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Boulton AJ, Smith E, Yasin A, Moreton J, Mendonca C. Tracheal tube introducer-associated airway trauma: a systematic review. Anaesthesia 2024; 79:1091-1101. [PMID: 39073144 DOI: 10.1111/anae.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Tracheal tube introducers are recommended in airway management guidelines and are used increasingly as videolaryngoscopy becomes more widespread. This systematic review aimed to summarise the published literature concerning tracheal tube introducer-associated airway trauma. METHODS PubMed, EMBASE and CINAHL databases were searched using pre-determined criteria. Two authors independently assessed search results and performed data extraction and risk of bias assessments. RESULTS We included 16 randomised controlled trials and five observational studies involving 10,797 patients. There was heterogeneity in patient characteristics, airway manipulation, and airway trauma definition and measurement. One study investigated hyperangulated videolaryngoscopy. The standard stylet was the most commonly reported introducer, followed by bougie and stylets with additional features such as video or lighted tip. Airway trauma resulted in low harm and most frequently involved injuries to the upper airway, followed by laryngeal and tracheobronchial injuries. Eighteen studies were comparative and reported a reduction in airway trauma incidence when an introducer was used, with the exception of the standard stylet. Median (IQR [range]) pooled incidence of airway trauma associated with standard stylets was 13.1% (4.2-31.4 [0.5-79.2])% and with bougies was 5.4% (0.4-49.9 [0.0-68.0])%. The risk of bias of included studies was variable and many randomised trials were found to be at high risk due to non-robust measurement of the outcome. CONCLUSIONS Stylets might be associated with an increased risk of airway trauma compared with other devices or when no stylet was used, though the quality of evidence is modest. However, other introducers appear to be safe and reduce the risk of airway trauma.
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Affiliation(s)
- Adam J Boulton
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Edward Smith
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ambreen Yasin
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Joseph Moreton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Cyprian Mendonca
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Çelik SŞ, Mert S, Arslan HN. The Effect of Cold Oral Applications in the Management of Postoperative Thirst: A Systematic Review. J Perianesth Nurs 2024; 39:907-914. [PMID: 38556965 DOI: 10.1016/j.jopan.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 04/02/2024]
Abstract
PURPOSE Thirst is one of the most bothersome symptoms experienced by surgical patients. Effective thirst intervention and management in the Post Anesthesia Care Unit (PACU) and hospital wards is critical because patients are less sedated and more aware than in the past. There is a need to review the literature on the identification and management of thirst in the inpatient and PACU settings. The aim of this systematic review was to examine the available evidence on the effectiveness of oral cold applications on thirst in postoperative patients. DESIGN This was a systematic review study. Articles in PUBMED, Web of Science, ScienceDirect, TÜBİTAK-ULAKBİM, and TRDizin databases between January 2008 and January 2023 that included oral cold applications to relieve the thirst of patients in the postoperative period were included. METHODS The PICOT-SD (Patients Interventions Comparison Outcome Time-Study Design) method was used as an eligibility criterion for inclusion in the study. The eligibility criteria included that the articles were written in English-Turkish and within the target dates, the studies included nursing interventions, the primary outcome of the studies was thirst, and the study sample included postoperative patients. The risk of bias was assessed using the RoB2 tool developed by Cochrane. FINDINGS A total of 254 articles were retrieved from the databases using the specified keywords. 244 articles did not meet the study criteria: 30 were excluded because they were not interventional studies, 61 were not conducted in a postoperative population, 56 were duplicates, and 79 were not on a related topic. A total of 10 studies consisting of randomized controlled trials and quasi-experimental articles met the criteria for our review. Oral cold applications effectively reduced the thirst rate of postoperative patients and improved their health-related quality of life. The intervention has also been shown to reduce other anesthesia-related complications. CONCLUSIONS This systematic review concluded that cold oral applications have promising effects on thirst, dry mouth, and health-related quality of life. Cold oral applications are cost-effective and suitable for large-scale health care applications.
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Affiliation(s)
| | - Sabiha Mert
- Istanbul Galata University, Vocational School, Anesthesia Program, Istanbul, Turkey
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El-Boghdadly K, Levy NA, Fawcett WJ, Knaggs RD, Laycock H, Baird E, Cox FJ, Eardley W, Kemp H, Malpus Z, Partridge A, Partridge J, Patel A, Price C, Robinson J, Russon K, Walumbe J, Lobo DN. Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. Anaesthesia 2024. [PMID: 39319373 DOI: 10.1111/anae.16391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Nearly half of adult patients undergoing surgery experience moderate or severe postoperative pain. Inadequate pain management hampers postoperative recovery and function and may be associated with adverse outcomes. This multidisciplinary consensus statement provides principles that might aid postoperative recovery, and which should be applied throughout the entire peri-operative pathway by healthcare professionals, institutions and patients. METHODS We conducted a directed literature review followed by a four-round modified Delphi process to formulate recommendations for organisations and individuals. RESULTS We make recommendations for the entire peri-operative period, covering pre-admission; admission; intra-operative; post-anaesthetic care unit; ward; intensive care unit; preparation for discharge; and post-discharge phases of care. We also provide generic principles of peri-operative pain management that clinicians should consider throughout the peri-operative pathway, including: assessing pain to facilitate function; use of multimodal analgesia, including regional anaesthesia; non-pharmacological strategies; safe use of opioids; and use of protocols and training for staff in caring for patients with postoperative pain. CONCLUSIONS We hope that with attention to these principles and their implementation, outcomes for adult patients having surgery might be improved.
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Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Nicholas A Levy
- Department of Anaesthesia and Perioperative Medicine, West Suffolk NHS Foundation Trust, Suffolk, UK
| | - William J Fawcett
- Department of Anaesthesia and Pain Medicine, Royal Surrey NHS Foundation Trust, Surrey, UK
- School of Medicine, University of Surrey, Guildford, UK
| | - Roger D Knaggs
- School of Pharmacy, Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Helen Laycock
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital, London, UK
| | - Emma Baird
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Felicia J Cox
- Pain Management Service, Critical Care and Anaesthesia, Royal Brompton and Harefield Hospitals (part of Guy's and St Thomas' NHS Foundation Trust), London, UK
| | - Will Eardley
- Department of Orthopaedics and Trauma, James Cook University Hospital, Middlesbrough, UK
| | - Harriet Kemp
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zoey Malpus
- Manchester NHS Pain Service, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Judith Partridge
- Department of Peri-operative Care for Older People Undergoing Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anjna Patel
- Department of Pre-operative Assessment, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Cathy Price
- Pain Management, Department of Chronic Pain, Solent NHS Trust, UK
| | | | - Kim Russon
- Department of Anaesthesia, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Jackie Walumbe
- Department of Physiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kummer I, Lüthi A, Klingler G, Andereggen L, Urman RD, Luedi MM, Stieger A. Adjuvant Analgesics in Acute Pain - Evaluation of Efficacy. Curr Pain Headache Rep 2024; 28:843-852. [PMID: 38865074 PMCID: PMC11416428 DOI: 10.1007/s11916-024-01276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF THE REVIEW Acute postoperative pain impacts a significant number of patients and is associated with various complications, such as a higher occurrence of chronic postsurgical pain as well as increased morbidity and mortality. RECENT FINDINGS Opioids are often used to manage severe pain, but they come with serious adverse effects, such as sedation, respiratory depression, postoperative nausea and vomiting, and impaired bowel function. Therefore, most enhanced recovery after surgery protocols promote multimodal analgesia, which includes adjuvant analgesics, to provide optimal pain control. In this article, we aim to offer a comprehensive review of the contemporary literature on adjuvant analgesics in the management of acute pain, especially in the perioperative setting. Adjuvant analgesics have proven efficacy in treating postoperative pain and reducing need for opioids. While ketamine is an established option for opioid-dependent patients, magnesium and α2-agonists have, in addition to their analgetic effect, the potential to attenuate hemodynamic responses, which make them especially useful in painful laparoscopic procedures. Furthermore, α2-agonists and dexamethasone can extend the analgesic effect of regional anesthesia techniques. However, findings for lidocaine remain inconclusive.
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Affiliation(s)
- Isabelle Kummer
- Department of Anesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
| | - Andreas Lüthi
- Department of Anesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Gabriela Klingler
- Department of Anesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Markus M Luedi
- Department of Anesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Stieger
- Department of Anesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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Watanabe Y, Nikaido T, Yabuki S, Abe J, Suzuki H, Shishido K, Kobayashi H, Yoshida R, Iinuma K, Nagamine S, Ono Y, Sato M, Oi N. Gender differences on preoperative psychologic factors affecting acute postoperative pain in patients with lumbar spinal disorders. J Orthop Sci 2024; 29:1174-1178. [PMID: 37838597 DOI: 10.1016/j.jos.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Psychosexual factors are one of the preoperative factors influencing acute postoperative pain. Because of gender differences in pain, the preoperative factors that influence acute postoperative pain may also differ between males and females. However, there have been no reports on such factors in patients with spinal disorders that focused on gender differences. Therefore, the purpose of this study was to examine the preoperative factors that influence acute postoperative pain, focusing on gender differences. METHODS The subjects were 75 males and 60 females admitted for surgery for lumbar spinal disorders. Preoperatively, the following were assessed: low back pain using the Numeric Rating Scale (NRS); anxiety and depression using the Japanese version of the Hospital Anxiety and Depression Scale (HADS); catastrophic thinking using the Pain Catastrophizing Scale (PCS); psychiatric problems using the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP); and neurological assessments. Acute postoperative pain was also assessed using the NRS within 48 h, postoperatively. Based on these data, we analyzed gender differences in preoperative factors affecting acute postoperative pain in patients with lumbar spinal disorders. RESULTS Postoperative NRS and preoperative PCS scores were higher in females compared to males. In the males, the coefficient of determination of the multiple regression equation was 0.088, and PCS (β = 0.323, p = 0.015) was extracted as a significant factor. In the females, the coefficient of determination of the multiple regression equation was 0.075, and BS-POP (β = 0.300, p = 0.019) was extracted as a significant factor. CONCLUSION Preoperative factors influencing acute postoperative pain for patients with lumbar spinal disorders vary by gender. It was suggested that males should be screened using PCS. In females, on the other hand, PCS alone is not sufficient for evaluation. It was suggested that evaluation using BS-POP should be considered in addition to PCS.
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Affiliation(s)
- Yuki Watanabe
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan.
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Jumpei Abe
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Hideki Suzuki
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Keita Shishido
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Hirotaka Kobayashi
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Rii Yoshida
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Kaori Iinuma
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Sakiko Nagamine
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Yoko Ono
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Mari Sato
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan; Department of Rehabilitation Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Naoyuki Oi
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan; Department of Rehabilitation Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
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Pei J, Meng J, Xue Y, Zhang L. Disease Experience of Patients With Differentiated Thyroid Cancer at Different Phases Based on Timing It Right Framework: A Qualitative Longitudinal Study. Cancer Nurs 2024; 47:388-396. [PMID: 36907952 DOI: 10.1097/ncc.0000000000001233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND As the incidence of differentiated thyroid cancer (DTC) continues to rise globally, it is important to gain insight into the disease experience of cancer patients at different phases of the disease. However, surveys addressing the longitudinal disease experience and specific needs of this population are lacking. OBJECTIVE The aim of this study was to explore the disease experience of people with DTC at key time points in their cancer trajectory so support can be rendered for "patient-centered" supportive care services. METHODS On the basis of the Timing It Right framework, a semistructured in-depth interview was conducted with 14 patients with DTC at 5 key phases from initial diagnosis to 6 months postoperatively, and data were analyzed using the Colaizzi 7-step analysis. RESULTS The themes of disease experience at different phases were as follows: (1) diagnostic phase: differences in acceptance; (2) perioperative phase: physical and mental distress; (3) discharge preparation phase: anxiety and helplessness, and gap of disease knowledge; (4) discharge adjustment phase: fear of recurrence and proactive health; and (5) discharge adaptation phase: multiple needs. CONCLUSION The experience, care needs, and nature of the needs of patients with DTC change dynamically with the different phases of the disease. Capturing the most appropriate time throughout the continuum of care to implement supportive care that patients need most will help to improve the continuity and precision of cancer care. IMPLICATIONS FOR PRACTICE Healthcare providers should provide a continuum of dynamic care by scientifically and systematically assessing the actual supportive care needs of patients with DTC according to their different phases of disease.
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Affiliation(s)
- Jiaqin Pei
- Author Affiliations: School of Nursing, Nanjing University of Chinese Medicine (Mss Pei, Meng, and Xue); and Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine (Ms Zhang)
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Chan SL, Sit JWH, Ang WW, Lau Y. Virtual reality-enhanced interventions on preoperative anxiety symptoms in adults undergoing elective surgery: A meta-analysis and meta-regression. Int J Nurs Stud 2024; 160:104886. [PMID: 39270596 DOI: 10.1016/j.ijnurstu.2024.104886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/18/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Virtual reality exposure and distraction are recent novel technologies for reducing preoperative anxiety symptoms. However, the effectiveness of virtual reality-enhanced interventions in adults is still controversial and has yet to be evaluated in a systematic review. OBJECTIVES The study aimed to (1) evaluate the effectiveness of virtual reality-enhanced interventions on preoperative anxiety symptoms in adults compared to comparators; and (2) identify the factors affecting the effectiveness of interventions. DESIGN Systematic review, meta-analysis, and meta-regression analysis of randomised controlled trials. METHODS We conducted a three-step systematic search from inception until May 1, 2024, using (1) eleven databases, (2) two clinical registries, and (3) citation and grey literature searches in either English or Chinese. The package meta of R software version 4.3.1 was used to perform the meta-analysis, subgroup analysis, and meta-regression analyses. We adopted the restricted maximum likelihood estimator for random-effects meta-analysis and univariate random-effects meta-regression analyses. The Cochrane risk-of-bias tool version 2 and the Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to examine quality assessment and the certainty of evidence. RESULTS We selected 26 randomised controlled trials with 2357 participants from 12 different countries. Random-effects meta-analyses showed that virtual reality-enhanced interventions had a statistically significant reduction in preoperative anxiety symptoms (t = -5.58, p < 0.001) with a moderate to large effect size (Hedges' g = -0.76, 95 % confidence interval: -1.03 to -0.48) compared to usual care. Statistically significant subgroup differences were found for the nature of the intervention, geographical region, country, and type of surgery. The improvement in preoperative anxiety symptom outcomes was greater when the virtual reality-enhanced interventions were chosen by patients (g = -2.55, 95 % CI: -3.08 to -2.02) when compared to virtual reality exposure interventions with educational content (g = -0.72, 95%CI: -1.07 to -0.38) or virtual reality distraction interventions (g = -0.64, 95 % CI: -1.04 to -0.23). Trials conducted in Asia had a greater effect on preoperative anxiety symptom outcomes (g = -0.98, 95 % CI: -1.33 to -0. 62) in comparison with those conducted in non-Asia (g = -0.23, 95 % CI: -0.54 to 0.07). The random-effects meta-regression identified sample size (β = -0.008, p = 0.031) as a statistically significant covariate of preoperative anxiety symptoms. The overall certainty of the evidence was very low. CONCLUSIONS Virtual reality-enhanced interventions can be considered supplementary interventions for adults undergoing elective surgery. Future trials on a large scale with follow-up assessments are needed. REGISTRATION PROSPERO registration ID: CRD42024486343.
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Affiliation(s)
- Sin Lun Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Janet Wing Hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Wen Wei Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Lau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
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Samara H, O’Hara L, Singh K. Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar. NURSING REPORTS 2024; 14:2061-2071. [PMID: 39189283 PMCID: PMC11348211 DOI: 10.3390/nursrep14030153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Pain is a complex and challenging phenomenon. People have different pain experiences, but everyone has the right to effective pain management. Pain assessment and management are integral components of a nurse's role. AIM To assess the knowledge and attitudes of nurses in Qatar about adult post-operative patients' pain assessment and management, and the factors that may be associated with such knowledge and attitudes. METHODS Post-operative registered nurses from all peri-operative areas at Hamad Medical Corporation participated in a cross-sectional online survey using a self-administered questionnaire. A knowledge and attitudes (K&A) score was calculated. Associations between K&A and potential explanatory variables were assessed using t-tests and one-way ANOVA. RESULTS A total of 151 post-operative nurses participated in the study. The mean knowledge and attitudes (K&A) score was 19.6 ± 4.5 out of 41 (48%), indicating a large deficit in nurses' knowledge and attitudes about adult post-operative pain. There were no statistically significant differences in the mean K&A scores of participants based on gender, nationality, education level, marital status, workplace facility, current job designation, or hours of pain education. CONCLUSIONS There is a significant deficit in post-operative nurses' knowledge and attitudes about pain across the nursing workforce in post-operative care. Implications for nursing education and policy: Evidence-based, innovative nursing education courses are needed to improve nurses' knowledge and attitudes about pain assessment and management. Health service policy is required to ensure that evidence-based in-service education on pain management is compulsory for all nurses. This study was not registered.
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Affiliation(s)
- Haya Samara
- Nursing Education Department, Hamad Medical Corporation, Doha 122014, Qatar
| | - Lily O’Hara
- Department of Public Health, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Kalpana Singh
- Department of Nursing Research, Hamad Medical Corporation, Doha 122014, Qatar;
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Huang L, Zhang T, Wang K, Chang B, Fu D, Chen X. Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients. Pain Ther 2024; 13:745-766. [PMID: 38836984 PMCID: PMC11254899 DOI: 10.1007/s40122-024-00619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have substantially proven their merit in diminishing recuperation durations and mitigating postoperative adverse events in geriatric populations undergoing colorectal cancer procedures. Despite this, the pivotal aspect of postoperative pain control has not garnered the commensurate attention it deserves. Typically, employing a multimodal analgesia regimen that weaves together nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and nerve blocks stands paramount in curtailing surgical complications and facilitating reduced convalescence within hospital confines. Nevertheless, this integrative pain strategy is not devoid of pitfalls; the specter of organ dysfunction looms over the geriatric cohort, rooted in the abuse of analgesics or the complex interplay of polypharmacy. Revolutionary research is delving into alternative delivery and release modalities, seeking to allay the inadvertent consequences of analgesia and thereby potentially elevating postoperative outcomes for the elderly post-colorectal cancer surgery populace. This review examines the dual aspects of multimodal analgesia regimens by comparing their established benefits with potential limitations and offers insight into the evolving strategies of drug administration and release.
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Affiliation(s)
- Li Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kaixin Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Bingcheng Chang
- The Second Affiliated Hospital of Guizhou, University of Traditional Chinese Medicine, Guiyang, 550003, China
| | - Daan Fu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
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Liang S, Li S, Zhong Z, Luo Q, Nie C, Hu D, Li Y. The Effect of Lidocaine-Prilocaine Cream Combined with or Without Remimazolam on VAS and APAIS Anxiety Score in Patient Undergoing Spinal Anesthesia. Drug Des Devel Ther 2024; 18:3429-3441. [PMID: 39105187 PMCID: PMC11299647 DOI: 10.2147/dddt.s468486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024] Open
Abstract
Purpose This study aimed to investigate patients' expectative pain of spinal anesthesia puncture and anxiety pre-anesthesia, and to examine the effect of lidocaine-prilocaine cream and remimazolam prior to spinal anesthesia puncture on pain relief and anxiety release. Methods Patients undergoing spinal anesthesia were divided into control, lidocaine-prilocaine cream, and lidocaine-prilocaine cream with remimazolam groups. A questionnaire consisting of The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and patient's concerns and Visual Analog Scale (VAS) was used to evaluate patient's anxiety and pain. The primary outcomes were differences in VAS and anxiety scores. Patient's spinal anesthesia-related concerns, advent events and hemodynamic index were also recorded. Results The expected spinal anesthesia puncture pain was 5.34±0.27 and anxiety scores before spinal anesthesia was 10.88 ± 0.64. A statistically significant positive correlation of 31.3% was detected between VAS and APAIS scores (r = 0.313; P=0.003). The VAS score at the time of puncture decreased by 29.7% (3.78±0.40, P=0.001) in lidocaine-prilocaine cream group and 29.2% (3.75±0.39, P=0.001) in lidocaine-prilocaine cream with remimazolam group compared with the expected VAS score. Lidocaine-prilocaine cream combined with or without remimazolam reduced the percentage of moderate pain (21.4% and 31.3% vs 50.0%, P=0.0001) and increased mild pain (60.7% vs 59.4% vs 22.7%, P=0.03). Anxiety score in lidocaine-prilocaine cream group was reduced by 2.84 (8.04±0.76 vs 10.88 ± 0.46, P=0.05) when compared with pre-anesthesia. Concerns about postoperative pain (P=0.03) and fear of the needle or intervention (P=0.000) both decreased post-anesthesia among groups. Conclusion Approximately half of the patients scheduled for spinal anesthesia experienced a moderate level of preoperative anxiety. The patient's pain expectation from the spinal anesthesia puncture was moderate, which was higher than the actual pain. Lidocaine-prilocaine cream with or without remimazolam sedative before spinal anesthesia puncture reduced the patient's pain and anxiety scores after surgery.
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Affiliation(s)
- Shuqing Liang
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Shuai Li
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Zhao Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Qichen Luo
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Cai Nie
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Donghua Hu
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Yalan Li
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
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11
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Pampel J, McCarthy C, Krankenberg H, Dannberg G, Schulze PC, Thieme M. The MULAN Trial - RCT on the use of MUsic in Cath-Lab to reduce ANxiety during peripheral vascular interventions. VASA 2024; 53:237-245. [PMID: 38738469 DOI: 10.1024/0301-1526/a001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Background: The purpose was to analyze the use of classical music to reduce procedure-related anxiety while conducting percutaneous transluminal angioplasty in patients with peripheral artery disease. Patients and methods: A total of 155 patients were analyzed in this single center randomized controlled trial. Procedure-related anxiety was assessed by a numerical rating scale (NRS, 0-10) and by recording of physiological parameters at three different points in time. A survey was conducted after the intervention. Results: This study showed that the patients listened to music overcame their procedure-related anxiety more quickly than the patients in the control group. The NRS at second timepoint was significantly reduced in intervention group compared to control group (p<0.01; r=0.2). Most participants stated that they would like to listen to music during possible future interventions. Conclusions: Classical music during endovascular interventions reduced procedure-related anxiety measured as greater reduction in NRS values in intervention group as well as in results of questionnaire performed post procedurally in PAD patients.
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Affiliation(s)
- Johannes Pampel
- REGIOMED Vascular-Center, Sonneberg, Germany
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | | | | | - Gudrun Dannberg
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | | | - Marcus Thieme
- REGIOMED Vascular-Center, Sonneberg, Germany
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
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12
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Bagle A, Yerramshetty M, Garud IG. Comparison Between Effect of Preoperative Verbal Counseling Versus Preoperative Counseling Using Anesthesia Information Sheet on Anxiety of Patients Undergoing Elective Surgeries: A Randomized Comparative Study. Cureus 2024; 16:e64667. [PMID: 39149646 PMCID: PMC11326750 DOI: 10.7759/cureus.64667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Preoperative anxiety refers to the feelings of unease, fear, or nervousness experienced by individuals before undergoing a surgical procedure. This anxiety can stem from various sources, including fear of the unknown, concerns about the surgical outcome, worries about pain or complications, and separation from loved ones during the procedure. Healthcare professionals can help minimize preoperative anxiety by employing various strategies and promoting better surgical experiences and outcomes. Hence, this study was designed to compare the effect of conventional preoperative verbal counseling versus preoperative verbal counseling using an anesthesia information sheet (AIS) on pre‑operative anxiety of patients. Methods A total of 80 patients were randomly placed into two groups of 40 each - preoperative verbal counseling (PC) and verbal counseling using an AIS. The Hamilton Anxiety Scale (HAM-A) was used to assess preoperative anxiety in both the group's pre- and post-counseling. Data was collected and compiled. Data was analyzed using SSPS software. Pearson correlation coefficient was used for the correlation of age, gender, education status, and ASA grading with pre- and post-counseling anxiety scores. Results A significant difference was seen in anxiety score pre- and post-counseling between group PC and AIS (p-value <0.05). The anxiety score after counseling in group PC was 16.27±4.57, which was significantly higher compared to group AIS (14.25±2.42; p-value=0.016). Conclusion As we continue to explore innovative ways to improve patient experiences and outcomes, integrating AISs into counseling practices stands as a promising strategy that can lead to more confident and well-informed patients, ultimately enhancing the quality of healthcare delivery.
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Affiliation(s)
- Aparna Bagle
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Mounika Yerramshetty
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ishan G Garud
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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13
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Gan HY, Liu HC, Huang HP, He M. The Prevalence and Risk Factors for Postoperative Thirst: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024:S1089-9472(24)00043-1. [PMID: 38935010 DOI: 10.1016/j.jopan.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Thirst is a symptom of dehydration and one of the main complications affecting postoperative outcomes and comfort. Persistent water scarcity can have a detrimental effect on the cognitive function and psychology of patients. However, the current evidence about the prevalence and risk factors for postoperative thirst is not fully understood. Therefore, this study aims to investigate the prevalence and risk factors of postoperative thirst and provide guidance for clinical practice. DESIGN Systematic review and meta-analysis. METHODS We searched PubMed, Cochrane Library, Web of Science, Embase, Clinicaltrials.gov, China National Knowledge Infrastructure, and Wanfang Database. Eligible studies were evaluated using the Agency for Healthcare Research and Quality. The collected data were pooled and analyzed using Stata15.0. FINDINGS A total of 11 cross-sectional studies were included involving 20,612 patients. Eight studies reported prevalence and the pooled prevalence of postoperative thirst was 76.8% (95% confidence interval [CI]: 0.664 to 0.858). Five studies contributed to meta-syntheses of risk factors for postoperative thirst. The results indicated that sex (odds ratio [OR] = 1.44, 95% CI = 1.13 to 1.84, I2 = 80.2%, P = .006), anesthesia drug (OR = 1.48, 95% CI = 1.06 to 2.06, I2 = 94.8%, P < .001), surgical type (OR = 0.66, 95% CI = 0.49 to 0.9, I2 = 77.9%, P = .004) were statistically associated with postoperative thirst. CONCLUSIONS Our study shows a high prevalence of postoperative thirst. Sex, anesthesia drug, and surgical type are risk factors that influence postoperative thirst. Nurses and other health care professionals should routinely assess the postoperative thirst of patients and perform targeted interventions to alleviate their distressing symptoms and improve the quality of care.
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Affiliation(s)
- Hao-Yue Gan
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China; Operating Room of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Hang-Cheng Liu
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hua-Ping Huang
- Nursing Department of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Mei He
- President Office of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China.
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14
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Rüggeberg A, Meybohm P, Nickel EA. Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives. BJA OPEN 2024; 10:100282. [PMID: 38741693 PMCID: PMC11089317 DOI: 10.1016/j.bjao.2024.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
In the early days of anaesthesia, the fasting period for liquids was kept short. By the mid-20th century 'nil by mouth after midnight' had become routine as the principles of the management of 'full stomach' emergencies were extended to include elective healthy patients. Back then, no distinction was made between the withholding of liquids and solids. Towards the end of the last century, recommendations of professional anaesthesiology bodies began to reduce the fasting time of clear liquids to 2 h. This reduction in fasting time was based on the understanding that gastric emptying of clear liquids is rapid, exponential, and proportional to the current filling state of the stomach. Furthermore, there was no evidence of a link between drinking clear liquids and the risk of aspiration. Indeed, most instances of aspiration are caused by failure to identify aspiration risk factors and adjust the anaesthetic technique accordingly. In contrast, long periods of liquid withdrawal cause discomfort and may also lead to serious postoperative complications. Despite this, more than two decades after the introduction of the 2 h limit, patients still fast for a median of up to 12 h before anaesthesia, mainly because of organisational issues. Therefore, some hospitals have decided to allow patients to drink clear liquids within 2 h of induction of anaesthesia. Well-designed clinical trials should investigate whether these concepts are safe in patients scheduled for anaesthesia or procedural sedation, focusing on both aspiration risk and complications of prolonged fasting.
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Affiliation(s)
- Anne Rüggeberg
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Eike A. Nickel
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
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15
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Schmid BC, Marsland D, Jacobs E, Rezniczek GA. A Preparatory Virtual Reality Experience Reduces Anxiety before Surgery in Gynecologic Oncology Patients: A Randomized Controlled Trial. Cancers (Basel) 2024; 16:1913. [PMID: 38791991 PMCID: PMC11119445 DOI: 10.3390/cancers16101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Perioperative anxiety is common among patients undergoing surgery, potentially leading to negative outcomes. Immersive virtual reality (VR) has shown promise in reducing anxiety in various clinical settings. This study aimed to evaluate the effectiveness of VR in reducing perioperative anxiety in patients undergoing gynecological oncology surgery and was conducted as a single-center, double-arm, single-blinded randomized controlled trial at the Gold Coast University Hospital, Queensland, Australia. Participants were randomized into the VR intervention + care as usual (CAU) group (n = 39) and the CAU group (n = 41). Anxiety scores were assessed using a six-tier visual facial anxiety scale at baseline, after the intervention/CAU on the same day, and, several days up to weeks later, immediately before surgery. There was no significant difference in baseline anxiety scores, type of operation, or suspected cancer between the two groups. The VR intervention significantly reduced anxiety scores from baseline to preoperative assessment (p < 0.001). The median anxiety score in the VR intervention group decreased from 3 (interquartile range 2 to 5) at baseline to 2 (2 to 3) prior to surgery, while the control group's scores were 4 (2 to 5) and 4 (3 to 5), respectively. Multivariate analysis showed that group assignment was the sole outcome predictor, not age, type of procedure, or the time elapsed until surgery. Thus, VR exposure was effective in reducing perioperative anxiety in patients undergoing gynecological oncology surgery. The use of VR as a preparation tool may improve patient experience and contribute to better surgical outcomes, warranting further research into exploring the potential benefits of VR in other surgical specialties and its long-term impact on patient recovery.
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Affiliation(s)
- Bernd C. Schmid
- Department of Gynaecological Oncology, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Dominic Marsland
- Department of Gynaecological Oncology, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Eilish Jacobs
- Department of Gynaecological Oncology, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Günther A. Rezniczek
- Department of Gynecology and Obstetrics, Ruhr-Universität Bochum, Marien Hospital Herne, Hölkeskampring 40, 44625 Herne, Germany
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16
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El-Gabalawy R, Sommer JL, Hebbard P, Reynolds K, Logan GS, Smith MSD, Mutter TC, Mutch WA, Mota N, Proulx C, Gagnon Shaigetz V, Maples-Keller JL, Arora RC, Perrin D, Benedictson J, Jacobsohn E. An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial. JMIR Res Protoc 2024; 13:e55692. [PMID: 38743939 PMCID: PMC11134251 DOI: 10.2196/55692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Preoperative state anxiety (PSA) is distress and anxiety directly associated with perioperative events. PSA is associated with negative postoperative outcomes such as longer hospital length of stay, increased pain and opioid use, and higher rates of rehospitalization. Psychological prehabilitation, such as education, exposure to hospital environments, and relaxation strategies, has been shown to mitigate PSA; however, there are limited skilled personnel to deliver such interventions in clinical practice. Immersive virtual reality (VR) has the potential for greater accessibility and enhanced integration into an immersive and interactive experience. VR is rarely used in the preoperative setting, but similar forms of stress inoculation training involving exposure to stressful events have improved psychological preparation in contexts such as military deployment. OBJECTIVE This study seeks to develop and investigate a targeted PSA intervention in patients undergoing oncological surgery using a single preoperative VR exposure. The primary objectives are to (1) develop a novel VR program for patients undergoing oncological surgery with general anesthesia; (2) assess the feasibility, including acceptability, of a single exposure to this intervention; (3) assess the feasibility, including acceptability, of outcome measures of PSA; and (4) use these results to refine the VR content and outcome measures for a larger trial. A secondary objective is to preliminarily assess the clinical utility of the intervention for PSA. METHODS This study comprises 3 phases. Phase 1 (completed) involved the development of a VR prototype targeting PSA, using multidisciplinary iterative input. Phase 2 (data collection completed) involves examining the feasibility aspects of the VR intervention. This randomized feasibility trial involves assessing the novel VR preoperative intervention compared to a VR control (ie, nature trek) condition and a treatment-as-usual group among patients undergoing breast cancer surgery. Phase 3 will involve refining the prototype based on feasibility findings and input from people with lived experience for a future clinical trial, using focus groups with participants from phase 2. RESULTS This study was funded in March 2019. Phase 1 was completed in April 2020. Phase 2 data collection was completed in January 2024 and data analysis is ongoing. Focus groups were completed in February 2024. Both the feasibility study and focus groups will contribute to further refinement of the initial VR prototype (phase 3), with the final simulation to be completed by mid-2024. CONCLUSIONS The findings from this work will contribute to the limited body of research examining feasible and broadly accessible interventions for PSA. Knowledge gained from this research will contribute to the final development of a novel VR intervention to be tested in a large population of patients with cancer before surgery in a randomized clinical trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04544618; https://www.clinicaltrials.gov/study/NCT04544618. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55692.
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Affiliation(s)
- Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- CancerCare Manitoba, Winnipeg, MB, Canada
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Gabrielle S Logan
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Thomas C Mutter
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - W Alan Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Rakesh C Arora
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States
| | - David Perrin
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Section of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jada Benedictson
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Eric Jacobsohn
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
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17
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Zhao Y, Xiao X. Efficacy of ultrasound-guided stellate ganglion block in relieving acute postoperative pain: a systematic review and meta-analysis. J Int Med Res 2024; 52:3000605241252237. [PMID: 38759220 PMCID: PMC11107331 DOI: 10.1177/03000605241252237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE The efficacy of ultrasound-guided stellate ganglion block (SGB) in alleviating postoperative pain remains unclear. This meta-analysis was performed to determine the efficacy of ultrasound-guided SGB in relieving acute postoperative pain in patients undergoing surgery with general anesthesia. METHODS This systematic review and meta-analysis focused on randomized controlled trials comparing SGB with control or placebo. The primary outcome was the pain score at 24 hours after surgery. A random-effects model was used to calculate the mean difference (MD) or risk ratio with a confidence interval (CI) of 95%. RESULTS Eight studies involving 470 patients were included in the meta-analysis. The results revealed that ultrasound-guided SGB was significantly associated with a lower pain score at 24 hours after surgery (MD = -0.74; 95% CI = -1.39, -0.08; I2 = 86%; low evidence) and at 8 hours after surgery (MD = -0.65; 95% CI = -1.03, -0.28; I2 = 29%; moderate evidence). CONCLUSION Ultrasound-guided SGB is effective in alleviating acute postoperative pain. However, considering the limited number of trials performed to date, more large-scale and high-quality randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Yan Zhao
- Department of Anesthesiology, Beihai People’s Hospital, Beihai, China
| | - Xiangli Xiao
- Department of Anesthesiology, Beihai People’s Hospital, Beihai, China
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18
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Roberts RL, Hanley AW, Garland EL. Mindfulness-Based Interventions for Perioperative Pain Management and Opioid Risk Reduction Following Surgery: A Stepped Care Approach. Am Surg 2024; 90:939-946. [PMID: 35802881 DOI: 10.1177/00031348221114019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical procedures often improve health and function but can sometimes also result in iatrogenic effects, including chronic pain and opioid misuse. Due to the known risks of opioids and the physical, emotional, and financial suffering that often accompanies chronic pain, there has been a call for greater use of complementary non-pharmacological treatments like mindfulness-based interventions. Mindfulness can be broadly described as an attentional state involving moment-by-moment meta-awareness of thoughts, emotions, and body sensations. An expanding number of randomized clinical trials have found strong evidence for the value of mindfulness techniques in alleviating clinical symptomology relevant to surgical contexts. The purpose of this review is to examine the empirical evidence for the perioperative use of mindfulness interventions. We present a mindfulness-based stepped care approach that first involves brief mindfulness to treat preoperative pain and anxiety and prevent development of postoperative chronic pain or opioid misuse. More extensive mindfulness-based interventions are then provided to patients who continue to experience high pain levels or prolonged opioid use after surgery. Finally, we review psychophysiological mechanisms of action that may be integral to the analgesic and opioid sparing effects of mindfulness.
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Affiliation(s)
- R Lynae Roberts
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
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19
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Gungor S, Tosun B, Candir G, Ozen N. Effects of cold spray on thirst, frequency of oral care, and pain of general surgery intensive care unit patients. Sci Rep 2024; 14:9997. [PMID: 38693271 PMCID: PMC11063212 DOI: 10.1038/s41598-024-58199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/26/2024] [Indexed: 05/03/2024] Open
Abstract
This study aims to investigate the effects of intraoral cold water spray on thirst, frequency of oral care and postoperative period pain at surgical incision site in patients having abdominal surgery. The study was carried out as a randomized controlled trial, registered under Clinical Trial Number: NCT05940818. The study involved 110 participants, divided equally into two groups (n = 55): the experimental group and the control group. Data were collected using patient information form, NRS, Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS) and Visual Analog Scale (VAS). The severity of thirst at 1st, 8th, 16th h of post-operative period (p < 0.01) and the frequency of oral care application at 16th h were statistically significantly decreased in the experimental group when compared to the control group (p < 0.01).There wasn't statistically significant difference between the patients in the experimental and control groups in terms of pain at surgical incision site (p > 0.05). The patient's thirst and need for frequent oral care in the postoperative period were reduced by the application of a cold water spray. In patients undergoing abdominal surgery, the use of cold water spray application may be recommended to reduce thirst and the need for frequency of oral care application.
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Affiliation(s)
- Serap Gungor
- Kahramanmaras Sutcu Imam University, Vocational School of Health Services, Kahramanmaras, Turkey.
| | - Betul Tosun
- Hacettepe University, Faculty of Nursing, Ankara, Turkey
| | - Gozde Candir
- Adana City Education and Research Hospital, General Surgery İntensive Care, Adana, Turkey
| | - Nurten Ozen
- Demiroglu Bilim University, Florence Nightingale Hospital School of Nursing, Department of English Nursing, İstanbul, Turkey
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20
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Bhanwra A, Palta S, Saroa R, Saxena P, Bhanwra S, Jain A. Role of preoperative zinc, magnesium and budesonide gargles in Postoperative Sore Throat (POST) - a randomised control trial. BMC Anesthesiol 2024; 24:164. [PMID: 38693477 PMCID: PMC11061912 DOI: 10.1186/s12871-024-02534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 04/09/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. METHODS We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). RESULTS POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. CONCLUSION Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. TRIAL REGISTRATION CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India).
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Affiliation(s)
- Aakanksha Bhanwra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Sanjeev Palta
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Richa Saroa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Puja Saxena
- Department of Anaesthesia and Intensive Care, Dr. B.R. Ambedkar State Institute of Medical Sciences, Sector 57, Sahibzada Ajit Singh Nagar, Punjab, 160055, India
| | - Sangeeta Bhanwra
- Department of Pharmacology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Aditi Jain
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
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21
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Dai S, Chen L, Wu M, Guo L, Wang R. Timing of early water intake post-general anaesthesia: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:135. [PMID: 38594662 PMCID: PMC11003094 DOI: 10.1186/s12871-024-02520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Early water intake has gained widespread attention considering enhanced recovery after surgery (ERAS). In the present systematic evaluation and meta-analysis, we assessed the effects of early water intake on the incidence of vomiting and aspiration in adult patients who received general anaesthesia on regaining consciousness during the resuscitation period. OBJECTIVE To systematically analyse the results of randomised controlled trials on early postoperative water intake in patients who underwent different types of surgery under general anaesthesia, both at home and abroad, to further explore the safety and application of early water intake and provide an evidence-based foundation for clinical application. DESIGN Systematic review and meta-analysis. METHODS To perform the systematic evaluation and meta-analysis, we searched the Web of Science, CINAHL, Embase, PubMed, Cochrane Library, Sinomed, China National Knowledge Infrastructure (CNKI), Wanfang, and Vipshop databases to identify randomised controlled trial studies on early water intake in adult patients who received general anaesthesia. RESULTS Herein, we included 10 publications with a total sample size of 5131 patients. Based on statistical analysis, there was no statistically significant difference in the incidence of vomiting (odds ratio [OR] = 0.81; 95% confidence interval [CI] [0.58-1.12]; p = 0.20; I-squared [I2] = 0%) and aspiration (OR = 0.78; 95%CI [0.45-1.37]; p = 0.40; I2 = 0%) between the two groups of patients on regaining consciousness post-general anaesthesia. CONCLUSION Based on the available evidence, early water intake after regaining consciousness post-anaesthesia did not increase the incidence of adverse complications when compared with traditional postoperative water abstinence. Early water intake could effectively improve patient thirst and facilitate the recovery of gastrointestinal function.
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Affiliation(s)
- Suwan Dai
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Lingyan Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Min Wu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Liangyou Guo
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Rong Wang
- The First Hospital of Jiaxing, Jiaxing, China.
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22
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Meier IM, Eikemo M, Trøstheim M, Buen K, Jensen E, Gurandsrud Karlsen S, Reme SE, Berna C, Leknes S, Ernst G. Factors associated with use of opioid rescue medication after surgery. Reg Anesth Pain Med 2024; 49:265-271. [PMID: 37479238 PMCID: PMC11041598 DOI: 10.1136/rapm-2023-104412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Opioid exposure after surgery increases risk of persistent opioid use. Here, we characterize at-home use of opioid rescue medication during 1-2 days after outpatient surgery (N=270) in a postoperative opioid-sparing context at a Norwegian hospital. METHODS The postsurgical pain management plan included non-steroidal anti-inflammatory drugs and up to six pills of 5 mg oxycodone as rescue analgesics. In this observational study we assessed risk factors for taking rescue opioids after surgery, by comparing patients who did, with those who did not. RESULTS Only 35% (N=228) of patients reported taking rescue opioids 1-2 days after discharge. Patients taking rescue opioids after surgery (opioid-takers) differed from non-takers by prevalence of preoperative chronic pain (>3 months; 74% vs 48%), higher pain severity and interference before and after surgery, reporting lower ability to cope with postsurgical pain, higher nervousness about the surgery, being younger, and having received more opioid analgesics in the recovery room. Exploratory predictive modeling identified opioid administration in the recovery room as the most important predictor of at-home rescue medication use. Follow-up after >4 months indicated low acute pain levels (mean±SD = 1.1±1.8), with only four patients (2%, N=217) reporting opioid analgesic use. CONCLUSION Factors related to at-home rescue medication use closely mirrored known risk factors for persistent opioid use after surgery, such as prior chronic pain, prior substance use, affective disturbances, and pain severity before surgery. These findings are potential targets in patient-centered care. Nevertheless, and reassuringly, findings are consistent with the idea that opioid-sparing postsurgical care can prevent large-scale chronic opioid use.
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Affiliation(s)
- Isabell M Meier
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Marie Eikemo
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Martin Trøstheim
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kaja Buen
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Eira Jensen
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Siri Gurandsrud Karlsen
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Silje E Reme
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Chantal Berna
- Centre of Integrative and Complementary Medicine, Division of Anaesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Siri Leknes
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Gernot Ernst
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
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23
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Li C, Tao M, Chen D, Wei Q, Xiong X, Zhao W, Tan W, Yang J, Han Y, Zhang H, Zhang S, Liu H, Cao JL. Transcranial Direct Current Stimulation for Anxiety During Laparoscopic Colorectal Cancer Surgery: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e246589. [PMID: 38635271 DOI: 10.1001/jamanetworkopen.2024.6589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Importance Perioperative anxiety is prevalent among patients undergoing surgical treatment of cancer and often influences their prognosis. Transcranial direct current stimulation (tDCS) has shown potential in the treatment of various anxiety-related disorders, but data on the impact of tDCS on perioperative anxiety are limited. Objective To evaluate the effect of tDCS in reducing perioperative anxiety among patients undergoing laparoscopic colorectal cancer (CRC) resection. Design, Setting, And Participants This randomized clinical trial was conducted from March to August 2023 at the Affiliated Hospital of Xuzhou Medical University. Patients aged 18 years or older undergoing elective laparoscopic radical resection for CRC were randomly assigned to either the active tDCS group or the sham tDCS group. Intention-to-treat data analysis was performed in September 2023. Interventions Patients were randomly assigned to receive 2 sessions of either active tDCS or sham tDCS over the left dorsolateral prefrontal cortex on the afternoon of the day before the operation and in the morning of the day of operation. Main Outcomes and Measures The main outcome was the incidence of perioperative anxiety from the day of the operation up to 3 days after the procedure, as measured using the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale (range: 0-21, with higher scores indicating more anxiety). Secondary outcomes included postoperative delirium (assessed by the Confusion Assessment Method or Confusion Assessment Method intensive care unit scale); pain (assessed by the 10-point Numeric Rating Scale [NRS], with scores ranging from 0 [no pain] to 10 [worst pain]); frailty (assessed by the Fatigue, Resistance, Ambulation, Illness and Loss of Weight [FRAIL] Index, with scores ranging from 0 [most robust] to 5 [most frail]; and sleep quality (assessed by the Pittsburgh Sleep Quality Index [PSQI], with scores ranging from 0 to 21 and higher scores indicating worse sleep quality) after the 2 sessions of the tDCS intervention. Results A total of 196 patients (mean [SD] age, 63.5 [11.0] years; 124 [63.3%] men) were recruited and randomly assigned to the active tDCS group (98 patients) or the sham tDCS group (98 patients). After the second tDCS intervention on the day of the operation, the incidence of perioperative anxiety was 38.8% in the active tDCS group and 70.4% in the sham tDCS group (relative risk, 0.55 [95% CI, 0.42-0.73]; P < .001). Patients in the active tDCS group vs the sham tDCS group were less likely to have postoperative delirium (8.2% vs 25.5%) and, at 3 days after the operation, had lower median (IQR) pain scores (NRS, 1.0 [1.0-1.0] vs 2.0 [2.0-2.0]), better median (IQR) sleep quality scores (PSQI, 10.5 [10.0-11.0] vs 12.0 [11.0-13.0]), and lower median (IQR) FRAIL Index (2.0 [1.0-2.0] vs 2.0 [2.0-3.0]). Conclusions and Relevance Findings of this randomized clinical trial indicate that administration of 2 preoperative sessions of tDCS was associated with a decreased incidence of perioperative anxiety in patients undergoing elective CRC resection. Active tDCS was also associated with better anxiety scores, pain levels, and sleep quality as well as reduced postoperative delirium and frailty. The findings suggest that tDCS may be a novel strategy for improving perioperative anxiety in patients undergoing CRC resection. Trial Registration Chinese Clinical Trial Register Identifier: ChiCTR2300068859.
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Affiliation(s)
- Chunyan Li
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Mingshu Tao
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Dexian Chen
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Qi Wei
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Xingyu Xiong
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Wenxin Zhao
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Wen Tan
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Jie Yang
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Hongxing Zhang
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Song Zhang
- Department of Anesthesiology, Renji Hospital and Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - He Liu
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University School of Medicine, Huzhou, China
| | - Jun-Li Cao
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
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24
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Langford R, Pogatzki-Zahn EM, Morte A, Sust M, Cebrecos J, Vaqué A, Ortiz E, Fettiplace J, Adeyemi S, López-Cedrún JL, Bescós S, Gascón N, Plata-Salamán C. Co-crystal of Tramadol-Celecoxib Versus Tramadol or Placebo for Acute Moderate-to-Severe Pain After Oral Surgery: Randomized, Double-Blind, Phase 3 Trial (STARDOM1). Adv Ther 2024; 41:1025-1045. [PMID: 38183526 PMCID: PMC10879371 DOI: 10.1007/s12325-023-02744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Co-crystal of tramadol-celecoxib (CTC) is the first analgesic co-crystal for acute pain. This completed phase 3 multicenter, double-blind trial assessed the efficacy and safety/tolerability of CTC in comparison with that of tramadol in the setting of moderate-to-severe pain up to 72 h after elective third molar extraction requiring bone removal. METHODS Adults (n = 726) were assigned randomly to five groups (2:2:2:2:1): orally administered twice-daily CTC 100 mg (44 mg rac-tramadol hydrochloride/56 mg celecoxib; n = 164), 150 mg (66/84 mg; n = 160) or 200 mg (88/112 mg; n = 160); tramadol 100 mg four times daily (n = 159); or placebo four times daily (n = 83). Participants in CTC groups also received twice-daily placebo. The full analysis set included all participants who underwent randomization. The primary endpoint was the sum of pain intensity differences over 0 to 4 h (SPID0-4; visual analog scale). Key secondary endpoints included 4-h 50% responder and rescue medication use rates. Safety endpoints included adverse events (AEs), laboratory measures, and Opioid-Related Symptom Distress Scale (OR-SDS) score. RESULTS All CTC doses were superior to placebo (P < 0.001) for primary and key secondary endpoints. All were superior to tramadol for SPID0-4 (analysis of covariance least squares mean differences [95% confidence interval]: - 37.1 [- 56.5, - 17.6], - 40.2 [- 59.7, - 20.6], and - 41.7 [- 61.2, - 22.2] for 100, 150, and 200 mg CTC, respectively; P < 0.001) and 4-h 50% responder rate. Four-hour 50% responder rates were 32.9% (CTC 100 mg), 33.8% (CTC 150 mg), 40.6% (CTC 200 mg), 20.1% (tramadol), and 7.2% (placebo). Rescue medication use was lower in the 100-mg (P = 0.013) and 200-mg (P = 0.003) CTC groups versus tramadol group. AE incidence and OR-SDS scores were highest for tramadol alone. CONCLUSIONS CTC demonstrated superior pain relief compared with tramadol or placebo, as well as an improved benefit/risk profile versus tramadol. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02982161; EudraCT number, 2016-000592-24.
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Affiliation(s)
| | | | | | | | | | - Anna Vaqué
- ESTEVE Pharmaceuticals, Barcelona, Spain
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25
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van den Heuvel SA, van Boekel RL, Cox FJ, Ferré F, Minville V, Stamer UM, Vissers KC, Pogatzki-Zahn EM. Perioperative pain management models in four European countries: A narrative review of differences, similarities and future directions. Eur J Anaesthesiol 2024; 41:188-198. [PMID: 37889549 DOI: 10.1097/eja.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
There is general agreement that acute pain management is an important component of perioperative medicine. However, there is no consensus on the best model of care for perioperative pain management, mainly because evidence is missing in many aspects. Comparing the similarities and differences between countries might reveal some insights into different organisational models and how they work. Here, we performed a narrative review to describe and compare the structures, processes and outcomes of perioperative pain management in the healthcare systems of four European countries using Donabedian's framework as a guide. Our comparison revealed many similarities, differences and gaps. Different structures of acute pain services in the four countries with no common definition and standards of care were found. Protocols have been implemented in all countries and guidelines in some. If outcome is assessed, it is mainly pain intensity, and many patients experiencing more intense pain than others have common risk factors (e.g. preoperative pain, preoperative opioid intake, female sex and young age). Outcome assessment beyond pain intensity (such as pain-related physical function, which is important for early rehabilitation and recovery) is currently not well implemented. Developing common quality indicators, a European guideline for perioperative pain management (e.g. for patients at high risk for experiencing severe pain and other outcome parameters) and common criteria for acute pain services might pave the way forward for improving acute pain management in Europe. Finally, the education of general and specialist staff should be aligned in Europe, for example, by using the curricula of the European Pain Federation (EFIC).
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Affiliation(s)
- Sandra A van den Heuvel
- From the Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands (SAvdH, RLvB, KCV), Department of Anaesthesiology and Critical Care, Royal Brompton & Harefield Hospitals part of GSST, London, United Kingdom (FJC), Département d'Anaesthésie-Réanimation, Hôpital Pierre-Paul Riquet, Centre Hospitalo-universitaire Purpan, Toulouse, France (FF, VM), Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (UMS) and Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Muenster, Muenster, Germany (EMPZ)
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26
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Pandrangi VC, Low G, Slijepcevic A, Shah S, Shindo M, Schindler J, Colaianni A, Clayburgh D, Andersen P, Flint P, Wax MK, Li RJ. Use of Perioperative Virtual Reality Experiences on Anxiety and Pain: A Randomized Comparative Trial. Laryngoscope 2024; 134:1197-1202. [PMID: 37578212 DOI: 10.1002/lary.30967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To evaluate the effect of different virtual reality (VR) experiences on perioperative anxiety and pain among patients undergoing head and neck surgery. METHODS Prospective, randomized, comparative trial among patients undergoing outpatient head and neck surgery from December 2021 to April 2022 at a single academic institution. Group 1 utilized a preoperative VR gaming experience and a postoperative VR mindfulness experience, while Group 2 utilized the same interventions in the reverse order. Anxiety and pain were measured using visual analog scales (VAS). Primary outcomes were changes in post-intervention anxiety and pain. Secondary outcomes included vital sign changes and subjective patient experiences using a 5-point Likert scale. RESULTS There were 32 patients randomized for inclusion, with 16 patients per group. The majority of patients were female (65.6%) and mean (standard deviation) age was 47.3 (16.7) years. After outlier exclusion, there were no differences in post-intervention preoperative anxiety reduction (Group 1 vs. Group 2, median [IQR]: -12.0 [15] vs. -10.5 [13], p = 0.62). There were minor differences in vital sign changes (p < 0.05). Among the 10 patients in Group 1 and 12 patients in Group 2 who completed postoperative VR use, there were no differences in post-intervention pain reduction (-8.5 [22.3] vs. -7.5 [19.3], p = 0.95) or vital sign changes (p > 0.05). There were no differences in questionnaire responses, with high satisfaction in both groups (p > 0.05). No adverse events encountered. CONCLUSIONS Use of different VR experiences among patients undergoing outpatient head and neck surgery appears associated with similar reductions in perioperative anxiety and pain. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1197-1202, 2024.
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Affiliation(s)
- Vivek C Pandrangi
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Garren Low
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Suparna Shah
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joshua Schindler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alessa Colaianni
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Clayburgh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Andersen
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Paul Flint
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Ryan J Li
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Al Modanat Z, Al-Husinat L, Mistarihi BM, Tashtoush M, Alsarabi J, Matalqah R, Mistarihi H, Amir MW, Debajah N, Rejoub E, Bereshy R, Tawaha M, Talj R, Varrassi G. The Delicate Dance of Intraoperative Anesthesia: Addressing Patient and Anesthesiologist Concerns. Cureus 2024; 16:e54746. [PMID: 38524082 PMCID: PMC10960964 DOI: 10.7759/cureus.54746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background In the realm of surgical procedures, patients and anesthesiologists have distinct concerns that can have an impact on their relationship. Patients are often riddled with anxiety about the unknowns of anesthesia and the possible risks. Anesthesiologists, too, face their own set of concerns. Despite the importance of this interaction, there has been little research on the specific concerns of both parties. Our study aims to fill this gap by describing and comparing the concerns of patients and anesthesiologists in Jordan. Methodology This cross-sectional study evaluated anesthesia-related problems based on specific questionnaires. The responses to the questionnaires were on a voluntary basis. The consent of the participants was granted after the aims of the study were clarified. Data were collected and analyzed using SPSS version 28 (IBM Corp., Armonk, NY, USA). Results A total of 155 Jordanian anesthesiologists and 1,858 participants from the population who had undergone anesthesia participated in the study. In general anesthesia, over 60% of the anesthesiologists were most worried about ventilation and intubation difficulties during anesthesia induction and death at the end of anesthesia. Regarding regional anesthesia, the primary concerns included toxicity from local anesthesia infiltration (64.5%) and total spinal anesthesia (49.0%). Patients were concerned about various anesthesia-related scenarios, with the highest worries about pain (3.41/4), a sharp drop in vital signs (3.40/4), and an irregular heartbeat (3.39/4). Female patients, those with lower incomes, and those with a bachelor's degree reported higher anesthesia concern levels. Additionally, anesthesiologists' mean concern score was significantly lower than that of patients. Conclusions Patients concentrated on pain, a drop in vital signs, and irregular heartbeats, whereas anesthesiologists were worried about ventilation, intubation, and hypoxia. Patients placed more emphasis on personal experiences and social factors than technical issues. Therefore, patient education about anesthesia and discussion about intra and postoperative expectations are imperative to improve the surgical experience and the relationship between patients and anesthesiologists.
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Affiliation(s)
- Zaid Al Modanat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Lou'i Al-Husinat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Bashar M Mistarihi
- Department of Neurology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Mohammad Tashtoush
- Department of Anesthesiology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Jood Alsarabi
- Department of Anesthesiology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Rama Matalqah
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Hassan Mistarihi
- Department of Anesthesiology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Mohammad Wasfi Amir
- Department of General Surgery, Faculty of Medicine, Mutah University, Karak, JOR
| | - Nawal Debajah
- Department of Anesthesiology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Esra'a Rejoub
- Department of Anesthesiology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Raneem Bereshy
- Department of Anesthesiology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Mustafa Tawaha
- Department of Anesthesiology, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | - Rana Talj
- Internal Medicine, Rochester General Hospital, New York, USA
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Sun J, Li N, Liu B, Duan G, Zheng H, Cao X, Wang M, Zhang Z, Zhang X. Efficacy and safety of patient-controlled intravenous analgesia after APS team standardized postoperative pain management: A 6-year experience of an acute pain service in 107802 Chinese patients. Heliyon 2024; 10:e24387. [PMID: 38312661 PMCID: PMC10834482 DOI: 10.1016/j.heliyon.2024.e24387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
There are few studies on the impact of postoperative pain management (such as Acute Pain Service, APS) on the prognosis of patients, especially the research on large samples, even less data on Chinese patients. It is reported that only 25.12 % of hospitals in China have established APS or similar teams, and less than 10 % of them are responsible for the whole process of postoperative analgesia services. Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology has established a professional APS team led by anesthesiologists (TJ-APS), and has a standardized workflow and management system. Based on the TJ-APS standardized postoperative pain management, the incidence and adverse effects of postoperative pain in different types of surgical patients were analyzed. In total, 107,802 patients receiving intravenous PCA from the Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected between January 2016 and December 2021, which were under TJ-APS standardized postoperative analgesia process, postoperative analgesia strategy based on the principle of "low opioid, multimodal, specialization and individualization", as well as regular ward rounds and 24-h on call on-duty system. We assessed the incidence and adverse effects of postoperative pain in different types of surgical patients. Based on the TJ-APS standardized postoperative pain management, the incidence of poor postoperative analgesia in patients with intravenous PCA is significantly lower than that reported in the current literature (20 %), and mainly occurs in biliary-pancreatic surgery, extrahepatic surgery and gastrointestinal surgery. The overall incidence of adverse effects was 5.52 %, of which nausea and vomiting was the highest, especially among gynecological tumors and gynecological patients, which were 10.75 % and 8.68 % respectively, but both were lower than the level reported in the current literature (20 %). This APS multimodal management and analgesia process can provide reference and guidance for PCA management of postoperative acute pain.
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Affiliation(s)
- Jiaoli Sun
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ningbo Li
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Baowen Liu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Hua Zheng
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xueqin Cao
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Mao Wang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhifa Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xianwei Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Bates A, West MA, Jack S, Grocott MPW. Preparing for and Not Waiting for Surgery. Curr Oncol 2024; 31:629-648. [PMID: 38392040 PMCID: PMC10887937 DOI: 10.3390/curroncol31020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Cancer surgery is an essential treatment strategy but can disrupt patients' physical and psychological health. With worldwide demand for surgery expected to increase, this review aims to raise awareness of this global public health concern, present a stepwise framework for preoperative risk evaluation, and propose the adoption of personalised prehabilitation to mitigate risk. Perioperative medicine is a growing speciality that aims to improve clinical outcome by preparing patients for the stress associated with surgery. Preparation should begin at contemplation of surgery, with universal screening for established risk factors, physical fitness, nutritional status, psychological health, and, where applicable, frailty and cognitive function. Patients at risk should undergo a formal assessment with a qualified healthcare professional which informs meaningful shared decision-making discussion and personalised prehabilitation prescription incorporating, where indicated, exercise, nutrition, psychological support, 'surgery schools', and referral to existing local services. The foundational principles of prehabilitation can be adapted to local context, culture, and population. Clinical services should be co-designed with all stakeholders, including patient representatives, and require careful mapping of patient pathways and use of multi-disciplinary professional input. Future research should optimise prehabilitation interventions, adopting standardised outcome measures and robust health economic evaluation.
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Affiliation(s)
- Andrew Bates
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Malcolm A. West
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Sandy Jack
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Michael P. W. Grocott
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Wiles MD, Macdonald A. The effect of a 'Sip til Send' policy on patient satisfaction: a quality improvement project. Anaesth Rep 2024; 12:e12271. [PMID: 38187936 PMCID: PMC10771015 DOI: 10.1002/anr3.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/09/2024] Open
Abstract
Patients often are nil by mouth for prolonged periods pre-operatively, which is associated with adverse effects including discomfort, anxiety, thirst and nausea. As a result, several hospitals have introduced a more liberal regimen of pre-operative drinking, with patients encouraged to sip small volumes of water until transfer to the operating theatre ('Sip til Send'). The impact of 'Sip til Send' on patient satisfaction is still to be determined. We hypothesised that the introduction of a 'Sip til Send' policy would increase patient's satisfaction with their pre-operative fluid management regimen. We conducted a staged implementation of a 'Sip til Send' quality improvement initiative in two campuses of a large tertiary teaching hospital. This involved a targeted education and implementation programme that was refined and delivered through 'plan, do, study and act' cycles. Patient satisfaction with their pre-operative fluid management was measured by rating the statement "I am happy with the management of pre-operative drinking", against a five-point Likert scale (0, strongly disagree; 1, disagree; 2, neutral; 3, agree; and 4, strongly agree). Patient satisfaction with pre-operative fluid management was high at baseline, with pooled data for both campuses showing a median (IQR [range]) satisfaction score of 4 (3-4 [1-4]). After the implementation of 'Sip til Send', this improved to a median (IQR [range]) satisfaction score of 4 (4-4 [2-4]) (p < 0.001). The introduction of a 'Sip til Send' policy resulted in an increase in patient satisfaction. Key factors in successful implementation included the provision of a clear explanation of the underlying rationale to patients, nursing and anaesthetic staff, and establishing the policy as the default position for all elective patients.
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Affiliation(s)
- M. D. Wiles
- Department of Critical CareSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
- Centre for Applied Health & Social Care Research (CARe)Sheffield Hallam UniversitySheffieldUK
- University of SheffieldSheffieldUK
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Mohsenpour M, Ebadi A, Mousavi B, Repišti S, Sharif Nia H, Ghanei Gheshlagh R. Psychometric Evaluation of the Farsi Version of the Surgical Anxiety Questionnaire. J Perianesth Nurs 2023; 38:907-911. [PMID: 37665300 DOI: 10.1016/j.jopan.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/04/2023] [Accepted: 03/11/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The aim of this study was to evaluate the psychometric properties of the Farsi version of the Surgical Anxiety Questionnaire. DESIGN Cross-sectional study. METHODS This study was performed on 402 patients who were candidates for elective surgery in Mashhad [East Iran) hospitals in winter 2021. After forward-backward translation, face and content validity checks were performed qualitatively. The construct validity was assessed by exploratory and confirmatory factor analysis. Data analysis was performed with SPSS 16 and AMOS 26. FINDINGS In exploratory factor analysis, two factors were extracted: concerns about surgery and anesthesia; and postdischarge concerns, which explained 52% of the total variance. The Cronbach's alpha for the entire questionnaire was 0.91 and for the subscales ranged from 0.80 to 0.87. The final model had a good fit as determined by confirmatory factor analysis. CONCLUSIONS The Farsi version of the surgical anxiety questionnaire has acceptable validity and reliability. The existence of this scale measuring domain-specific anxiety allows for further research in this area.
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Affiliation(s)
- Mohaddeseh Mohsenpour
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bahare Mousavi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Selman Repišti
- Applied Psychology, Faculty of Applied Sciences, University of Donja Gorica (UDG), Podgorica, Montenegro
| | - Hamid Sharif Nia
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Ghanei Gheshlagh
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
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Luo L, Jiang J, Zhang M, Guo Z, Zhang X, Wang F, Yang F. Comparative Study About Different Doses of Remimazolam in Short Laparoscopic Surgery: A Randomized Controlled Double-Blind Trial. Ther Clin Risk Manag 2023; 19:829-837. [PMID: 37881329 PMCID: PMC10596194 DOI: 10.2147/tcrm.s428278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
Objective To study the efficacy and safety of different doses of remimazolam used for induction and maintenance in short laparoscopic surgery. Methods A randomized controlled trial was conducted between May 2021 and May 2022 on patients underwent laparoscopic surgery for 30 minutes to an hour. Based on the drug used and the infusion rate, included patients were allocated into the Low-group of remimazolam (using a constant infusion rate of 6.0 mg/kg/h for induction and the rate of 1 mg/kg/h for maintenance), the Median-group (9.0 mg/kg/h for induction, 2 mg/kg/h for maintenance), the High-group (12.0 mg/kg/h for induction, 3.0 mg/kg/h for maintenance), and the Propofol group. The postoperative extubation time was used as the primary outcome. Results A total of 192 patients were included in the study, with 47, 48, 48, and 49 patients in the Low-, Median-, High-, and Propofol group, respectively. There was a significant difference in postoperative extubation time, with the High-group having the highest duration of 15.21±2.34 minutes compared to the Median-group (13.17±1.71 minutes, p<0.001), Low- group (12.72±1.31 minutes, p<0.001), and the Propofol group (12.24±1.23 minutes, p<0.001). No significant difference was found between the Low-group and the Propofol group, while the Median-group still showed higher postoperative extubation time compared to the Propofol group (p=0.008). Conclusion Compared to propofol, total intravenous induction and maintenance with high and median dosages of remimazolam may prolong postoperative extubation time. Remimazolam can be safely used for induction and maintenance at various doses while not increasing the likelihood of adverse events.
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Affiliation(s)
- Li Luo
- Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, People’s Republic of China
| | - Jiduan Jiang
- Department of Anesthesiology, Suining First People’s Hospital, Suining City, Sichuan Province, People’s Republic of China
| | - Min Zhang
- Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, People’s Republic of China
| | - Zhiqiang Guo
- Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, People’s Republic of China
| | - Xianzheng Zhang
- Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, People’s Republic of China
| | - Fenglin Wang
- Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, People’s Republic of China
| | - Fan Yang
- Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, People’s Republic of China
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Xing J, Gong C, Wu B, Li Y, Liu L, Yang P, Wang T, Hei Z, Zhou S, Chen C. Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery. Heliyon 2023; 9:e20536. [PMID: 37842611 PMCID: PMC10568319 DOI: 10.1016/j.heliyon.2023.e20536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023] Open
Abstract
Video propaganda is reported effectively improving patients' understanding of operation. However, whether a video introducing patients' most concerns can reduce preoperative anxiety and promote recovery stays unsealed. In this study, we investigated the effects of complementary therapy of educational video during preoperative visit. The results showed that thirty-five (23.2%) parents in Group Control were diagnosed as anxiety according to SAS, and nineteen (12.3%) patients were diagnosed after video intervention. The APAIs anxiety score and APAIs information score in Group Video were lower than those in Group Control. Compared with Group Control, video visit helped to increase the first-attempt pass rate of the knowledge retention exam and solve the patient's most worried concerns, and decrease incidence of emergence agitation, total cost of hospitalization and length of hospital stay. Moreover, video visit improved satisfaction degrees of patients and their main family members. Briefly, our study demonstrated video visit can improve patients' knowledge of anesthesia and decrease their preoperative anxiety, which may represent an important complementary therapy to routine preoperative visits.
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Affiliation(s)
- Jibin Xing
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chulian Gong
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Wu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou, China
| | - Yanting Li
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liling Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou, China
| | - Panyang Yang
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tienan Wang
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ziqing Hei
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaoli Zhou
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chaojin Chen
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Salzmann S, Euteneuer F, Kampmann S, Rienmüller S, Rüsch D. Preoperative anxiety and need for support - A qualitative analysis in 1000 patients. PATIENT EDUCATION AND COUNSELING 2023; 115:107864. [PMID: 37393683 DOI: 10.1016/j.pec.2023.107864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Preoperative anxiety is prevalent, emotionally distressing for many patients, and can have harmful effects on postoperative outcomes. Despite its high prevalence, there has been little research on preoperative anxiety using qualitative methods. This study's main goal was to qualitatively examine factors that may contribute to preoperative anxiety in a large sample. METHODS In a survey, a total of 1000 patients awaiting surgery were asked open questions i) about reasons which they associate with their preoperative anxiety and ii) which coping strategies they would prefer in addition to premedication. RESULTS The qualitative analysis indicated five overarching domains, 16 themes, and 54 subthemes of preoperative anxiety. Intra- or postoperative complications was the most common theme regarding preoperative anxiety (n = 516). Personal conversation was the most frequently desired supportive measure in addition to premedication. CONCLUSIONS This study indicated a considerable heterogeneity of reasons associated with preoperative anxiety based on an unbiased assessment in a large sample. The study further suggests that a personal conversation is a clinically important coping strategy in addition to premedication. PRACTICE IMPLICATIONS Providers should assess patients' preoperative anxiety and the resulting need for support individually to offer supportive measures adapted to the patients' needs.
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Affiliation(s)
- Stefan Salzmann
- Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Medical Psychology, Health and Medical University Erfurt, Erfurt, Germany.
| | - Frank Euteneuer
- Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | | | | | - Dirk Rüsch
- Philipps-University Marburg, Marburg, Germany; University Hospital Giessen-Marburg (Marburg Campus), Department of Anesthesia and Intensive Care, Marburg, Germany
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Eikemo M, Meier IM, Løseth G, Trøstheim M, Ørstavik N, Jensen EN, Garland EL, Berna C, Ernst G, Leknes S. Opioid analgesic effects on subjective well-being in the operating theatre. Anaesthesia 2023; 78:1102-1111. [PMID: 37381617 PMCID: PMC10714491 DOI: 10.1111/anae.16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/30/2023]
Abstract
Exposure to opioid analgesics due to surgery increases the risk of new persistent opioid use. A mechanistic hypothesis for opioids' abuse liability rests on the belief that, in addition to pain relief, acute opioid treatment improves well-being (e.g. via euphoria) and relieves anxiety. However, opioids do not consistently improve mood in laboratory studies of healthy non-opioid users. This observational study determined how two commonly used opioid analgesics affected patients' subjective well-being in standard clinical practice. Day surgery patients rated how good and how anxious they felt before and after an open-label infusion of remifentanil (n = 159) or oxycodone (n = 110) in the operating theatre before general anaesthesia. One minute after drug injection, patients reported feeling intoxicated (> 6/10 points). Anxiety was reduced after opioids, but this anxiolytic effect was modest (remifentanil Cohen's d = 0.21; oxycodone d = 0.31). There was moderate to strong evidence against a concurrent improvement in well-being (Bayes factors > 6). After remifentanil, ratings of 'feeling good' were significantly reduced from pre-drug ratings (d = 0.28). After oxycodone, one in three participants felt better than pre-drug. Exploratory ordered logistic regressions revealed a link between previous opioid exposure and opioid effects on well-being, as only 14 of the 80 opioid-naïve patients reported feeling better after opioid injection. The odds of improved well-being ratings after opioids were higher in patients with previous opioid exposure and highest in patients with > 2 weeks previous opioid use (adjusted OR = 4.4). These data suggest that opioid-induced improvement of well-being is infrequent in opioid-naïve patients. We speculate that peri-operative exposure could increase risk of persistent use by rendering subsequent positive opioid effects on well-being more likely.
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Affiliation(s)
- M. Eikemo
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - I. M. Meier
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - G.E. Løseth
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - M. Trøstheim
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - N. Ørstavik
- Department of Psychology, University of Oslo, Oslo, Norway
| | - E. N. Jensen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - E. L. Garland
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA
| | - C. Berna
- Center for Integrative and Complementary Medicine, Division of Anaesthesiology, Lausanne University Hospital, Lausanne, Switzerland
- The Sense, Lausanne University, Switzerland
| | - G. Ernst
- Department of Psychology, University of Oslo, Oslo, Norway
- Kongsberg Hospital, Kongsberg, Norway
| | - S. Leknes
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Coventry H, Rogers HJ. Beyond targets: A broader perspective to quality improvement with children, young people and families. Int J Paediatr Dent 2023; 33 Suppl 2:59-62. [PMID: 37665151 DOI: 10.1111/ipd.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Heather Coventry
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Helen J Rogers
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Xie W, Ye F, Yan X, Cao M, Ho MH, Kwok JYY, Lee JJ. Acupressure can reduce preoperative anxiety in adults with elective surgery: A systematic review and meta-analysis of randomised controlled trials. Int J Nurs Stud 2023; 145:104531. [PMID: 37321140 DOI: 10.1016/j.ijnurstu.2023.104531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/28/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Preoperative anxiety is prevalent amongst adults with elective surgery and is associated with multiple detrimental perioperative physiological effects. Increasing studies support the effectiveness of acupressure in managing preoperative anxiety. However, the magnitude of acupressure's positive association with preoperative anxiety is still unclear due to a lack of rigorous evidence synthesis. OBJECTIVE To estimate the efficacy of acupressure on preoperative anxiety and physiological parameters amongst adults scheduled for elective surgery. DESIGN Systematic review and meta-analysis. DATA SOURCES Search terms were combined for acupressure and preoperative anxiety in PubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and WanFang Data Knowledge Service Platform to search for eligible randomised controlled trials from the inception of each database through September 2022. METHODS Pairs of researchers independently screened and extracted data from included studies. The risk of bias was assessed using the Cochrane risk of bias tool Version 2.0. Meanwhile, random-effects meta-analysis of overall effects and prespecified subgroup (i.e., surgery types, intervention providers, and acupressure stimulation tools) was conducted using Review Manager Software 5.4.1. Meta-regression was performed to explore study-level variables that may contribute to heterogeneity using STATA 16. RESULTS Of 24 eligible randomised controlled trials, there were a total of 2537 participants from 5 countries contributed to this synthesis. When comparing acupressure with usual care or placebo, acupressure showed a large effect size for preoperative anxiety (SMD = -1.30; 95%CI = -1.54 to -1.06; p < 0.001; I2 = 86%). The significant mean reduction of heart rate, and systolic and diastolic blood pressure was -4.58 BPM (95%CI = -6.70 to -2.46; I2 = 89%), -6.05 mmHg (95%CI = -8.73 to -3.37; p < 0.001; I2 = 88%), and -3.18 mmHg (95%CI = -5.09 to -1.27; p = 0.001; I2 = 78%), respectively. Exploratory subgroup analyses showed significant differences in surgery types and acupressure stimulation tools, whilst the intervention providers (i.e., healthcare professionals and self-administered) showed no statistically significant difference for acupressure therapy. None of the predefined participants and study-level characteristics moderated preoperative anxiety through meta-regression. CONCLUSION Acupressure appears efficacious as a therapy for improving preoperative anxiety and physiological parameters amongst adults with elective surgery. Self-administered acupressure, which is effective with a large effect, may be considered as an evidence-based approach to managing preoperative anxiety. Hence, this review aids in the development of acupressure in different types of elective surgeries and the improvement of the rigour of acupressure therapy.
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Affiliation(s)
- Wenxuan Xie
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Fen Ye
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Xinyi Yan
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Mengyao Cao
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Jojo Yan Yan Kwok
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China.
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Wang D, Guo Y, Yin Q, Cao H, Chen X, Qian H, Ji M, Zhang J. Analgesia quality index improves the quality of postoperative pain management: a retrospective observational study of 14,747 patients between 2014 and 2021. BMC Anesthesiol 2023; 23:281. [PMID: 37598151 PMCID: PMC10439647 DOI: 10.1186/s12871-023-02240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND The application of artificial intelligence patient-controlled analgesia (AI-PCA) facilitates the remote monitoring of analgesia management, the implementation of mobile ward rounds, and the automatic recording of all types of key data in the clinical setting. However, it cannot quantify the quality of postoperative analgesia management. This study aimed to establish an index (analgesia quality index (AQI)) to re-monitor and re-evaluate the system, equipment, medical staff and degree of patient matching to quantify the quality of postoperative pain management through machine learning. METHODS Utilizing the wireless analgesic pump system database of the Cancer Hospital Affiliated with Nantong University, this retrospective observational study recruited consecutive patients who underwent postoperative analgesia using AI-PCA from June 1, 2014, to August 31, 2021. All patients were grouped according to whether or not the AQI was used to guide the management of postoperative analgesia: The control group did not receive the AQI guidance for postoperative analgesia and the experimental group received the AQI guidance for postoperative analgesia. The primary outcome was the incidence of moderate-to-severe pain (numeric rating scale (NRS) score ≥ 4) and the second outcome was the incidence of total adverse reactions. Furthermore, indicators of AQI were recorded. RESULTS A total of 14,747 patients were included in this current study. The incidence of moderate-to-severe pain was 26.3% in the control group and 21.7% in the experimental group. The estimated ratio difference was 4.6% between the two groups (95% confidence interval [CI], 3.2% to 6.0%; P < 0.001). There were significant differences between groups. Otherwise, the differences in the incidence of total adverse reactions between the two groups were nonsignificant. CONCLUSIONS Compared to the traditional management of postoperative analgesia, application of the AQI decreased the incidence of moderate-to-severe pain. Clinical application of the AQI contributes to improving the quality of postoperative analgesia management and may provide guidance for optimum pain management in the postoperative setting.
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Affiliation(s)
- Di Wang
- Department of Anesthesiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yihui Guo
- Department of Anesthesiology, The People's Hospital of Pizhou, Pizhou Hospital affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qian Yin
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Hanzhong Cao
- Department of Anesthesiology, Tumor Hospital Affiliated to NanTong University, Nantong, Jiangsu, China
| | - Xiaohong Chen
- Department of Anesthesiology, Tumor Hospital Affiliated to NanTong University, Nantong, Jiangsu, China
| | - Hua Qian
- Department of Anesthesiology, Tumor Hospital Affiliated to NanTong University, Nantong, Jiangsu, China
| | - Muhuo Ji
- Department of Anesthesiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Jianfeng Zhang
- Department of Anesthesiology, Tumor Hospital Affiliated to NanTong University, Nantong, Jiangsu, China.
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Bello C, Nübling M, Luedi MM, Heidegger T. Patient satisfaction in anesthesiology: a narrative review. Curr Opin Anaesthesiol 2023; 36:452-459. [PMID: 37222215 DOI: 10.1097/aco.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE OF REVIEW Healthcare is increasingly expanding its view in outcome discussions to integrate patient-reported outcomes such as patient satisfaction. Involving patients in the evaluation of services and the development of quality improvement strategies is paramount, especially in the service-oriented discipline of anaesthesiology. RECENT FINDINGS Currently, while the development of validated patient satisfaction questionnaires is well established, the use of rigorously tested scores in research and clinical practice is not standardized. Furthermore, most questionnaires are validated for specific settings, which limits our ability to draw relevant conclusions from them, especially considering the rapidly expanding scope of anaesthesia as a discipline and the addition of same-day surgery. SUMMARY For this manuscript, we review recent literature regarding patient satisfaction in the inpatient and ambulatory anaesthesia setting. We discuss ongoing controversies and briefly digress to consider management and leadership science regarding 'customer satisfaction'.
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Affiliation(s)
- Corina Bello
- Department of Anesthesiology, Spitalregion Rheintal, Werdenberg, Sarganserland, Spitalstrasse, Grabs
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Heidegger
- Department of Anesthesiology, Spitalregion Rheintal, Werdenberg, Sarganserland, Spitalstrasse, Grabs
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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Yee MS, Tarshis J. Anesthesia quality indicators to measure and improve your practice: a modified delphi study. BMC Anesthesiol 2023; 23:256. [PMID: 37525089 PMCID: PMC10388503 DOI: 10.1186/s12871-023-02195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/02/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Implementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice. METHODS An initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel. RESULTS The initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome. CONCLUSION This ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.
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Affiliation(s)
- May-Sann Yee
- Southlake Regional Health Centre, Newmarket, ON, L3Y 2P9, Canada.
| | - Jordan Tarshis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Sobot Novakovic S, Cuk S, Svraka D, Milosevic D. Patient Satisfaction With General Anesthesia Compared to Spinal Anesthesia for Cesarean Section: A Multicenter Observational Study. Cureus 2023; 15:e42666. [PMID: 37521592 PMCID: PMC10386895 DOI: 10.7759/cureus.42666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background Satisfaction in patients undergoing cesarean section (CS) is of great importance in every hospital. There are big differences between spinal and general anesthesia for CS in terms of outcome, recovery times, and quality of service. Methods This multicenter observational study included 1443 patients who had elective (n=622) or emergency (n=821) CS in five medical centers over the period of 16 months. Bauer questionnaire was used for measuring patient satisfaction after CS. The questionnaire contained 15 questions about anesthesia-related discomfort and satisfaction with anesthesia care. Results During the study period, 1161 (80%) patients underwent CS under general anesthesia (GA) and 282 of them (20%) received spinal anesthesia (SA) for CS. The most frequently reported anesthesia-related discomfort was pain at the surgical site (>70%), drowsiness (68%), and thirst (60%). The data on patient satisfaction showed high satisfaction that exceeded 90%. Anesthesia side effects were less frequent and the general satisfaction rate was higher in the SA group compared to the GA group (P < .001). Conclusion SA for CS had less frequent side effects and a better satisfaction rate compared to GA for CS. Hospitals need to make room for improvement of postoperative acute pain control and introduction to Enhanced Recovery After Surgery (ERAS) protocols for elective CS.
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Affiliation(s)
- Suzana Sobot Novakovic
- Anesthesiology and Critical Care, University Clinical Center of Republic of Srpska, Banja Luka, BIH
| | - Sanja Cuk
- Anesthesiology and Critical Care, University Clinical Center of the Republic of Srpska, Banja Luka, BIH
| | - Dragan Svraka
- Anesthesiology and Critical Care, University Clinical Center of Republic of Srpska, Banja Luka, BIH
| | - Dragan Milosevic
- Anesthesiology and Critical Care, University Clinical Center of Republic of Srpska, Banja Luka, BIH
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Nimmaanrat S, Charuenporn B, Jensen MP, Geater AF, Tanasansuttiporn J, Chanchayanon T. The anxiolytic effects of preoperative administration of pregabalin in comparison to diazepam and placebo. Sci Rep 2023; 13:9680. [PMID: 37322140 PMCID: PMC10272144 DOI: 10.1038/s41598-023-36616-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
We aimed to evaluate the potential anxiolytic effects of premedication with pregabalin, compared with diazepam and placebo. We conducted this non-inferiority, double-blind, randomized controlled trial in ASA classification I-II patients aged 18-70 years, scheduled for elective surgery under general anesthesia. They were allocated to receive pregabalin (75 mg the night before surgery and 150 mg 2 h before surgery), diazepam (5 and 10 mg in the same manner) or placebo. Preoperative anxiety was evaluated using verbal numerical rating scale (VNRS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) before and after premedication. Sleep quality, sedation level, and adverse effects were assessed as secondary outcomes. A total of 231 patients were screened and 224 completed the trial. The mean change (95%CI) in anxiety scores from before to after medication in pregabalin, diazepam, and placebo groups for VNRS were - 0.87 (- 1.43, - 0.30), - 1.17 (- 1.74, - 0.60), and - 0.99 (- 1.56, - 0.41), and for APAIS were - 0.38 (- 1.04, 0.28), - 0.83 (- 1.49, - 0.16), and - 0.27 (- 0.95, 0.40). The difference in change for pregabalin versus diazepam was 0.30 (- 0.50, 1.11) for VNRS and 0.45 (- 0.49, 1.38) for APAIS, exceeding the limit of inferiority for APAIS of 1.3. Sleep quality was statistically different between pregabalin and placebo groups (p = 0.048). Sedation in pregabalin and diazepam groups were significantly higher than placebo group (p = 0.008). No significant differences of other side effects, except dry mouth was higher in placebo group compared with diazepam (p = 0.006). The study filed to provide evidence at non-inferiority of pregabalin compared to diazepam. Furthermore, premedication with either pregabalin or diazepam did not significantly reduce the preoperative anxiety in comparison to placebo, despite the fact that both resulted in higher levels of sedation. Clinicians should weigh the benefits and risks of premedication with these 2 drugs.Thai Clinical Trials Registry: TCTR20190424001 (24/04/2019) Registry URL: https://www.thaiclinicaltrials.org/ .
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Affiliation(s)
- Sasikaan Nimmaanrat
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Benjalak Charuenporn
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Alan F Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Jutarat Tanasansuttiporn
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Thavat Chanchayanon
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Hachenberg T, Scheller B. [Accidental Awareness during General Anaesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:380-390. [PMID: 37385244 DOI: 10.1055/a-1768-5161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Accidental awareness during general anaesthesia (AAGA) is a rare but severe complication. The reported incidence of AAGA may depend on the assessment of intraoperative awareness with explicit recall and there are substantial variations between subspecialties and groups of patients. The majority of prospective studies using structured interviews reported an incidence of AAGA at 0.1-0.2% during general anaesthesia, however, higher values were observed in paediatric (0.2-1.2%) and obstetric patients (0.47%). Risk factors that predispose to AAGA are patient conditions, ASA status, female gender, patient age, history of AAGA, surgical procedure, anaesthetic drug type, muscle relaxation, dosages of hypnotic or analgesic drugs, monitoring and malfunction of anaesthesia systems. Preventive strategies include careful assessment of risk factors, avoidance of underdosages of hypnotics and analgetics during general anaesthesia and monitoring of depth of anaesthesia in risk patients. The health-related consequences can be serious and psychopharmacological and psychotherapeutic interventions are indicated in patients who have experienced AAGA.
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Dahlem C, Monteiro C, Mendes E, Martinho J, Oliveira C, Bettencourt M, Coelho M, Neves P, Azevedo L, Granja C. Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain. J Clin Med 2023; 12:jcm12072669. [PMID: 37048752 PMCID: PMC10095355 DOI: 10.3390/jcm12072669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Anxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its relationship with preoperative anxiety. A prospective observational cohort study was conducted in three Portuguese ambulatory units between September 2018 and March 2020. Variable doses of midazolam were administered. Postsurgical pain was evaluated up to three months after surgery. We enrolled 306 patients and analyzed 281 patients. The mean preoperative anxiety Numeric Rating Scale score was 4 (3) and the mean Surgical Fear Questionnaire score was 22 (16); the mean midazolam dose was 1.7 (1.1) mg with no correlation to preoperative anxiety scores. Pain ≥4 was present in 67% of patients 24 h after surgery and in 54% at seven days; at three months, 27% were classified as having chronic postsurgical pain. Preoperative anxiety correlated to pain severity at all time points. In multivariable regression, higher midazolam doses were associated with less pain during the first week, with no apparent effect on chronic pain. However, subgroup analyses uncovered an effect modification according to preoperative anxiety: the decrease in acute pain occurred in the low-anxiety patients with no effect on the high-anxiety group. Inversely, there was an increase in chronic postsurgical pain in the very anxious patients, without any effect on the low-anxiety group. Midazolam, generally used as an anxiolytic, might impact distinctively on pain depending on anxiety.
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Affiliation(s)
- Caroline Dahlem
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Entre Douro e Vouga, 4520-211 Santa Maria da Feira, Portugal
| | - Catarina Monteiro
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Eunice Mendes
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Joana Martinho
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
| | - Carmen Oliveira
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Margarida Bettencourt
- Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, Portugal
| | - Miguel Coelho
- Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, Portugal
| | - Paula Neves
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Luís Azevedo
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Cristina Granja
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Tsai HY, Chao A, Hsiao WL. The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis. Intensive Crit Care Nurs 2023; 75:103359. [PMID: 36535871 DOI: 10.1016/j.iccn.2022.103359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/21/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the effectiveness of cold oral stimuli in quenching postoperative thirst in patients undergoing surgery. DESIGN A systematic review and meta-analysis of interventional studies. SETTING Postoperative care units. METHODS Seven electronic databases (Medline, Scopus, Web of Science, PubMed, CINHAL, PsycInfo, and EMBASE) were systematically searched from their inception to January 12, 2022. The Cochrane Handbook for Systematic Reviews of Interventions was followed. Two researchers examined the study quality using the Cochrane risk of bias tools. A meta-analysis with a subgroup analysis was performed. Sensitivity analysis, funnel plots and Egger's test were used to examine publication bias. MAIN OUTCOME MEASURE A thirst intensity score was used to rate postoperative thirst. RESULTS Data were collected from 11 interventional studies for this systematic review. Eight studies underwent a meta-analysis with a total of 1504 patients. Our meta-analysis showed that the thirst intensity scores decreased in the experimental groups by 1.42 points (95% confidence interval: -2.162 to -0.684) more than those of the control groups. Subgroup analysis indicated that Asian patients and age were two factors that moderated the thirst intensity score after applying cold oral stimuli. CONCLUSION Cold oral stimuli were effective in mitigating postoperative thirst. Ice products such as ice cubes, or ice chips are easily available in postoperative units. When applying cold oral stimuli, health professionals should be aware of that in Asian and older patients. Cultural acceptance and physiological degeneration, respectively, may influence the thirst ratings. Future research should investigate various factors underlying the perioperative period. Network meta-analysis can be used to examine multiple strategies for thirst management.
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Affiliation(s)
- Han-Yi Tsai
- School of Nursing, College of Medicine, National Taiwan University, No 1, Sec 1, Jen-Ai Rd, Taipei 10051, Taiwan; Department of Nursing, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan.
| | - Anne Chao
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei 100225, Taiwan; School of Medicine, College of Medicine, National Taiwan University, No 1, Sec 1, Jen-Ai Rd, Taipei 10051, Taiwan
| | - Wei-Ling Hsiao
- School of Nursing, College of Medicine, National Taiwan University, No 1, Sec 1, Jen-Ai Rd, Taipei 10051, Taiwan; Department of Nursing, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei 100225, Taiwan.
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Patel ABU, Bibawy PPWM, Althonayan JIM, Majeed Z, Gan WL, Abbott TEF, Ackland GL. Effect of transauricular nerve stimulation on perioperative pain: a single-blind, analyser-masked, randomised controlled trial. Br J Anaesth 2023; 130:468-476. [PMID: 36822987 PMCID: PMC10080471 DOI: 10.1016/j.bja.2022.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Activation of central autonomic pathways, including those regulating the arterial baroreflex, might reduce acute pain. We tested the hypothesis that transcutaneous auricular nerve stimulation (TAN) reduces pain after orthopaedic trauma surgery through autonomic modulation. METHODS A total of 86 participants aged >18 yr were randomly assigned to 50 min of either sham or active bilateral TAN, undertaken before, and again 24 h after, surgery for orthopaedic trauma. The primary outcome was absolute change in pain 24 h postoperatively, comparing the 100 mm visual analogue scale (VAS) before and after TAN. Secondary outcomes included the minimal clinically important difference in pain (>10 mm increase or reduction in VAS) before/after surgery, using intention-to-treat analysis. Holter monitoring, the analysis of which was masked to allocation, quantified autonomic modulation of heart rate. RESULTS From June 22, 2021 to July 7, 2022, 79/86 participants (49 yr; 45% female) completed TAN before and after surgery. For the primary outcome, the mean reduction in VAS was 19 mm (95% confidence interval [CI]: 12-26) after active TAN (n=40), vs 10 mm (95% CI: 3-17) after sham TAN (n=39; P=0.023). A minimally clinically important reduction in postoperative pain occurred in 31/40 (78%) participants after active TAN, compared with 15/39 (38%) allocated to sham TAN (odds ratio 5.51 [95% CI: 2.06-14.73]; P=0.001). Only active TAN increased heart rate variability (log low-frequency power increased by 0.19 ms2 [0.01-0.37 ms2]). Prespecified adverse events (auricular skin irritation) occurred in six participants receiving active TAN, compared with two receiving sham TAN. CONCLUSION Bilateral TAN reduces perioperative pain through autonomic modulation. These proof-of-concept data support a non-pharmacological, generalisable approach to improve perioperative analgesia.
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Affiliation(s)
- Amour B U Patel
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Phillip P W M Bibawy
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, UK
| | | | - Zehra Majeed
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Weng L Gan
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, UK
| | - Tom E F Abbott
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.
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Abstract
The global volume of surgery is increasing. Adverse outcomes after surgery have resource implications and long-term impact on quality of life and consequently represent a significant and underappreciated public health issue. Standardization of outcome reporting is essential for evidence synthesis, risk stratification, perioperative care planning, and to inform shared decision-making. The association between short- and long-term outcomes, which persists when corrected for base-line risk, has significant implications for patients and providers and warrants further investigation. Candidate mechanisms include sustained inflammation and reduced physician activity, which may, in the future, be mitigated by targeted interventions.
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Affiliation(s)
- David Alexander Harvie
- From the Department of Anaesthesia & Perioperative Care and General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Denny Zelda Hope Levett
- From the Department of Anaesthesia & Perioperative Care and General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Michael Patrick William Grocott
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, United Kingdom
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Rüggeberg A, Nickel EA. Unrestricted drinking before surgery: a structured patient interview. Anaesthesia 2023. [PMID: 36929501 DOI: 10.1111/anae.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Affiliation(s)
- A Rüggeberg
- Helios Klinikum Emil von Behring, Berlin, Germany
| | - E A Nickel
- Helios Klinikum Emil von Behring, Berlin, Germany
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Li J, Li S, Zhang T, Yu L, Wei J, Wu M, Xie Y, Tan H. Label-free serum proteomics for the identification of the putative biomarkers of postoperative pain in patients with gastric cancer. Mol Omics 2023; 19:351-361. [PMID: 36892434 DOI: 10.1039/d2mo00296e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background: Individualized pain therapy conforms to the concept of precision medicine and contributes to adequate pain management after surgery. Preoperative biomarkers associated with postoperative pain may instruct anesthesiologists to improve personalized suitable analgesia. Therefore, it is essential to explore the association between preoperative proteins and postoperative acute pain using the proteomics platform. Methods: In this study, the 24 hours postoperative sufentanil consumption of 80 male patients with gastric cancer was ranked. Patients with sufentanil consumption in the lowest 12% were included in the sufentanil low consumption group, while patients with sufentanil consumption in the highest 12% were included in the sufentanil high consumption group. The secretion of serum proteins in both groups was analyzed using label-free proteomics technology. The results were validated by ELISA. Results: Proteomics identified 29 proteins that were significantly differentially expressed between groups. ELISA confirmed that secretion of TNC and IGFBP2 was down-regulated in the SLC group. The differential proteins were mainly extracellular and were involved in several terms, including calcium ion binding, laminin-1 binding, and so on. Pathway analysis showed that they were mainly enriched in focal adhesion and extracellular matrix-receptor interaction. The protein-protein interaction network analysis showed 22 proteins that interacted with other proteins. F13B had the strongest correlation with sufentanil consumption and its AUC value was 0.859. Conclusions: Several differential proteins are associated with postoperative acute pain and are involved in ECM-related processes, inflammation, and blood coagulation cascades. F13B may be a novel marker for postoperative acute pain. Our results may benefit postoperative pain management.
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Affiliation(s)
- Jianing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Shuo Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Tianzhuo Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Ling Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Jin Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Mengge Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Yining Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Hongyu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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El-Jack K, Henderson K, Andy AU, Southwick L. Reddit Users' Questions and Concerns about Anesthesia. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2023. [DOI: 10.5195/ijms.2022.1687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background: Patients utilize social media in search of support networks. Reddit is one of the most popular social media sites and allows users to anonymously connect. Anesthesia patients are actively using Reddit to discuss their treatment options and experiences within the medical system.
Methods: Posts published on an active Reddit forum on Anesthesia (i.e., /r/Anesthesia) were used. Big Query was used to collect posts from /r/Anesthesia. We collected 3,288 posts published between December 2015 and August 2019. We collected a control group of 3,288 posts from a Reddit forum not related to Anesthesia. Using latent Dirichlet allocation (LDA) we extracted 20 topics from our data set. The LDA topic themes most associated with posts in /r/Anesthesia compared to the control group were determined.
Results: LDA analysis of posts in /r/Anesthesia relative to a control group produced 6 distinct categories of posts (Table 1). The posts most associated with /r/Anesthesia when compared to a control group were posts belonging to the “Physician-Patient Experience” category (Cohen’s d= 0.389) while the posts least associated with /r/Anesthesia were from the “Uncertainties” category of posts (Cohen’s d= 0.147). Example experiences from members of the /r/Anesthesia forum highlight subjective experiences of patients undergoing anesthesia.
Conclusions: The language used on social media can provide insights into an individual's experience with anesthesia and inform physicians about patient concerns. Anesthesiologists are poised to address these concerns and prevent anonymous misinformation by providing verified physician insights on the forum /r/Anesthesia.
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