mean difference (95%CI):-0.08 (-1.00, 0.84). In Table 1, we obtain similar results for POD1 with the MMRM approach. Moreover, we can conclude that there is not enough evidence to rejct the null hypothesis of no difference in pain score at movement between the Metamizole and Controle group. Furthermore, the least square means (LSmeans) obtained for the MMRM are calculated per time and group and are displayed in figure 1a, which is similar to the figure reported in the original article. However, in figure 1b, the response profiles per patient are added as requested by the rebuttal. We agree that including the patient trajectories over time in the corresponding figures are important t
Evaluation of patient-centered and clinical outcomes after minimally invasive cardiac surgery: an observational cohort study
No full textPerception and knowledge of anesthesia and the role of anesthesiologists : a Belgian single-center cross-sectional survey
No full textStudy Objective : To assess the knowledge of anesthesia and the role of anesthesiologists and evaluate the prevalence of concerns of certain risks of anesthesia and surgery in Belgian patients. Design : Observational mono-center cross-sectional survey. Setting : Preoperative patients planned for elective surgery in Jessa Hospital, Belgium. Interventions : An observational survey in Dutch. Measurements : Patient demographics and charac-teristics, perception of the patient of the expertise, role, and responsibility of the anesthesiologist, knowledge of the patient regarding anesthesia, and patients acute accent fear of specific risks and side effects of anesthesia and surgery. Associations were analyzed with the Pearson correlation coefficient or the Spearman rank's correlation coefficient. Main Results : In total 361 patients completed the survey. Patient demographics were as follows : 54.8% males, mean age (+/- SD) 58,84 +/- 16,38 years. Most patients (87.3%) recognized anesthesiologists as specially trained medical doctors but more than 50% underestimated their different perioperative responsibilities. Patients underestimated the dura-tion of education of an anesthesiologist in 84.2%. Their role at the intensive care unit (69.3%), the emergency department (71.2%), and the delivery room (71.2%) were relatively well known. Their role at the chronic pain management clinic (44.8%) and the preoperative anesthesia consultation (40.7%) was less well known. Some patients thought that general anesthesia frequently results in brain damage (22.7%). Older age and lower educational level were associated with lower knowledge. In general, 8.3% of all patients were very anxious about anesthesia, 22.7% somewhat, and 69% not at all. Female gender and lower educational level were positively correlated with a higher risk of fear. : Most patients in this single-center Belgian cohort were aware that anesthesiologists are specialized medical doctors. Overall, the patient acute accent s knowledge of the anesthesiologist's expertise and responsibilities and anesthesia was rather limited.This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital
Evaluation of patient-centered and clinical outcomes after minimally invasive cardiac surgery: an observational cohort study
No full textPerception and knowledge of anesthesia and the role of anesthesiologists : a Belgian single-center cross-sectional survey
No full textStudy Objective : To assess the knowledge of anesthesia and the role of anesthesiologists and evaluate the prevalence of concerns of certain risks of anesthesia and surgery in Belgian patients. Design : Observational mono-center cross-sectional survey. Setting : Preoperative patients planned for elective surgery in Jessa Hospital, Belgium. Interventions : An observational survey in Dutch. Measurements : Patient demographics and charac-teristics, perception of the patient of the expertise, role, and responsibility of the anesthesiologist, knowledge of the patient regarding anesthesia, and patients acute accent fear of specific risks and side effects of anesthesia and surgery. Associations were analyzed with the Pearson correlation coefficient or the Spearman rank's correlation coefficient. Main Results : In total 361 patients completed the survey. Patient demographics were as follows : 54.8% males, mean age (+/- SD) 58,84 +/- 16,38 years. Most patients (87.3%) recognized anesthesiologists as specially trained medical doctors but more than 50% underestimated their different perioperative responsibilities. Patients underestimated the dura-tion of education of an anesthesiologist in 84.2%. Their role at the intensive care unit (69.3%), the emergency department (71.2%), and the delivery room (71.2%) were relatively well known. Their role at the chronic pain management clinic (44.8%) and the preoperative anesthesia consultation (40.7%) was less well known. Some patients thought that general anesthesia frequently results in brain damage (22.7%). Older age and lower educational level were associated with lower knowledge. In general, 8.3% of all patients were very anxious about anesthesia, 22.7% somewhat, and 69% not at all. Female gender and lower educational level were positively correlated with a higher risk of fear. : Most patients in this single-center Belgian cohort were aware that anesthesiologists are specialized medical doctors. Overall, the patient acute accent s knowledge of the anesthesiologist's expertise and responsibilities and anesthesia was rather limited.This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital
Evaluation of patient-centered and clinical outcomes after minimally invasive cardiac surgery: an observational cohort study
No full textBacterial surinfection and venous thromboembolism in critically ill ICU patients with COVID-19: What is the relationship
No full textstatus: Publishe
Addition of nitrous oxide and oxygen to carbon dioxide pneumoperitoneum during laparoscopic surgery for pain reduction: A double-blinded randomized controlled trial
No full textObjective: To examine if peritoneal conditioning with an altered insufflation gas mixture is associated with reduced postoperative pain intensity compared to the standard insufflation gas (i.e., 100% CO2). Design: A prospective, single-centre, randomized, double-blind, superiority trial was performed. Setting: This study was conducted between 4 April 2019 and 10 February 2022 at the Jessa Hospital, Hasselt, Belgium. Population: Patients scheduled for elective gynaecologic laparoscopic surgery. Methods: Seventy-four patients scheduled for elective gynaecologic laparoscopic surgery were randomised to receive either the standard insufflation gas with 100 CO2 (n = 37; control group) or the altered gas mixture of 86% CO2, 10% N2O and 4% O-2 (n = 37; experimental group). Main Outcome Measures: Postoperative pain was assessed at 4, 8 and 24 hours after surgery and on postoperative day (POD) 7 by an 11-point Numeric Rating Scale, with 0 indicating no pain and 10 indicating worst imaginable pain. Results: No significant differences were found between the control and experimental groups regarding postoperative pain at 4, 8 and 24 h after surgery, as well as on POD7. In addition, the median (25% and 75%) total amount of IV piritramide consumption during the first 24 h after surgery was not significantly different between groups (control group: 18.0 [10.0, 27.0] mg vs. experimental group: 17.0 [10.0, 34.0] mg, p = 0.62). Conclusion: The alternative insufflation gas mixture comprising 86% CO2, 10% N2O and 4% O-2 used for the pneumoperitoneum during gynaecologic laparoscopic surgery does not appear to reduce postoperative pain compared to the standard insufflation gas of 100% CO2
Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery.
No full textBACKGROUND: Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting. OBJECTIVES: The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery. METHODS: The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4. RESULTS: Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent. CONCLUSIONS: Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.status: Published onlin
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