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Savage M, Spence A, Turbitt L. The educational impact of technology-enhanced learning in regional anaesthesia: a scoping review. Br J Anaesth 2024; 133:400-415. [PMID: 38824073 DOI: 10.1016/j.bja.2024.04.045] [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: 12/31/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Effective training in regional anaesthesia (RA) is paramount to ensuring widespread competence. Technology-based learning has assisted other specialties in achieving more rapid procedural skill acquisition. If applicable to RA, technology-enhanced training has the potential to provide an effective learning experience and to overcome barriers to RA training. We review the current evidence base for use of innovative technologies in assisting learning of RA. METHODS Using scoping review methodology, three databases (MEDLINE, Embase, and Web of Science) were searched, identifying 158 relevant citations. Citations were screened against defined eligibility criteria with 27 studies selected for inclusion. Data relating to study details, technological learning interventions, and impact on learner experience were extracted and analysed. RESULTS Seven different technologies were used to train learners in RA: artificial intelligence, immersive virtual reality, desktop virtual reality, needle guidance technology, robotics, augmented reality, and haptic feedback devices. Of 27 studies, 26 reported a positive impact of technology-enhanced RA training, with different technologies offering benefits for differing components of RA training. Artificial intelligence improved sonoanatomical knowledge and ultrasound skills for RA, whereas needle guidance technologies enhanced confidence and improved needling performance, particularly in novices. Immersive virtual reality allowed more rapid acquisition of needling skills, but its functionality was limited when combined with haptic feedback technology. User friendly technologies enhanced participant experience and improved confidence in RA; however, limitations in technology-assisted RA training restrict its widespread use. CONCLUSIONS Technology-enhanced RA training can provide a positive and effective learning experience, with potential to reduce the steep learning curve associated with gaining RA proficiency. A combined approach to RA education, using both technological and traditional approaches, should be maintained as no single method has been shown to provide comprehensive RA training.
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Affiliation(s)
- Mairead Savage
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK.
| | - Andrew Spence
- Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
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Illescas A, Cozowicz C, Zhong H, Reisinger L, Liu J, Poeran J, Memtsoudis SG. Comparative effectiveness of neuraxial versus general anesthesia in total joint replacement surgery: an updated retrospective analysis using more recent data. Reg Anesth Pain Med 2024:rapm-2024-105438. [PMID: 38977283 DOI: 10.1136/rapm-2024-105438] [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: 02/29/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Over a decade ago, our study group showed improved outcomes among total hip/knee arthroplasty (THA/TKA) patients given neuraxial versus general anesthesia. As the use of neuraxial anesthesia has increased and anesthesia practices evolve, updated analyses are critical to ensure if previously found differences still persist. METHODS This retrospective cohort study included elective THA/TKAs from 2006 to 2021 as recorded in the all-payor Premier Healthcare Database. Multivariable regression models measured the association between anesthesia type (neuraxial, general, combined) and several adverse outcomes (pulmonary embolism, cerebrovascular events, pulmonary compromise, cardiac complications, acute myocardial infarction, pneumonia, all infections, acute renal failure, gastrointestinal complications, postoperative mechanical ventilation, intensive care unit admissions, and blood transfusions); models were run separately by period (2006-2015 and 2016-2021) and THA/TKA. RESULTS We identified 587,919 and 499,484 THAs for 2006-2015 and 2016-2021, respectively; this was 1,186,483 and 803,324 for TKAs. Among THAs, neuraxial anesthesia use increased from 10.7% in 2006 to 25.7% in 2021; during both time periods, specifically neuraxial versus general anesthesia was associated with lower odds for most adverse outcomes, with sometimes stronger (protective) effect estimates observed for 2016-2021 versus 2006-2015 (eg, acute renal failure OR 0.72 CI 0.65 to 0.80 vs OR 0.56 CI 0.50 to 0.63 and blood transfusion OR 0.91 CI 0.89 to 0.94 vs OR 0.44 CI 0.41 to 0.47, respectively; all p<0.001). Similar patterns existed for TKAs. CONCLUSION These findings re-confirm our study group's decade-old study using more recent data and offer additional evidence toward the sustained benefit of neuraxial anesthesia in major orthopedic surgery.
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Affiliation(s)
- Alex Illescas
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Lisa Reisinger
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Jashvant Poeran
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
- Departments of Orthopaedics / Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
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3
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Gohad R, Jain S. Regional Anaesthesia, Contemporary Techniques, and Associated Advancements: A Narrative Review. Cureus 2024; 16:e65477. [PMID: 39188450 PMCID: PMC11346749 DOI: 10.7759/cureus.65477] [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: 06/19/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
In particular, the application of regional anaesthesia techniques in existing medicine can be characterized as experiencing regular changes in recent decades. It is useful for obtaining accurate and efficient pain management solutions, from the basic spinal and epidural blocks to the novel ultrasound nerve blocks and constant catheter procedures. These advancements do enhance not only the value of the perioperative period but also the patient's rated optimization as enhancing satisfaction, better precision, and the safety of nerve block placement. The use of ultrasound technology makes it even easier to determine the proper positioning of the needle and to monitor nerve block placement. Moreover, the duration and efficiency of regional anaesthesia are being enhanced by state-of-the-art approaches, which come in the form of liposomal bupivacaine, and better recovery plans and protocols, which shorten recovery time and decrease the number of hospital days. As these methods develop further, more improvements in the safety, efficacy, and applicability of regional anaesthesia in contemporary medicine are anticipated through continued research and innovation.
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Affiliation(s)
- Rutuja Gohad
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sudha Jain
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Chuan A, Bogdanovych A, Moran B, Chowdhury S, Lim YC, Tran MT, Lee TY, Duong J, Qian J, Bui T, Chua AMH, Jeyaratnam B, Siu S, Tiong C, McKendrick M, McLeod GA. Using Virtual Reality to teach ultrasound-guided needling skills for regional anaesthesia: A randomised controlled trial. J Clin Anesth 2024; 97:111535. [PMID: 38889487 DOI: 10.1016/j.jclinane.2024.111535] [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: 02/04/2024] [Revised: 04/21/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
STUDY OBJECTIVE We previously designed and validated a virtual reality-based simulator to help train novices in ultrasound-guided needling skills necessary for safe and competent ultrasound-guided regional anaesthesia. This study was designed to compare the performance and error rates of novices trained by a human faculty aided with the assistance of this virtual reality simulator (virtual reality-assisted training), versus novices trained wholly by humans (conventional training). DESIGN, SETTING, AND PARTICIPANTS In this single centre, randomised controlled study, we used a standardised teaching protocol, rigorous blinding, iterative training of assessors, and validated global rating scale and composite error score checklists to assess skills learning of novice participants. MAIN RESULTS We recruited 45 novices and scored 270 assessments of performance and error rates. Inter-rater correlation coefficient of reliability of scoring between assessors for the global rating scale was 0.84 (95%CI 0.68-0.92) and for the composite error score checklist was 0.87 (95%CI 0.73-0.93). After adjustment for age, sex, Depression, Anxiety and Stress-21, and baseline score, there was no statistical difference for virtual reality-assisted training compared to conventional training in final global rating score (average treatment effect -3.30 (95%CI-13.07-6.48), p = 0.51) or in the final composite error score (average treatment effect 1.14 (95%CI -0.60-2.88), p = 0.20). Realism in the virtual reality simulator was similar to real-life when measured by the Presence Questionnaire, all components p > 0.79; and task workload assessed by the NASA-Task Load Index was not statistically different between groups, average treatment effect 5.02 (95%CI -3.51-13.54), p = 0.25. Results were achieved in the virtual reality-assisted group with half the human faculty involvement. CONCLUSION Novices trained using a hybrid, virtual reality-assisted teaching program showed no superiority to novices trained using a conventional teaching program, but with less burden on teaching resources.
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Affiliation(s)
- Alwin Chuan
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Anaesthesia, Liverpool Hospital, Sydney, Australia.
| | - Anton Bogdanovych
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia
| | - Benjamin Moran
- Department of Anaesthesia, Gosford Hospital, Gosford, Australia
| | - Supriya Chowdhury
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | - Yean Chin Lim
- Department of Anaesthesia & Surgical Intensive Care, Changi General Hospital, Singapore
| | - Minh T Tran
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | - Tsz Yui Lee
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Jayden Duong
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Jennifer Qian
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Tung Bui
- Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | - Alex M H Chua
- Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | | | - Steven Siu
- Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | - Clement Tiong
- Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | - Mel McKendrick
- School of Social Sciences, Hariot-Watt University, Edinburgh, UK
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5
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Zhang X, Vanstone RJ, Turbitt L, West S, Harty E. Regional anaesthesia education for consultants and specialists in the UK: a mixed-methods analysis. Br J Anaesth 2024; 132:1073-1081. [PMID: 38448267 DOI: 10.1016/j.bja.2024.01.032] [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: 10/20/2023] [Revised: 01/06/2024] [Accepted: 01/25/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Regional anaesthesia plays an important role in perioperative care, but gaps in proficiency persist among consultants and specialists. This study aimed to assess confidence levels in performing Plan A blocks among this cohort and to examine the barriers and facilitators influencing regional anaesthesia education. METHODS Utilising a mixed-methods design, we performed a quantitative survey to gauge self-reported confidence in performing Plan A blocks, coupled with qualitative interviews to explore the complexities of educational barriers and facilitators. UK consultant and specialist anaesthetists were included in the study. RESULTS A total of 369 survey responses were analysed. Only 22% of survey respondents expressed confidence in performing all Plan A blocks. Specialists (odds ratio [OR] 0.391, 95% confidence interval [CI] 0.179-0.855, P=0.016) and those in their roles for >10 yr (OR 0.551, 95% CI 0.327-0.927, P = 0.024) reported lower confidence levels. A purposive sample was selected for interviews, and data saturation was reached at 31 interviews. Peer-led learning emerged as the most effective learning modality for consultants and specialists. Barriers to regional anaesthesia education included apprehensions regarding complications, self-perceived incompetence, lack of continuing professional development time, insufficient support from the multidisciplinary team, and a lack of inclusivity within the regional anaesthesia community. Organisational culture had a substantial impact, with the presence of local regional anaesthesia champions emerging as a key facilitator. CONCLUSIONS This study highlights persistent perceived deficiencies in regional anaesthesia skills among consultants and specialists. We identified multiple barriers and facilitators, providing insights for targeted interventions aimed at improving regional anaesthesia education in this group.
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Affiliation(s)
- Xiaoxi Zhang
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK; Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK. https://twitter.com/xiaoxi_6
| | - Ross J Vanstone
- Department of Anaesthesia, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Simeon West
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eoin Harty
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
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6
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Xie J, De Souza E, Perez F, Suárez-Nieto MV, Wang E, Anderson TA. Perioperative Regional Anesthesia Pain Outcomes in Children: A Retrospective Study of 3160 Regional Anesthetics in Routine Practice. Clin J Pain 2024; 40:72-81. [PMID: 37942728 DOI: 10.1097/ajp.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Randomized controlled trials indicate regional anesthesia (RA) improves postoperative outcomes with reduced pain and opioid consumption. Therefore, we hypothesized children who received RA, regardless of technique, would have reduced pain/opioid use in routine practice. METHODS Using a retrospective cohort, we assessed the association of RA with perioperative outcomes in everyday practice at our academic pediatric hospital. Patients 18 years or below undergoing orthopedic, urologic, or general surgeries with and without RA from May 2014 to September 2021 were categorized as single shot, catheter based, or no block. Outcomes included intraoperative opioid exposure and dose, preincision anesthesia time, postanesthesia care unit (PACU) opioid exposure and dose, PACU antiemetic/antipruritic administration, PACU/inpatient pain scores, PACU/inpatient lengths of stay, and cumulative opioid exposure. Regression models estimated the adjusted association of RA with outcomes, controlling for multiple variables. RESULTS A total of 11,292 procedures with 3160 RAs were included. Compared with no-block group, single-shot and catheter-based blocks were associated with opioid-free intraoperative anesthesia and opioid-free PACU stays. Post-PACU (ie, while inpatient), single-shot blocks were not associated with improved pain scores or reduced opioid use. Catheter-based blocks were associated with reduced PACU and inpatient opioid use until 24 hours postop, no difference in opioid use from 24 to 36 hours, and a higher probability of use from 36 to 72 hours. RA was not associated with reduced cumulative opioid consumption. DISCUSSION Despite adjustment for confounders, the association of RA with pediatric pain/opioid use outcomes was mixed. Further investigation is necessary to maximize the benefits of RA.
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Affiliation(s)
- James Xie
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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7
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Bailey CR. Patients have great expectations, but there is more to do. Anaesthesia 2023; 78:1199-1202. [PMID: 37499115 DOI: 10.1111/anae.16105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
Affiliation(s)
- C R Bailey
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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8
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Carev M, Čivljak M, Puljak L, Došenović S. Characteristics, completion and publication of PROSPERO records in regional anesthesia for acute perioperative pain. J Comp Eff Res 2023; 12:e220129. [PMID: 36688587 PMCID: PMC10288962 DOI: 10.2217/cer-2022-0129] [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] [Received: 07/15/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Aim: We analyzed characteristics and completion status of Systematic Reviews (SRs) about regional anesthesia for acute perioperative pain relief registered in PROSPERO. Materials & methods: PROSPERO was searched on 5 January 2022. Characteristics of PROSPERO records, completion status and publication information were extracted. PubMed and Google Scholar were searched by 31 May 2022, for additional published SRs. The inconsistency of PROSPERO records' status was analyzed by comparing the most recent PROSPERO status with subsequent publication of completed SR. Time-to-publication was calculated. Results: Almost half of 174 included PROSPERO records (49%) were registered in 2021. A median of 3 (IQR: 2-4.75) authors, and a search of 4 information sources (IQR: 3-5) was planned. At first registration, 51 (29%) records had already started or completed formal screening. PROSPERO records included mostly adults (48%) undergoing trunk blocks (56%), with pain intensity (74%) as a main outcome. 147 (84%) PROSPERO records had a status "ongoing". Yet, 71 (41%) PROSPERO records were completed SRs, published after a median of 291 days. Inconsistency in status was found in 34% of PROSPERO records. Conclusion: Despite an increase in PROSPERO registrations about regional anesthesia, most were not published, and a third had inaccurate status.
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Affiliation(s)
- Martina Carev
- University of Split School of Medicine, 21000 Split, Croatia
| | - Marta Čivljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, 10000, Zagreb, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, 10000, Zagreb, Croatia
| | - Svjetlana Došenović
- Department of Anesthesiology & Intensive Care Medicine, University Hospital Split, 21000, Split, Croatia
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9
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Closing the gap: artificial intelligence applied to ultrasound-guided regional anaesthesia. Br J Anaesth 2023; 130:245-247. [PMID: 36639327 DOI: 10.1016/j.bja.2022.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023] Open
Abstract
The role of artificial intelligence in ultrasound-guided regional anaesthesia is explored in a recent study by Bowness and colleagues, published in the British Journal of Anaesthesia. The investigators showed that non-expert ability to identify key sono-anatomical structures was improved with the assistance of proprietary artificial intelligence software. Whether such software could increase learning efficiency, and thereby patient access, to regional anaesthesia, will require further study.
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10
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Jørgensen CC, Petersen PB, Daugberg LO, Jakobsen T, Gromov K, Varnum C, Andersen MR, Palm H, Kehlet H. Peripheral nerve-blocks and associations with length of stay and readmissions in fast-track total hip and knee arthroplasty. Acta Anaesthesiol Scand 2023; 67:169-176. [PMID: 36354132 PMCID: PMC10098538 DOI: 10.1111/aas.14169] [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: 08/23/2022] [Revised: 10/05/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Peripheral nerve blocks (PNB) have recently been recommended in total hip (THA) and knee (TKA) arthroplasty as they may reduce pain, morphine consumption, length of stay (LOS) and complications. However, whether PNBs are associated with early discharge within an enhanced recovery protocol including multimodal analgesia is uncertain. METHODS An observational multicenter study from January to August 2017 in six Danish Arthroplasty Centers with established fast-track protocols. Prospective recording of preoperative characteristics and information on PNB, LOS and readmissions through the Danish National Patient Registry and medical records. Multiple logistic regression was used to investigate associations between PNB and a LOS >1 day, LOS >4 days, and 30-days readmissions. We also reported on mobilization, pain, opioid and fall-related complications leading to LOS >4 days or readmissions. RESULTS A total of 2027 (58.6%) THA and 1432 (41.4%) TKAs with a median LOS of 1 day (IQR 1-2) and 5.3% (CI:4.6-6.1) 30-days readmission rate were identified. PNB was used in 40.7% (CI:38.2-43.3) of TKA and 2.7% (CI:2.0-3.5) of THA, but with considerable interdepartmental variation (0.0-89.0% for TKA). There was no association between PNB and LOS >1 day (OR:1.19 CI:0.82-1.72; p = .354), LOS >4 days (OR:1.4 CI:0.68-2.89; p = .359) or 30-days readmissions (OR:1.02 CI:0.63-1.65; p = .935) in TKA. Logistic regression in THA was not possible due to limited use of PNB. In TKA there were 12 (2.1% CI:1.2-3.6) with and 1 (0.1% CI:0.02-0.7) without a PNB, who had mobilization, pain or opioid-related complications, and 5 (0.9% CI:0.4-2.0) versus 4 (0.5% CI:0.2-1.2) who fell. Correspondingly, 2 (3.7% CI:1.0-12.6) and 11 (0.6% CI:0.3-1.0) of THA patients had these complications, while 0 (0.0% CI:0.0-6.6) and 17 (0.8% CI:0.5-1.3) fell. CONCLUSION Routine use of peripheral nerve blocks was not associated with early discharge or 30-days readmissions in fast-track THA and TKA. Future studies should focus on benefits of PNB in high-risk patients.
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Affiliation(s)
- Christoffer C Jørgensen
- Section for Surgical Pathophysiology and the Center for Fast-Track Hip and Knee Replacement, Rigshospitalet Copenhagen University, Copenhagen, Denmark
| | - Pelle B Petersen
- Section for Surgical Pathophysiology and the Center for Fast-Track Hip and Knee Replacement, Rigshospitalet Copenhagen University, Copenhagen, Denmark
| | - Louise O Daugberg
- Department of Orthopedics, Holstebro Hospital, Center for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark
| | - Thomas Jakobsen
- Department of Orthopedics, Interdisciplinary Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Aalborg University Hospital, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Hvidovre University Hospital, Copenhagen, Denmark
| | - Claus Varnum
- Department of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Lillebaelt Hospital - Vejle, Copenhagen, Denmark
| | - Mikkel R Andersen
- Department of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Gentofte Hospital, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Bispebjerg Hospital, Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology and the Center for Fast-Track Hip and Knee Replacement, Rigshospitalet Copenhagen University, Copenhagen, Denmark
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11
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Hill J, Ashken T, West S, Macfarlane AJR, El-Boghdadly K, Albrecht E, Chin KJ, Fox B, Gupta A, Haskins S, Haslam N, Hogg RMG, Hormis A, Johnston DF, Mariano ER, Merjavy P, Moll T, Parry J, Pawa A, Russon K, Sebastian MP, Turbitt L, Womack J, Chazapis M. Core outcome set for peripheral regional anesthesia research: a systematic review and Delphi study. Reg Anesth Pain Med 2022; 47:rapm-2022-103751. [PMID: 35863787 DOI: 10.1136/rapm-2022-103751] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/IMPORTANCE There is heterogeneity among the outcomes used in regional anesthesia research. OBJECTIVE We aimed to produce a core outcome set for regional anesthesia research. METHODS We conducted a systematic review and Delphi study to develop this core outcome set. A systematic review of the literature from January 2015 to December 2019 was undertaken to generate a long list of potential outcomes to be included in the core outcome set. For each outcome found, the parameters such as the measurement scale, timing and definitions, were compiled. Regional anesthesia experts were then recruited to participate in a three-round electronic modified Delphi process with incremental thresholds to generate a core outcome set. Once the core outcomes were decided, a final Delphi survey and video conference vote was used to reach a consensus on the outcome parameters. RESULTS Two hundred and six papers were generated following the systematic review, producing a long list of 224 unique outcomes. Twenty-one international regional anesthesia experts participated in the study. Ten core outcomes were selected after three Delphi survey rounds with 13 outcome parameters reaching consensus after a final Delphi survey and video conference. CONCLUSIONS We present the first core outcome set for regional anesthesia derived by international expert consensus. These are proposed not to limit the outcomes examined in future studies, but rather to serve as a minimum core set. If adopted, this may increase the relevance of outcomes being studied, reduce selective reporting bias and increase the availability and suitability of data for meta-analysis in this area.
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Affiliation(s)
- Jeremy Hill
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Toby Ashken
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simeon West
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Eric Albrecht
- Department of Anaesthesia, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ki Jinn Chin
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Ben Fox
- Department of Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Ashwani Gupta
- Anaesthetics, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Stephen Haskins
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery Department of Anesthesiology Critical Care & Pain Management, New York, New York, USA
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Nat Haslam
- City Hospitals Sunderland NHS Foundation Trust, South Shields, UK
| | | | - Anil Hormis
- Department of Anaesthetics, The Rotherham NHS Foundation Trust, UK, Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Timothy Moll
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James Parry
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Amit Pawa
- Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kim Russon
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | | | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Maria Chazapis
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK
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12
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Kearns RJ, Womack J, Macfarlane AJR. Regional anaesthesia research - where to now? Br J Pain 2022; 16:132-135. [PMID: 35419194 PMCID: PMC8998529 DOI: 10.1177/20494637221091139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rachel J Kearns
- Department of Anaesthesia, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Jonathan Womack
- Department of Anaesthesia, Royal Victoria, Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Alan JR Macfarlane
- Department of Anaesthesia, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, University of Glasgow, Glasgow, UK
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13
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Moorthy A, Eochagáin AN, Buggy DJ. Can Acute Postoperative Pain Management After Tumour Resection Surgery Modulate Risk of Later Recurrence or Metastasis? Front Oncol 2022; 11:802592. [PMID: 34976840 PMCID: PMC8716859 DOI: 10.3389/fonc.2021.802592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background Cancer is a leading cause of mortality worldwide, but death is rarely from the primary tumour: Rather it is multi-organ dysfunction from metastatic disease that is responsible for up to 90% of cancer-related deaths. Surgical resection of the primary tumour is indicated in 70% of cases. The perioperative stress response, tissue hypoxia at the site of surgery, and acute pain contribute to immunosuppression and neo-angiogenesis, potentially promoting tumour survival, proliferation, and metastasis. Poorly controlled acute postoperative pain decreases Natural Killer (NK) immune cell activity, which could potentially facilitate circulating tumour cells from evading immune detection. This consequently promotes tumour growth and distal metastasis. Methods We conducted a comprehensive literature search for links between acute pain and cancer outcomes using multiple online databases. Relevant articles from January 1st, 2010 to September 1st, 2021 were analysed and appraised on whether postoperative pain control can modulate the risk of recurrence, metastasis, and overall cancer survival. Results Although experimental and retrospective clinical data suggest a plausible role for regional anaesthesia in cancer outcome modulation, this has not been supported by the single, largest prospective trial to date concerning breast cancer. While there are mixed results on anaesthesiology drug-related interventions, the most plausible data relates to total intravenous anaesthesia with propofol, and to systemic administration of lidocaine. Conclusion The hypothesis that anaesthetic and analgesic technique during cancer surgery could influence risk of subsequent recurrence or metastasis has been prevalent for >15 years. The first, large-scale definitive trial among women with breast cancer found robust equivalent findings between volatile anaesthesia with opioid analgesia and regional anaesthesia. Therefore, while regional anaesthesia during tumour resection does not seem to have any effect on cancer outcomes, it remains plausible that other anaesthetic techniques (e.g. total intravenous anaesthesia and systemic lidocaine infusion) might influence oncologic outcome in other major tumour resection surgery (e.g. colorectal and lung). Therefore, another large trial is needed to definitively answer these specific research questions. Until such evidence is available, perioperative analgesia for cancer surgery of curative intent should be based on patient co-morbidity and non-cancer endpoints, such as optimising analgesia and minimising postoperative complications.
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Affiliation(s)
- Aneurin Moorthy
- Anaesthesiology & Perioperative Medicine Research Fellow, Division of Anaesthesiology and Peri-operative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Aisling Ní Eochagáin
- Anaesthesiology Research Fellow, St. James's University Hospital, Dublin, Ireland
| | - Donal J Buggy
- Consultant and Professor, Division of Anaesthesiology and Peri-operative Medicine, Mater Misericordiae University Hospital, School of Medicine, University College, Dublin, Ireland.,Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
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14
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Sato F, Matsuki Y, Ogata H, Ueki R, Kariya N, Tatara T, Shigemi K, Hirose M. Quantitative evaluation of the effects of interscalene block on physiological responses to the balance between nociception and anti-nociception among inpatients undergoing total shoulder arthroplasty under general anesthesia. J Clin Monit Comput 2021; 36:1519-1524. [PMID: 34954807 DOI: 10.1007/s10877-021-00794-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
Although the suppression of physiological responses to the balance between nociception caused by surgical trauma and anti-nociception due to anesthesia during total shoulder arthroplasty (TSA) is relevant for better perioperative managements, quantitative evaluations of the effects of ultrasound-guided interscalene brachial plexus block (ISB) on physiological responses have not been performed. Physiological responses were assessed using the nociceptive response (NR) index. In this multi-institutional observational study, associations between ISB and NR values were examined among inpatients undergoing TSA under general anesthesia between March 2019 and January 2021. The effects of ISB on acute postoperative pain and major complications within 30 days after surgery were also examined. NR values after skin incision clearly showed significant suppressions of physiological responses in patients undergoing TSA with ISB (n = 60), compared to those without ISB (n = 24). Acute postoperative pain on the day of surgery was also significantly less in patients with ISB than in those without ISB. Postoperative complications, classified by Clavien-Dindo grades, showed no significant differences between patients with and without ISB. A propensity score-matched sensitivity analysis confirmed the same results in patients with (n = 21) and without ISB (n = 21). In conclusion, suppression of physiological responses to the balance between nociception and anti-nociception by ISB can be quantitatively evaluated by NR index during TSA.
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Affiliation(s)
- Fumiya Sato
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuka Matsuki
- Department of Anesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan
| | - Hiroki Ogata
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryusuke Ueki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nobutaka Kariya
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tsuneo Tatara
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kenji Shigemi
- Department of Anesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan
| | - Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
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15
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Testa B, Reid J, Scott ME, Murison PJ, Bell AM. The Short Form of the Glasgow Composite Measure Pain Scale in Post-operative Analgesia Studies in Dogs: A Scoping Review. Front Vet Sci 2021; 8:751949. [PMID: 34660773 PMCID: PMC8515184 DOI: 10.3389/fvets.2021.751949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
The measurement and treatment of acute pain in animals is essential from a welfare perspective. Valid pain-related outcome measures are also crucial for ensuring reliable and translatable findings in veterinary clinical trials. The short form of the Glasgow Composite Measure Pain Scale (CMPS-SF) is a multi-item behavioral pain assessment tool, developed and validated using a psychometric approach, to measure acute pain in the dog. Here we conduct a scoping review to identify prospective research studies that have used the CMPS-SF. We aim to describe the contexts in which it has been used, verify the correct use of the scale, and examine whether these studies are well-designed and adequately powered. We identify 114 eligible studies, indicating widespread use of the scale. We also document a limited number of modifications to the scale and intervention level, which would alter its validity. A variety of methods, with no consensus, were used to analyse data derived from the scale. However, we also find many deficiencies in reporting of experimental design in terms of the observers used, the underlying hypothesis of the research, the statement of primary outcome, and the use of a priori sample size calculations. These deficiencies may predispose to both type I and type II statistical errors in the small animal pain literature. We recommend more robust use of the scale and derived data to ensure success of future studies using the tool ensuring reliable and translatable outcomes.
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Affiliation(s)
- Barbara Testa
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jacqueline Reid
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom.,NewMetrica Research, Glasgow, United Kingdom
| | - Marian E Scott
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Pamela J Murison
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Andrew M Bell
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
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16
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Grape S, Kirkham KR, Akiki L, Albrecht E. Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth 2021; 75:110450. [PMID: 34243030 DOI: 10.1016/j.jclinane.2021.110450] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Both transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. We undertook this systematic review and meta-analysis with trial sequential analysis to determine the best analgesic technique. METHODS We systematically searched the literature for trials comparing TAP block with wound infiltration after laparoscopic cholecystectomy. The primary outcome was pain score during rest (analogue scale, 0-10) at 2 postoperative hours. Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, pain scores during movement and intravenous morphine consumption at 2, 12 and 24 h, and postoperative nausea and vomiting. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, hematoma, visceral injury and local anesthetic systemic toxicity. RESULTS Ten trials including 668 patients were identified. There was a significant difference in pain score during rest at 2 postoperative hours in favour of TAP block when compared with wound infiltration (mean difference [95%CI]: -0.7 [-1.2, -0.2]; I2 = 71%; p = 0.008). Pain scores during rest at 12 and 24 h and pain scores during movement at 24 h were also significantly lower with TAP block than wound infiltration. Postoperative morphine consumption and the incidence of postoperative nausea and vomiting were significantly lower in patients who received a TAP block. Data were insufficient to compare block-related complications. The overall quality of evidence was moderate-to-high. CONCLUSIONS There is moderate-to-high level evidence that the TAP block provides superior analgesia when compared with wound infiltration in patients undergoing laparoscopic cholecystectomy. Trial registry number: PROSPERO CRD42020208057.
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Affiliation(s)
- Sina Grape
- Department of Anesthesia, Valais Hospital, Sion, and University of Lausanne, Lausanne, Switzerland.
| | - Kyle Robert Kirkham
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Liliane Akiki
- Department of Anesthesia, Valais Hospital, Sion, Switzerland
| | - Eric Albrecht
- Program Director of Regional Anaesthesia, Department of Anesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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17
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Yeung J, Small C. Impact of regional analgesia in surgery. Br J Surg 2021; 108:1009-1010. [PMID: 34131701 PMCID: PMC10364902 DOI: 10.1093/bjs/znab214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/16/2021] [Indexed: 11/14/2022]
Affiliation(s)
- J Yeung
- Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - C Small
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
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18
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Chin KJ, Mariano ER, El-Boghdadly K. Advancing towards the next frontier in regional anaesthesia. Anaesthesia 2021; 76 Suppl 1:3-7. [PMID: 33426654 DOI: 10.1111/anae.15321] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Affiliation(s)
- K J Chin
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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