1,721,015 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
Comments on: “Wide awake local anesthesia no tourniquet (WALANT) versus axillary brachial plexus block for carpal tunnel release: Care pathways and operating room costs” by B. Boukebous, C. Maillot, L.C. Castel, J. Donadio, P. Boyer, M.A. Rousseau, published in Orthop Traumatol Surg Res 2022;103358
No full textstatus: Publishe
Regional anaesthesia for ambulatory surgery
No full textRegional anaesthesia (RA) has an important and ever-expanding role in ambulatory surgery. Specific practices vary depending on the preferences and resources of the anaesthesia team and hospital setting. It is used for various purposes, including as primary anaesthetic technique for surgery but also as postoperative analgesic modality. The limited duration of action of currently available local anaesthetics limits their application in postoperative pain control and enhanced recovery. The search for the holy grail of regional anaesthetics continues. Current evidence suggests that a peripheral nerve block performed with long-acting local anaesthetics in combination with intravenous or perineural dexamethasone gives the longest and most optimal sensory block. In this review, we outline some possible blocks for ambulatory surgery and additives to perform RA. Moreover, we give an update on local anaesthesia drugs and adjuvants, paediatric RA in ambulatory care and discuss the impact of RA by COVID-19.(c) 2022 Elsevier Ltd. All rights reserved.This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors
Perception 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
The Effect of a Handheld Game (HospiAvontuur) on Preoperative Anxiety, Induction Compliance, Postoperative Emergence Delirium, and Pain Among Young Children Undergoing Otorhinolaryngological Surgery: A Pilot Study.
No full textEvaluation of patient-centered and clinical outcomes after minimally invasive cardiac surgery: an observational cohort study
No full textNon-pharmacological sedation techniques: The role of hypnosis, virtual reality, and other strategies
No full textNon-pharmacological sedation techniques are increasingly recognised as valuable adjuncts in modern perioperative care. This narrative review explores the clinical applications of hypnosis, virtual reality, music therapy, aromatherapy, and mindfulness-based interventions in various settings, including regional anaesthesia, paediatrics, obstetrics, and ambulatory surgery. These strategies aim to reduce perioperative anxiety, enhance patient comfort, and lower reliance on pharmacological sedatives. Hypnosis and virtual reality are supported by growing evidence from randomised trials, while simpler interventions such as music and aromatherapy are easily implementable with minimal training. Mindfulness and breathing exercises show promise but remain underexplored in anaesthesia-specific settings. Successful implementation requires selecting appropriate patients, developing effective protocols, and providing staff education. These techniques are most effective when used as part of a multimodal approach to sedation. Further research is needed to assess long-term outcomes, cost-effectiveness, and standardisation across institutions. Non-pharmacological sedation offers a patient-centred, low-risk contribution to safe and personalised anaesthesia care. Their use during procedural sedation, either as standalone strategies or in combination with pharmacological agents, is increasingly recognised across a range of interventional and diagnostic settings.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector
Costing of perioperative intravenous paracetamol and ketorolac therapy in a tertiary Belgian hospital and the economic effect of an adjusted approach in pain therapy
No full textGoal of study: Belgium spends 10% of its annual Gross Domestic Product on healthcare expenditure. To economize healthcare, cost-effectiveness analyses gain importance. A recent systematic review found that the perioperative route of paracetamol administration, intravenous vs. oral, did not affect pain or any other postoperative outcome 1. Several studies investigating the analgesic efficacy of different doses of ketorolac in an emergence 2 or perioperative 3 setting failed to demonstrate superiority of a dosing of 30mg over 10mg. In the JESSA hospital, a large tertiary hospital with over 30.000 annual surgical procedures, preoperatively administered intravenous paracetamol and ketorolac 30mg are standard of care in the prevention and treatment of perioperative pain. Our goal was to evaluate the total cost and to calculate the cost reduction of an alternative treatment regimen comprising oral paracetamol and intravenous ketorolac 10mg. Material and Methods: We performed a retrospective observational financial analysis. We reviewed the annual consumption of intravenous paracetamol and ketorolac 10mg at the operating theatre. We also reviewed the total cost price of ketorolac, oral and intravenous paracetamol prescribed for an hospitalized patient in Belgium and subsequently clarified which part are chargeable to the national health insurance, the hospital and the patient. Finally, we calculated the estimated cost reduction in all patients at the operating theatre department and of implementation of this adjusted therapy in half of all other patients admitted to the JESSA hospital. Results: The annual consumption is presented in table 1. The total cost of analgesic drugs is presented in table 2. The estimated cost reduction of the alternative regimen at the operating theatre and the rest of the hospital is 44.914 euro and 75.185 euro, respectively, resulting in a potential cost reduction of 120.099 euro. Conclusion: Implementation of an alternative analgesic treatment regimen would provide a significant cost reduction
Perception 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
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