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van der Meulen JF, Bongers MY, van der Zee LG, Leemans JC, Duijnhoven RG, de Leeuw RA, Overdijk LE, Radder CM, van der Voet LF, Smeets NAC, van Vliet HAAM, Hehenkamp WJK, Manger AP, Lim AC, Peters LW, Horree N, Briët JM, van der Steeg JW, Coppus SFPJ, Kok HS. Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy (PROSECCO trial): A multicenter randomized controlled trial. PLoS Med 2023; 20:e1004323. [PMID: 38153958 PMCID: PMC10754450 DOI: 10.1371/journal.pmed.1004323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Hysteroscopic resection is the first-choice treatment for symptomatic type 0 and 1 fibroids. Traditionally, this was performed under general anesthesia. Over the last decade, surgical procedures are increasingly being performed in an outpatient setting under procedural sedation and analgesia. However, studies evaluating safety and effectiveness of hysteroscopic myomectomy under procedural sedation are lacking. This study aims to investigate whether hysteroscopic myomectomy under procedural sedation and analgesia with propofol is noninferior to hysteroscopic myomectomy under general anesthesia. METHODS AND FINDINGS This was a multicenter, randomized controlled noninferiority trial conducted in 14 university and teaching hospitals in the Netherlands between 2016 and 2021. Inclusion criteria were age ≥18 years, maximum number of 3 type 0 or 1 fibroids, maximum fibroid diameter 3.5 cm, American Society of Anesthesiologists class 1 or 2, and having sufficient knowledge of the Dutch or English language. Women with clotting disorders or with severe anemia (Hb < 5.0 mmol/L) were excluded. Women were randomized using block randomization with variable block sizes of 2, 4, and 6, between hysteroscopic myomectomy under procedural sedation and analgesia (PSA) with propofol or under general anesthesia (GA). Primary outcome was the percentage of complete resections, assessed on transvaginal ultrasonography 6 weeks postoperatively by a sonographer blinded for the treatment arm and surgical outcome. Secondary outcomes were the surgeon's judgment of completeness of procedure, menstrual blood loss, uterine fibroid related and general quality of life, pain, recovery, hospitalization, complications, and surgical reinterventions. Follow-up period was 1 year. The risk difference between both treatment arms was estimated, and a Farrington-Manning test was used to determine the p-value for noninferiority (noninferiority margin 7.5% of incomplete resections). Data were analyzed according to the intention-to-treat principle, including a per-protocol analysis for the primary outcome. A total of 209 women participated in the study and underwent hysteroscopic myomectomy with PSA (n = 106) or GA (n = 103). Mean age was 45.1 [SD 6.4] years in the PSA group versus 45.0 [7.7] years in the GA group. For 98/106 women in the PSA group and 89/103 women in the GA group, data were available for analysis of the primary outcome. Hysteroscopic resection was complete in 86/98 women (87.8%) in the PSA group and 79/89 women (88.8%) in the GA group (risk difference -1.01%; 95% confidence interval (CI) -10.36 to 8.34; noninferiority, P = 0.09). No serious anesthesiologic complications occurred, and conversion from PSA to GA was not required. During the follow-up period, 15 serious adverse events occurred (overnight admissions). All were unrelated to the intervention studied. Main limitations were the choice of primary outcome and the fact that our study proved to be underpowered. CONCLUSIONS Noninferiority of PSA for completeness of resection was not shown, though there were no significant differences in clinical outcomes and quality of life. In this study, hysteroscopic myomectomy for type 0 and 1 fibroids with PSA compared to GA was safe and led to shorter hospitalization. These results can be used for counseling patients by gynecologists and anesthesiologists. Based on these findings, we suggest that hysteroscopic myomectomies can be performed under PSA in an outpatient setting. TRIAL REGISTRATION The study was registered prospectively in the Dutch Trial Register (NTR 5357; registration date: 11 August 2015; Date of initial participant enrollment: 18 February 2016).
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Affiliation(s)
- Julia F. van der Meulen
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands
- Grow school for oncology and reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marlies Y. Bongers
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands
- Grow school for oncology and reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lisa G. van der Zee
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jaklien C. Leemans
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Ruben G. Duijnhoven
- Department of Obstetrics & Gynecology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
- Clinical Trials Unit, Netherlands Society for Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Robert A. de Leeuw
- Department of Obstetrics & Gynecology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | - Celine M. Radder
- Department of Obstetrics & Gynecology, OLVG, Amsterdam, the Netherlands
| | - Lucet F. van der Voet
- Department of Obstetrics & Gynecology, Deventer Ziekenhuis, Deventer, the Netherlands
| | - Nicol A. C. Smeets
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Huib A. A. M. van Vliet
- Department of Obstetrics & Gynecology, Catharina Ziekenhuis, Eindhoven, the Netherlands
- Department of human structure and repair, Ghent University, Gent, Belgium
| | - Wouter J. K. Hehenkamp
- Department of Obstetrics & Gynecology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Arentje P. Manger
- Department of Obstetrics & Gynecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Arianne C. Lim
- Department of Obstetrics & Gynecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Nicole Horree
- Department of Obstetrics & Gynecology, Flevoziekenhuis, Almere, the Netherlands
| | - Justine M. Briët
- Department of Obstetrics & Gynecology, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Jan Willem van der Steeg
- Department of Obstetrics & Gynecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, the Netherlands
| | - Sjors F. P. J. Coppus
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands
- Department of Obstetrics & Gynecology, University Medical Centre St Radboud, Nijmegen, the Netherlands
| | - Helen S. Kok
- Department of Obstetrics & Gynecology, Alrijne Ziekenhuis, Leiden, the Netherlands
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Yang H, Shi X, Li J, Yang L. Efficacy and safety of alfentanil plus propofol versus propofol only in painless gastrointestinal endoscopy: A meta-analysis. Medicine (Baltimore) 2023; 102:e34745. [PMID: 37565872 PMCID: PMC10419350 DOI: 10.1097/md.0000000000034745] [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: 01/26/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND To systematically evaluate the efficacy and safety of alfentanil plus propofol versus propofol only for painless gastrointestinal endoscopy. METHODS The Cochrane Library, PubMed, Embase, China Biology Medicine, CNKI, WanFang, and VIP databases were searched to identify randomized controlled trials on alfentanil combined with propofol versus propofol only for painless gastrointestinal endoscopy from the inception of the database to August 2022. The Rev Man 5.4 software was used for statistical analyses. RESULTS Thirteen randomized controlled trials involving 1762 patients were identified as eligible for this study. The meta-analysis showed that compared with propofol, alfentanil combined with propofol had a more stable mean arterial pressure [mean difference (MD) = 5.38, 95% confidence interval (CI): 1.97-8.80; P = .002], heart rate (MD = 3.78, 95% CI: 1.30-6.26; P = .003) and pulse oxygen saturation (MD = 1.90, 95% CI: 0.93-2.78; P = .0001); a lower propofol dose (standard mean difference = -2.82, 95% CI: -3.70 to -1.94; P < .00001), lower awakening time (MD = -3.23, 95% CI: -4.01 to -2.45; P < .00001) and lower directional force recovery time (MD = -3.62, 95% CI: -4.22 to -3.03; P < .00001); a lower incidence of nausea and vomiting (relative risk [RR] = 0.32, 95% CI: 0.14-0.71; P = .005), body movement (RR = 0.27, 95% CI: 0.13-0.54; P = .0002), hypotension (RR = 0.23, 95% CI: 0.12-0.46; P < .0001), respiratory depression (RR = 0.37, 95% CI: 0.15-0.89; P = .03) and cough reflex (RR = 0.33, 95% CI: 0.12-0.89; P = .03). CONCLUSION This meta-study found that current evidence indicates that alfentanil plus propofol is better than propofol alone for painless gastrointestinal endoscopy and is associated with a lower incidence of adverse reactions. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to validate these above conclusions.
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Affiliation(s)
- Huan Yang
- Department of Anesthesiology, Huangshi Central Hospital, Hubei, China
- Medical College of Wuhan University of Science and Technology, Hubei, China
| | - Xiaoling Shi
- Department of Anesthesiology, Huangshi Central Hospital, Hubei, China
| | - Jinping Li
- Medical College of Wuhan University of Science and Technology, Hubei, China
| | - Longqiu Yang
- Department of Anesthesiology, Huangshi Central Hospital, Hubei, China
- Medical College of Wuhan University of Science and Technology, Hubei, China
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van der Meulen JF, Fisch C, Dreessen JRJ, Coppus SFPJ, Kok HS, Bongers MY. Procedural sedation and analgesia with propofol (PSA) for gynecologic surgery: A systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2023; 287:137-146. [PMID: 37327552 DOI: 10.1016/j.ejogrb.2023.05.035] [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: 02/17/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To identify which gynecologic procedures are eligible to be performed under PSA with propofol and to describe safety and effectiveness of these procedures in this setting. METHODS A systematic review of the literature was conducted in Pubmed (MEDLINE), Embase and The Cochrane Library from inception until September 21st 2022. Cohort studies and randomized controlled trials were included when they reported on clinical outcomes of gynecologic procedures under procedural sedation and analgesia in which propofol was used as an anesthetic. Studies were excluded when sedation without propofol was used, when they only mentioned the use of procedural sedation and analgesia but did not describe any clinical outcome parameters or when < 10 patients were included. The primary outcome parameter was completeness of procedure. Secondary outcome parameters were type of gynecologic procedure, intraoperative complication rate, patient satisfaction, postoperative pain, duration of hospital admission, patient's discomfort and ease of procedure as judged by the surgeon. The Cochrane risk of bias tool and the ROBINS-I tool were used for bias assessment. A narrative synthesis of the findings from the included studies was provided. Numbers and percentages were presented, as well as means with standard deviations and medians with interquartile range where applicable. RESULTS Eight studies were included. A total of 914 patients underwent gynecologic surgical procedures with procedural sedation and analgesia with propofol. Gynecological procedures varied from hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The percentage of complete procedures was 89.8%-100%. Complications occurred in 0-6.5% of patients. Other outcomes were measured in various ways, but overall patient satisfaction was high and postoperative pain was low. CONCLUSION The use of PSA with propofol is promising for a wide range of gynecologic procedures, including hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The use of PSA with propofol seems to be effective and safe and leads to high degree of patient satisfaction. More research is needed in order to determine for which types of procedures PSA can be used.
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Affiliation(s)
- Julia F van der Meulen
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Grow School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
| | - Charlotte Fisch
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Janique R J Dreessen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen, The Netherlands.
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands.
| | - Helen S Kok
- Department of Obstetrics & Gynecology, Alrijne Ziekenhuis, Leiden, The Netherlands.
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Grow School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Wang L, Wang Y, Ma L, Wang Y, Mu X, Huang Z, Zheng Z, Nie H. Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial. Drug Des Devel Ther 2023; 17:1233-1243. [PMID: 37125082 PMCID: PMC10132382 DOI: 10.2147/dddt.s405057] [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: 01/18/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose This study aimed to compare the cardiopulmonary safety of remimazolam and propofol in patients undergoing cervical conization. Methods This was a single-blind, parallel, randomized controlled study. A total of 204 patients scheduled for day surgery of cold knife cervical conization received either remimazolam-alfentanil anesthesia (remimazolam group) or propofol-alfentanil anesthesia (propofol group). The primary outcome was the incidence of intraoperative cardiopulmonary adverse events (a composite outcome of hypotension, bradycardia and hypoxemia). The occurrence of hypotension, bradycardia, hypoxemia and the degree of body movement were secondary outcomes, as well as the moment at which consciousness was lost, the interval between the end of anesthesia and the operating room's release of the patient, and the overall dosage of alfentanil administered during the procedure. Results The incidence of intraoperative cardiopulmonary adverse events was 45 (44.1%) in the remimazolam group and 72 (70.6%) in the propofol group (absolute risk difference [95% CI], -26.47% [-39.55% to -13.39%]; odds ratio (OR) [95% CI], 0.43 [0.28 to 0.65]; P < 0.001). The remimazolam group showed lower incidences of hypotension and hypoxemia compared to the propofol group (P = 0.01 for both). No significant differences were observed in the overall alfentanil dosages administered, bradycardia, bodily movement, or time to losing consciousness between the two groups. Conclusion In patients who underwent cold knife cervical conization, remimazolam-alfentanil anesthesia was associated with a reduced incidence of intraoperative cardiopulmonary adverse events compared with propofol-alfentanil anesthesia.
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Affiliation(s)
- Lini Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Yi Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Li Ma
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Yiting Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Xiaoxiao Mu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Zhaoxu Huang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Ziyu Zheng
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Huang Nie
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
- Correspondence: Huang Nie; Ziyu Zheng, Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Changle West Road 127, Xi’an, Shaanxi, 710032, People’s Republic of China, Email ;
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A comparative study on the efficacy and safety of propofol combined with different doses of alfentanil in gastroscopy: a randomized controlled trial. J Anesth 2022; 37:201-209. [PMID: 36482231 DOI: 10.1007/s00540-022-03145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Propofol can be used alone or in combination with opioids during gastroscopy. This study aimed to assess the efficacy and safety of intravenous propofol and different doses of alfentanil in patients undergoing gastroscopy. METHODS A total of 300 patients undergoing sedative gastroscopy were randomly divided into four groups, and 0.9% saline (group A), 2 μg/kg alfentanil (group B), 3 μg/kg alfentanil (group C) or 4 μg/kg alfentanil (group D) were injected intravenously 1 min before the intravenous injection of 1.5 mg/kg propofol. If body movement and coughing occurred during the procedure, 0.5 mg/kg propofol would be administered intravenously. The primary outcome (awakening time) and secondary outcomes were recorded and analyzed, including hemodynamic changes, the incidences of body movement, coughing, hypoxemia, hypotension, hypertension, bradycardia, tachycardia, nausea and vomiting, drowsiness and dizziness. RESULTS Patients in group C (7.0 [5.0 to 8.0] min) and group D (6.0 [5.0 to 7.0] min) woke up significantly earlier than those in group A (8.0 [6.0 to 10.0] min) (P < 0.001). Patients in group A experienced more body movement (P = 0.001) and coughing (P < 0.001) than the other groups. With the increasing dose of alfentanil, the morbidity of hypotension and bradycardia increased significantly (P = 0.001), while the incidence of dizziness decreased significantly (P = 0.037). The incidences of hypoxemia, tachycardia, drowsiness, nausea and vomiting were similar among the four groups (P > 0.05). CONCLUSIONS Intravenous 1.5 mg/kg propofol combined with 3 μg/kg alfentanil is more suitable for patients undergoing gastroscopy, and the dose of alfentanil can be reduced according to the patient's actual physical condition.
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Seifert S, Taxbro K, Hammarskjöld F. Patient-Controlled Sedation in Port Implantation (PACSPI 1) - A feasibility trial. BJA OPEN 2022; 3:100026. [PMID: 37588584 PMCID: PMC10430819 DOI: 10.1016/j.bjao.2022.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/23/2022] [Indexed: 08/18/2023]
Abstract
Background Central venous access is essential for the administration of chemotherapy and frequent blood sampling in patients with cancer. The subcutaneous venous port is commonly used for this purpose. Subcutaneous venous port implantation is a minor surgical procedure; however, it can provoke pain and anxiety in these vulnerable patients. The aim of this study was, before a full-scale RCT, to determine the feasibility of patient-controlled sedation with propofol and alfentanil as an adjunct to local anaesthesia during SVP implantation. Methods We prospectively studied 40 patients scheduled for SVP implantation between 14 April 2021 and 15 October 2021 at a 500-bed secondary level hospital in Sweden. Anaesthesiologists performed subcutaneous venous port implantation with patient-controlled sedation using propofol and alfentanil. We determined pain perception (primary outcome), patient satisfaction, sedation score, and key safety measures. Results Of the 40 patients with cancer, 80% reported a pain score ≤3 on an 11-point numeric rating scale during subcutaneous venous port implantation. Overall satisfaction with pain management and operating conditions was graded as 10 of 10 on the numeric rating scale. Four patients (10%) had bradypnoea (<8 bpm) without oxygen desaturation to ≤90%. Rescue sedation was administered to one patient (2.5%). Conclusion Patient-controlled sedation with propofol and alfentanil during subcutaneous venous port implantation is feasible and well accepted. Ultimately the efficacy of patient-controlled sedation with propofol and alfentanil needs to be evaluated in an RCT to provide clinicians with evidence-based guidance for choosing the optimal perioperative strategy for subcutaneous venous port implantation. Clinical trial registration NCT04631393.
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Affiliation(s)
- Stefanie Seifert
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Uustal E. Pre-emptive digitally guided pudendal block after posterior vaginal repair. Int Urogynecol J 2020; 32:2265-2271. [PMID: 32876714 PMCID: PMC8346423 DOI: 10.1007/s00192-020-04488-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/30/2020] [Indexed: 12/25/2022]
Abstract
Introduction and hypothesis The aim of this study was to establish if digitally guided pre-emptive pudendal block (PDB) reduces postoperative pain and facilitates recovery after posterior vaginal repair under local anesthesia and sedation. Methods We carried out a prospective, randomized, double-blind trial in an outpatient surgery facility. Forty-one women between 18 and 70 years of age, scheduled for primary posterior vaginal reconstructive outpatient surgery, completed the study. The surgery was performed using sedation and local anesthesia with bupivacaine/adrenaline. At the end of surgery, 20 ml of either ropivacaine 7.5 mg/ml or sodium chloride (placebo) was administered as a digitally guided PDB. The primary aim was to establish if PDB with ropivacaine compared with placebo reduced the maximal pain as reported by visual analog scale (VAS) during the first 24 h after surgery. Secondary aims were to compare the duration and experience of the hospital stay, nausea, need for additional opioids, and adverse events. Results PDB with ropivacaine after local infiltration with bupivacaine/adrenaline after outpatient posterior repair did not significantly reduce maximal postoperative pain, need for hospital admittance, nausea, or opioid use. Mild transient sensory loss occurred after ropivacaine in two women. Two women the placebo group were unable to void owing to severe postoperative pain, which was resolved by a rescue PDB. Conclusions When bupivacaine/adrenaline is used for anesthesia in posterior vaginal repair, PDB with ropivacaine gives no benefit regarding postoperative pain, recovery or length of hospital stay. Rescue PDB can be useful for postoperative pain relief.
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Affiliation(s)
- Eva Uustal
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, 581 85, Linköping, Sweden.
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8
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van der Meulen JF, Bongers MY, Coppus SFPJ, Bosmans JE, Maessen JMC, Oude Rengerink K, Overdijk LE, Radder CM, van der Voet LF, Smeets NAC, van Vliet HAAM, Hehenkamp WJK, Manger AP, Spaans WA, Bakkum EA, Horrée N, Briët JM, van der Steeg JW, Kok HS. The (cost) effectiveness of procedural sedation and analgesia versus general anaesthesia for hysteroscopic myomectomy, a multicentre randomised controlled trial: PROSECCO trial, a study protocol. BMC WOMENS HEALTH 2019; 19:46. [PMID: 30902087 PMCID: PMC6431064 DOI: 10.1186/s12905-019-0742-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 03/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND In women with abnormal uterine bleeding, fibroids are a frequent finding. In case of heavy menstrual bleeding and presence of submucosal type 0-1 fibroids, hysteroscopic resection is the treatment of first choice, as removal of these fibroids is highly effective. Hysteroscopic myomectomy is currently usually performed in the operating theatre. A considerable reduction in costs and a higher patient satisfaction are expected when procedural sedation and analgesia with propofol (PSA) in an outpatient setting is applied. However, both safety and effectiveness - including the necessity for re-intervention due to incomplete resection - have not yet been evaluated. METHODS This study is a multicentre randomised controlled trial with a non-inferiority design and will be performed in the Netherlands. Women > 18 years with a maximum of 3 symptomatic type 0 or 1 submucosal fibroids with a maximum diameter of 3.5 cm are eligible to participate in the trial. After informed consent, 205 women will be randomised to either hysteroscopic myomectomy using procedural sedation and analgesia with propofol in an outpatient setting or hysteroscopic myomectomy using general anaesthesia in a clinical setting in the operating theatre. Primary outcome will be the percentage of complete resections, based on transvaginal ultrasonography 6 weeks postoperatively. Secondary outcomes are cost effectiveness, menstrual blood loss (Pictorial blood assessment chart), quality of life, pain, return to daily activities/work, hospitalization, (post) operative complications and re-interventions. Women will be followed up to one year after hysteroscopic myomectomy. DISCUSSION This study may demonstrate comparable effectiveness of hysteroscopic myomectomy under procedural sedation and analgesia versus general anaesthesia in a safe and patient friendly environment, whilst achieving a significant cost reduction. TRIAL REGISTRATION Dutch trial register, number NTR5357 . Registered 11th of August 2015.
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Affiliation(s)
- Julia F van der Meulen
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, PO Box 777, 5500, MB, Veldhoven, The Netherlands. .,Grow school of oncology and developmental biology, MUMC, Maastricht, The Netherlands.
| | - Marlies Y Bongers
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, PO Box 777, 5500, MB, Veldhoven, The Netherlands.,Grow school of oncology and developmental biology, MUMC, Maastricht, The Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, PO Box 777, 5500, MB, Veldhoven, The Netherlands.,Department of Obstetrics & Gynaecology, UMC St Radboud, Nijmegen, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Section of Health Economics & Health Technology Assessment, VU Medical Centre, Amsterdam, The Netherlands
| | - José M C Maessen
- Department of Quality and Safety, MUMC, Maastricht, The Netherlands
| | - Katrien Oude Rengerink
- Julius Center of Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,Department of Obstetrics & Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lucilla E Overdijk
- Department of Anaesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Celine M Radder
- Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
| | - Lucet F van der Voet
- Department of Obstetrics & Gynaecology, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Nicol A C Smeets
- Department of Obstetrics & Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Huib A A M van Vliet
- Department of Obstetrics & Gynaecology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics & Gynaecology, VU Medical Centre, Amsterdam, The Netherlands
| | - Arentje P Manger
- Department of Obstetrics & Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - Wilbert A Spaans
- Department of Obstetrics & Gynaecology, MUMC, Maastricht, The Netherlands
| | - Erica A Bakkum
- Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis Oost, Amsterdam, The Netherlands
| | - Nicole Horrée
- Department of Obstetrics & Gynaecology, Flevoziekenhuis, Almere, The Netherlands
| | - Justine M Briët
- Department of Obstetrics & Gynaecology, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Jan Willem van der Steeg
- Department of Obstetrics & Gynaecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Helen S Kok
- Department of Obstetrics & Gynaecology, Alrijne Ziekenhuis, Leiden, The Netherlands
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Therapeutic hysteroscopy in an outpatient office-based setting compared to conventional inpatient treatment: superior? a cohort study. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s10397-016-0974-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nilsson A, Grossmann B, Kullman E, Uustal E, Sjöberg F, Nilsson L. Sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled study of patient-controlled propofol sedation and that given by a nurse anesthetist. Scand J Gastroenterol 2016; 50:1285-92. [PMID: 25898782 DOI: 10.3109/00365521.2015.1038848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Different regimens are used for sedation during endoscopic retrograde cholangiopancreatography (ERCP). Our objectives were to compare safety, ease of treatment, recovery, and patients' experiences using patient-controlled sedation (PCS) with propofol, nurse anesthetist-controlled sedation (ACS), or the department's standard of care, midazolam given by the procedure team (control group). MATERIAL AND METHODS The study included 281 adults in 301 procedures. The PCS group (n = 101) delivered bolus doses of 5 mg of propofol according to their need for sedation. The ACS group (n = 100) had 2-8 mg/kg/h of propofol infused, with the target for sedation being level 3 of the Observer's Assessment of Alertness/Sedation (OAA/S) scale. The control group was given 2-3 mg of midazolam for induction and additional 1 mg if required. RESULTS PCS and ACS increased the ease of the procedure and reduced the number of sedation failures compared to midazolam sedation (ACS n = 0; PCS n = 4; midazolam n = 20). The ACS group had more deeply sedated patients (OAA/S level 2), desaturation, and obstructed airways than the PCS and midazolam groups. Time to full recovery (Aldrete score ≥9) was shortest following PCS. PCS resulted in the least fatigue and pain after the procedure. Patients' preference for PCS and ACS was the same. CONCLUSION PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, fewer respiratory events, and was almost as effective as ACS in ensuring a successful examination.
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Affiliation(s)
- Andreas Nilsson
- Department of Medical and Health Sciences, Linköping University , County Council of Östergötland, S-581 85 Linköping , Sweden
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