1,721,195 research outputs found
Das Stellungsverhalten unbetonter Pronomina im Mittelfeld im Deutschen und im Niederländischen
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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
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
Non-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
Labour epidural analgesia and anti-infectious management of the neonate: a meta-analysis
No full textBackground: A known side effect of labour epidural analgesia (EDA) is maternal fever. It is unclear whether this has effects on the anti-infectious management of the neonate. Methods: A systematic literature search and a hand search of abstract publications were conducted. Studies reporting sepsis evaluation or antibiotic treatment were further assessed. For meta-analysis, risk ratio (RR) and 95% confidence interval (CI) were calculated using the random effects model. Results: Five relevant articles reporting on 4667 parturients were identified; three were observational studies and two were randomised controlled trials (RCT). The RR for sepsis workup of all studies analysed together was 2.58 (95% CI, 1.06-6.27, P = 0.04). The RR for antibiotic treatment of the neonate was 2.76 (95% CI, 1.20-6.31, P = 0.02). When considering the RCTs alone, the RRs for sepsis evaluation and antimicrobial treatment were still significantly elevated. Discussion: Our data suggest that EDA-related maternal hyperthermia results in an increased likelihood of sepsis workup and antibiotic treatment of the infant. A crucial question is whether EDA-related maternal hyperthermia is truly infectious. If not, administration of antibiotics would not be justified and may be dangerous
Insertion of an intrathecal catheter following accidental dural puncture: a meta-analysis
No full textBackground: Inserting an intrathecal catheter after accidental dural puncture in parturients to prevent postdural puncture headache is becoming increasingly popular. We aimed to identify relevant published articles investigating this intervention and subject data to a meta-analysis. Methods: A systematic literature search was performed, paralleled by a hand search of abstract publications. Studies that reported. the dichotomous outcome parameters postdural puncture headache or need for an epidural blood patch were considered eligible. Risk ratios with 95% confidence intervals were calculated. Results: We identified nine reports investigating placement of intrathecal catheters after accidental dural puncture. The risk ratio for an epidural blood patch after intrathecal catheter insertion was 0.64 (95% CI 0.49-0.84, P = 0.001). The risk ratio for postdural puncture headache was 0.82 (95% CI 0.67-1.01, P = 0.06). Discussion: Inserting an intrathecal catheter significantly reduced the risk for an epidural blood patch; the incidence of postdural puncture headache was reduced but not significantly. Accidental dural puncture is a rare complication and therefore trials on intervention need to include a large number of patients which is time-consuming and costly. Intrathecal catheterisation is a promising approach for the prevention of postdural puncture headache and should be evaluated further. This intervention has additional benefits including a reduced risk of repeat dural puncture, rapid onset of action and use for anaesthesia. (C) 2012 Elsevier Ltd. All rights reserved
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
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Concerning the timing of antibiotic administration in women undergoing caesarean section: a systematic review and meta-analysis
No full textObjective To assess the effects on maternal infectious morbidity and neonatal outcomes of the timing of antibiotic prophylaxis in women undergoing caesarean section. A recent National Institute for Health and Clinical Excellence (NICE) guideline reported that antibiotic administration before skin incision reduces the risk of maternal infection; this recommendation was based on a meta-analysis, however one including trials that were not double blind and not including a trial published recently. Design Systematic review and meta-analysis. Data sources Searches of PubMed and EMBASE and reference lists of the retrieved articles. Inclusion criteria Randomised double-blind controlled trials comparing the administration of antibiotics before skin incision with administration after cord clamping. Data extraction and analysis Data on maternal total infectious morbidity, endometritis and wound infection, as well as neonatal intensive care unit admission, neonatal infection and neonatal sepsis were extracted and combined using random effects meta-analysis. Results Five studies reporting on 1777 parturients were included in our systematic review. The relative risk (RR) for maternal total infectious morbidity for antibiotic administration before incision compared with antibiotic administration after cord clamping was 0.64 (95% CI 0.36 to 1.15). Likewise, there was no difference in the risk of wound infection (RR 0.72, 95% CI 0.41 to 1.27). Parturients receiving the antibiotic preoperatively had a significantly reduced risk of endometritis (RR 0.48, 95% CI 0.27 to 0.87; number needed to treat 41, 95% CI 23 to 165). Analyses of the neonatal outcome parameters revealed no differences between the regimens of antibiotic administration, but were based on few studies. Conclusions In contrast to a recent NICE guideline, we did not find a reduction in total infectious morbidity with antibiotic administration before skin incision; we confirmed a reduction in the risk of endometritis and a lack of effect on the risk for wound infection
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