1
|
Joshi GP, Albrecht E, Van de Velde M, Kehlet H, Lobo DN. PROSPECT methodology for developing procedure-specific pain management recommendations: an update. Anaesthesia 2023; 78:1386-1392. [PMID: 37751453 DOI: 10.1111/anae.16135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
The procedure-specific postoperative pain management (PROSPECT) working group develops evidence-based pain management recommendations. PROSPECT methodology is unique and rigorous. However, several limitations were recognised that needed to be addressed, and several new factors were identified that improved PROSPECT methodology. The aim of this article is to present updated PROSPECT methodology for development of recommendations for procedure-specific pain management, focusing on the methodological revisions we will implement. In future, included randomised clinical trials will need to be prospectively registered on a publicly accessible clinical trials database and the study design, including the primary outcome in the registration, should coincide with that in the published manuscript. Placebo-controlled studies in which the analgesic intervention of interest is solely paracetamol, non-steroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors or opioids will not be included. Studies comparing one drug in a particular class with another in the same class will also not be included. Future projects will use the Cochrane Collaboration risk of bias tool for quality of reporting of methodology and results. A modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach will be used for grading of level of evidence and strength of recommendations. Finally, the updated PROSPECT methodology addresses several other limitations and implements new factors that all add rigour and transparency to developing procedure-specific pain management recommendations.
Collapse
Affiliation(s)
- G P Joshi
- Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - E Albrecht
- Program Director of Regional Anaesthesia, Department of Anaesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - M Van de Velde
- Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Belgium
| | - H Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, Division of Translation Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Benhamou D, Mercier FJ, Van de Velde M, Lucas N, Sng BL, Gaiser R. Education in obstetric anesthesiology: an international approach. Int J Obstet Anesth 2023; 55:103896. [PMID: 37270857 DOI: 10.1016/j.ijoa.2023.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023]
Abstract
Competency-based training and active teaching methods are increasingly becoming accepted and utilized in medical schools and hospitals, and obstetric anesthesiology training is expected to follow this process. This article summarizes current modalities of obstetric anesthesiology training in five countries from various parts of the world. Analysis of these curricula shows that implementation of new educational methods is variable, incomplete, and lacking in data related to patient outcomes. Research in assessments and practical applications are required to avoid wide ranges of educational strategies.
Collapse
Affiliation(s)
- D Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP.Université Paris Saclay, Hôpital Bicêtre, Le Kremlin Bicêtre Cedex, France.
| | - F J Mercier
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP.Université Paris Saclay, Hôpital Antoine Béclère, Clamart Cedex, France
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, and Department of Anaesthesiology, UZ Leuven, Leuven, Belgium
| | - N Lucas
- London North West Healthcare NHS Trust, United Kingdom
| | - B L Sng
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore and Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - R Gaiser
- Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
3
|
Roofthooft E, Joshi GP, Rawal N, Van de Velde M. PROSPECT guideline for elective caesarean section: an update. Anaesthesia 2023. [PMID: 37387254 DOI: 10.1111/anae.16079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
|
4
|
Roofthooft E, Joshi GP, Rawal N, Van de Velde M. PROSPECT guideline for elective caesarean section: an update and reply. Anaesthesia 2023. [PMID: 37387202 DOI: 10.1111/anae.16075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/01/2023]
|
5
|
Roofthooft E, Filetici N, Van Houwe M, Van Houwe P, Barbé A, Fieuws S, Rex S, Wong CA, Van de Velde M. High-volume patient-controlled epidural vs. programmed intermittent epidural bolus for labour analgesia: a randomised controlled study. Anaesthesia 2023. [PMID: 37340620 DOI: 10.1111/anae.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/22/2023]
Abstract
The aim of neuraxial analgesia is to achieve excellent pain relief with the fewest adverse effects. The most recently introduced technique for epidural analgesia maintenance is the programmed intermittent epidural bolus. In a recent study, we compared this with patient-controlled epidural analgesia without a background infusion and found that a programmed intermittent epidural bolus was associated with less breakthrough pain, lower pain scores, higher local anaesthetic consumption and comparable motor block. However, we had compared 10 ml programmed intermittent epidural boluses with 5 ml patient-controlled epidural analgesia boluses. To overcome this potential limitation, we designed a randomised, multicentre non-inferiority trial using 10 ml boluses in each group. The primary outcome was the incidence of breakthrough pain and total analgesic intake. Secondary outcomes included motor block; pain scores; patient satisfaction; and obstetric and neonatal outcomes. The trial was considered positive if two endpoints were met: non-inferiority of patient-controlled epidural analgesia with respect to breakthrough pain; and superiority of patient-controlled epidural analgesia with respect to local anaesthetic consumption. A total of 360 nulliparous women were allocated randomly to patient-controlled epidural analgesia-only or programmed intermittent epidural bolus groups. The patient-controlled group received 10 ml boluses of ropivacaine 0.12% with sufentanil 0.75 μg.ml-1 ; the programmed intermittent group received 10 ml boluses supplemented by 5 ml patient-controlled boluses. The lockout period was 30 min in each group and the maximum allowed hourly local anaesthetic/opioid consumption was identical between the groups. Breakthrough pain was similar between groups (11.2% patient controlled vs. 10.8% programmed intermittent, p = 0.003 for non-inferiority). Total ropivacaine consumption was lower in the PCEA-group (mean difference 15.3 mg, p < 0.001). Motor block, patient satisfaction scores and maternal and neonatal outcomes were similar across both groups. In conclusion, patient-controlled epidural analgesia is non-inferior to programmed intermittent epidural bolus if equal volumes of patient-controlled epidural analgesia are used to maintain labour analgesia and superior with respect to local anaesthetic consumption.
Collapse
Affiliation(s)
- E Roofthooft
- Department of Anaesthesiology, GZA Sint Augustinus Hospital, Antwerp, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - N Filetici
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - M Van Houwe
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - P Van Houwe
- Department of Anaesthesiology, GZA Sint Augustinus Hospital, Antwerp, Belgium
| | - A Barbé
- Department of Anaesthesiology, GZA Sint Augustinus Hospital, Antwerp, Belgium
| | - S Fieuws
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - S Rex
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - C A Wong
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Roofthooft E, Joshi GP, Rawal N, Van de Velde M. PROSPECT guideline for elective caesarean section: an update. Anaesthesia 2023. [PMID: 37104085 DOI: 10.1111/anae.16034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
|
7
|
Bleeser T, Devroe S, Lucas N, Debels T, Van de Velde M, Lemiere J, Deprest J, Rex S. Neurodevelopmental outcomes after prenatal exposure to anaesthesia for maternal surgery: a propensity-score weighted bidirectional cohort study. Anaesthesia 2023; 78:159-169. [PMID: 36283123 DOI: 10.1111/anae.15884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 01/11/2023]
Abstract
Up to 1% of pregnant women undergo anaesthesia for non-obstetric surgery. This study investigated neurodevelopmental outcomes after prenatal anaesthesia for maternal surgery. A bidirectional cohort study of children born between 2001 and 2018 was performed: neurodevelopmental outcomes of children who had received prenatal anaesthesia for maternal surgery were prospectively compared with unexposed children, with exposure status being assessed retrospectively. Children exposed to anaesthesia for obstetric and fetal surgery were excluded. The primary outcome was the global executive composite of the behaviour rating inventory of executive function score. Our secondary outcomes were: total problems; internalising problems and externalising problems derived from the child behaviour checklist; psychiatric diagnoses; and learning disorders. In 90% of exposed children, there was a single mean (SD) antenatal anaesthesia exposure lasting 91(94) min. There was a broad spectrum of indications, with abdominal surgery being most frequent. Parents of 129 exposed (response rate 68%) and 453 unexposed (response rate 63%) children participated. There were no arguments for non-response bias. After propensity weighting, there were no statistically significant differences in primary outcome, with a weighted mean difference (95%CI) of exposed minus unexposed children of 1.9 (-0.4-4.2), p = 0.10; or any of the secondary outcomes. Sensitivity analyses confirmed the robustness. Exploratory analyses, however, showed significant differences in certain subgroups for the primary outcome, (e.g. for intra-abdominal surgery, exposure duration > 1 h) and some cognitive subdomains (e.g. working memory and attention). This bidirectional cohort study, the largest investigation on the subject to date, has found no evidence in the general population for an association between prenatal exposure to anaesthesia and impaired neurodevelopmental outcomes.
Collapse
Affiliation(s)
- T Bleeser
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - S Devroe
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - N Lucas
- Department of Anaesthesia, Northwick Park Hospital, Harrow, UK
| | - T Debels
- Faculty of Medicine, KU Leuven, Belgium
| | - M Van de Velde
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - J Lemiere
- Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Belgium
| | - J Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Belgium
| | - S Rex
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| |
Collapse
|
8
|
Van de Velde M. Acute kidney injury in the peripartum period and the association with cesarean delivery. J Clin Anesth 2022; 82:110954. [PMID: 36027650 DOI: 10.1016/j.jclinane.2022.110954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022]
Affiliation(s)
- M Van de Velde
- Department of Anaesthesiology, UZ Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
| |
Collapse
|
9
|
Joshi GP, Bonnet F, Van de Velde M. PROSPECT guidelines for pain management after video-assisted thoracoscopic surgery: a reply. Anaesthesia 2022; 77:938. [PMID: 35388475 DOI: 10.1111/anae.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Affiliation(s)
- G P Joshi
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen, Leuven, Belgium
| | - F Bonnet
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen, Leuven, Belgium
| | - M Van de Velde
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen, Leuven, Belgium
| | | |
Collapse
|
10
|
Roofthooft E, Van de Velde M. PROSPECT guideline for elective caesarean section. Anaesthesia 2022; 77:617. [PMID: 35285012 DOI: 10.1111/anae.15713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Feray S, Lubach J, Joshi GP, Bonnet F, Van de Velde M. PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 77:311-325. [PMID: 34739134 PMCID: PMC9297998 DOI: 10.1111/anae.15609] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 01/13/2023]
Abstract
Video‐assisted thoracoscopic surgery has become increasingly popular due to faster recovery times and reduced postoperative pain compared with thoracotomy. However, analgesic regimens for video‐assisted thoracoscopic surgery vary significantly. The goal of this systematic review was to evaluate the available literature and develop recommendations for optimal pain management after video‐assisted thoracoscopic surgery. A systematic review was undertaken using procedure‐specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials published in the English language, between January 2010 and January 2021 assessing the effect of analgesic, anaesthetic or surgical interventions were identified. We retrieved 1070 studies of which 69 randomised controlled trials and two reviews met inclusion criteria. We recommend the administration of basic analgesia including paracetamol and non‐steroidal anti‐inflammatory drugs or cyclo‐oxygenase‐2‐specific inhibitors pre‐operatively or intra‐operatively and continued postoperatively. Intra‐operative intravenous dexmedetomidine infusion may be used, specifically when basic analgesia and regional analgesic techniques could not be given. In addition, a paravertebral block or erector spinae plane block is recommended as a first‐choice option. A serratus anterior plane block could also be administered as a second‐choice option. Opioids should be reserved as rescue analgesics in the postoperative period.
Collapse
Affiliation(s)
- S Feray
- Department of Anaesthesia, Intensive Care and Peri-operative Medicine, Hôpital Tenon, Paris, France
| | - J Lubach
- Department of Anaesthesiology, KU Leuven and University Hospital Leuven, Leuven, Belgium
| | - G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F Bonnet
- Department of Anaesthesia, Intensive Care and Peri-operative Medicine, Hôpital Tenon, Paris, France
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven and University Hospital Leuven, Leuven, Belgium
| | | |
Collapse
|
12
|
Gharae N, Roofthooft E, Fileticci N, Devroe S, Vanhove P, Rex S, Van de Velde M. Postoperative pain after cesarean section: an audit of practice after implementation of the PROSPECT recommendations. Acta Anaest Belg 2021. [DOI: 10.56126/72.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cesarean section (CS) is the most frequently performed surgical intervention worldwide. Post- cesarean pain is often underestimated and undertreated and can impair rapid maternal recovery, mother and child bonding and breastfeeding. Recently, PROSPECT recommendations on postoperative pain for CS were published and they include systematic paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), intravenous dexamethasone, neuraxial morphine/dia- morphine or an abdominal wall block or wound infiltration, abdominal wall binders, non-closure of the peritoneum and a Joel-Cohen incision. Opioids are administered as rescue. In UZ Leuven, these PROSPECT recommendations were implemented at the end of 2020. To evaluate the efficacy of these PROSPECT recommendations, a prospective audit was performed from January 1 st , 2021 till April 30 th , 2021. All patients with a CS were prospectively followed for correct implementation of the pain protocol and for pain scores in rest and at mobilization. Rescue opioid consumption as well as patient satisfaction were recorded. 185 consecutive patients that had undergone a CS were included in the audit. In 55 patients the pain protocol was not followed mostly due to no or reduced administration of NSAIDs. Patient satisfaction was high, especially in patients in which the protocol was followed. Pain scores at rest and at mobilization were low and the percentage of patients having pain scores above 30 mm VAS remained low. Rescue opioid consumption was low. We conclude that the implementation of the PROSPECT based pain protocol after CS was effective in controlling pain, reducing opioid consumption and resulted in high patient satisfaction especially if the protocol was correctly followed. Omission of NSAIDs is occurring relatively frequent, but mostly because of valid medical reasons to omit NSAIDs.
Collapse
|
13
|
Nijs K, Castelein N, Salimans L, Callebaut I, De Pauw I, Swinnen V, Van de Velde M, Stessel B. Perception and knowledge of anesthesia and the role of anesthesiologists : a Belgian single-center cross-sectional survey. Acta Anaest Belg 2021. [DOI: 10.56126/72.2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Study Objective : To assess the knowledge of anesthesia and the role of anesthesiologists and evaluate the prevalence of concerns of certain risks of anesthesia and surgery in Belgian patients.
Design : Observational mono-center cross-sectional survey.
Setting : Preoperative patients planned for elective surgery in Jessa Hospital, Belgium.
Interventions : An observational survey in Dutch.
Measurements : Patient demographics and characteristics, perception of the patient of the expertise, role, and responsibility of the anesthesiologist, knowledge of the patient regarding anesthesia, and patients´ fear of specific risks and side effects of anesthesia and surgery. Associations were analyzed with the Pearson correlation coefficient or the Spearman rank’s correlation coefficient.
Main Results : In total 361 patients completed the survey. Patient demographics were as follows : 54.8% males, mean age (± SD) 58,84 ± 16,38 years. Most patients (87.3%) recognized anesthesiologists as specially trained medical doctors but more than 50% underestimated their different perioperative responsibilities. Patients underestimated the dura-tion of education of an anesthesiologist in 84.2%. Their role at the intensive care unit (69.3%), the emergency department (71.2%), and the delivery room (71.2%) were relatively well known. Their role at the chronic pain management clinic (44.8%) and the preoperative anesthesia consultation (40.7%) was less well known. Some patients thought that general anesthesia frequently results in brain damage (22.7%). Older age and lower educational level were associated with lower knowledge. In general, 8.3% of all patients were very anxious about anesthesia, 22.7% somewhat, and 69% not at all. Female gender and lower educational level were positively correlated with a higher risk of fear. : Most patients in this single-center Belgian cohort were aware that anesthesiologists are specialized medical doctors. Overall, the patient´s knowledge of the anesthesiologist’s expertise and responsibilities and anesthesia was rather limited.
Collapse
|
14
|
Anger M, Valovska T, Beloeil H, Lirk P, Joshi GP, Van de Velde M, Raeder J. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 76:1082-1097. [PMID: 34015859 DOI: 10.1111/anae.15498] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 12/11/2022]
Abstract
The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intra-operative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.
Collapse
Affiliation(s)
- M Anger
- Service d'Anesthésie Réanimation et Médecine Péri-opératoire, CHU Rennes, Université Rennes, Rennes, France
| | - T Valovska
- Service d'Anesthésie Réanimation et Médecine Péri-opératoire, CHU Rennes, Université Rennes, Rennes, France
| | - H Beloeil
- Department of Anesthesiology, Henry Ford Health Systems, Wayne State School of Medicine, Detroit, MI, USA
| | - P Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Anaesthesiology, UZLeuven, Leuven, Belgium
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.,Division of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | | |
Collapse
|
15
|
Roofthooft E, Joshi GP, Rawal N, Van de Velde M. Tailoring postoperative pain management using a procedure-specific approach. Anaesthesia 2021; 76:1282. [PMID: 33942900 DOI: 10.1111/anae.15505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - G P Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N Rawal
- Orebro University, Orebro, Sweden
| | | |
Collapse
|
16
|
Roofthooft E, Joshi GP, Rawal N, Van de Velde M. PROSPECT guideline for elective caesarean section: a reply. Anaesthesia 2021; 76:1280-1281. [PMID: 33891309 DOI: 10.1111/anae.15496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 12/29/2022]
Affiliation(s)
| | - G P Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N Rawal
- Orebro University, Orebro, Sweden
| | | |
Collapse
|
17
|
Orbach-Zinger S, Jadon A, Lucas DN, Sia AT, Tsen LC, Van de Velde M, Heesen M. Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations. Anaesthesia 2021; 76:1111-1121. [PMID: 33476424 DOI: 10.1111/anae.15390] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/20/2023]
Abstract
If an accidental dural puncture occurs, one option is to insert a catheter and use it as an intrathecal catheter. This avoids the need for a further injection and can rapidly provide labour analgesia and anaesthesia for caesarean section. However, there are no recommendations for managing intrathecal catheters and, therefore, significant variation in clinical practice exists. Mismanagement of the intrathecal catheter can lead to increased motor block, high spinal anaesthesia, drug error, hypotension and fetal bradycardia. Care must be taken with an intrathecal catheter to adhere to strict aseptic technique, meticulous labelling, cautious administration of medications and good communication with the patient and other staff. Every institution considering the use of intrathecal catheters should establish a protocol. For labour analgesia, we recommend the use of dilute local anaesthetic agents and opioids. For caesarean section anaesthesia, gradual titration to the level of the fourth thoracic dermatome, with full monitoring, in a facility equipped to manage complications, should be performed using local anaesthetics combined with lipophilic opioids and morphine or diamorphine. Although evidence of the presence and duration of intrathecal catheters on the development of post-dural puncture headache and need for epidural blood patch is limited, we suggest considering leaving the intrathecal catheter in for 24 hours to reduce the chance of developing a post-dural puncture headache while maintaining precautions to avoid drug error and cerebrospinal fluid leakage. Injection of sterile normal saline into the intrathecal catheter may reduce post-dural puncture headache. The level of evidence for these recommendations was low.
Collapse
Affiliation(s)
- S Orbach-Zinger
- Department of Anaesthesia, Rabin Medical Centre, Beilinson Hospital, Petach Tikvah, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - A Jadon
- Tata Motors Hospital, Jamshedpur, Jharkhand, India.,Anaesthesia, Pain Relief Service, Department of Anaesthesia and Pain Relief Service, Jata Motors Hospital, Jamshedpur, Jharkhand, India
| | - D N Lucas
- LNWH NHS Trust, Harrow, UK.,Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - A T Sia
- Department of Women's Anaesthesia, KK Women and Children Hospital, Singapore, Anaesthesiology Program, Duke-NUS Graduate Medical School, Singapore
| | - L C Tsen
- Harvard Medical School, Department of Anesthesiology, Peri-operative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | - M Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| |
Collapse
|
18
|
Roofthooft E, Joshi GP, Rawal N, Van de Velde M. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 76:665-680. [PMID: 33370462 PMCID: PMC8048441 DOI: 10.1111/anae.15339] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
Caesarean section is associated with moderate‐to‐severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother‐child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50–100 µg or diamorphine 300 µg administered pre‐operatively; paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single‐injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non‐steroidal anti‐inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel‐Cohen incision; non‐closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.
Collapse
Affiliation(s)
- E Roofthooft
- Department of Anesthesiology, GZA Sint-Augustinus Hospital, Antwerp, Belgium.,Department of Cardiovascular Sciences, KULeuven and UZLeuven, Leuven, Belgium
| | - G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - N Rawal
- Department of Anesthesiology, Orebro University, Orebro, Sweden
| | - M Van de Velde
- Department of Cardiovascular Sciences, KULeuven and UZLeuven, Leuven, Belgium
| | | |
Collapse
|
19
|
Van de Velde M, Barvais I, Coppens M, Flamée P, Jastrowicz J, Mulier J, Robu B, Van Beersel D, Van Reeth V. Procedural sedation in Belgium : guideline for safe patient care. Acta Anaest Belg 2020. [DOI: 10.56126/71.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Guideline produced by the Society for Anesthesia and Resuscitation of Belgium Working Group on Procedural Sedation (SARB-WG-PS).
Collapse
|
20
|
Lemoine A, Van de Velde M, Jacobs A, Joshi G, Bonnet F. PROSPECT review methodology for oncological breast surgery: a reply. Anaesthesia 2020; 76:288-289. [PMID: 33080069 DOI: 10.1111/anae.15284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A Lemoine
- APHP - Sorbonne Université, Paris, France
| | | | - A Jacobs
- University Hospital, Leuven, Belgium
| | - G Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F Bonnet
- APHP - Sorbonne Université, Paris, France
| |
Collapse
|
21
|
Lemoine A, Van de Velde M, Jacobs A, Joshi G, Bonnet F. PROSPECT guidelines for oncological breast surgery: the role of non-opioid analgesics, a reply. Anaesthesia 2020; 76:141-142. [PMID: 33015825 DOI: 10.1111/anae.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- A Lemoine
- APHP - Sorbonne Université, Paris, France
| | | | - A Jacobs
- University Hospital, Leuven, Belgium
| | - G Joshi
- University of Texas Southwestern Medical Center, Dallas, USA
| | - F Bonnet
- APHP - Sorbonne Université, Paris, France
| |
Collapse
|
22
|
Lemoine A, Van de Velde M, Jacobs A, Joshi G, Bonnet F. Breast surgery analgesia: a reply. Anaesthesia 2020; 75:1406-1407. [PMID: 32654117 DOI: 10.1111/anae.15192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A Lemoine
- APHP - Sorbonne Université, Paris, France
| | | | - A Jacobs
- University Hospital, Leuven, Belgium
| | - G Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F Bonnet
- APHP - Sorbonne Université, Paris, France
| |
Collapse
|
23
|
Roofthooft E, Barbé A, Schildermans J, Cromheecke S, Devroe S, Fieuws S, Rex S, Wong CA, Van de Velde M. Programmed intermittent epidural bolus vs. patient-controlled epidural analgesia for maintenance of labour analgesia: a two-centre, double-blind, randomised study†. Anaesthesia 2020; 75:1635-1642. [PMID: 32530518 DOI: 10.1111/anae.15149] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
The programmed intermittent epidural bolus technique has shown superiority to continuous epidural infusion techniques, with or without patient-controlled epidural analgesia for pain relief, reduced motor block and patient satisfaction. Many institutions still use patient-controlled epidural analgesia without a background infusion, and a comparative study between programmed intermittent epidural bolus and patient-controlled epidural analgesia without a background infusion has not yet been performed. We performed a randomised, two-centre, double-blind, controlled trial of these two techniques. The primary outcome was the incidence of breakthrough pain requiring a top-up dose by an anaesthetist. Secondary outcomes included: motor block; pain scores; patient satisfaction; local anaesthetic consumption; and obstetric and neonatal outcomes. We recruited 130 nulliparous women who received initial spinal analgesia, and then epidural analgesia was initiated and maintained with either programmed intermittent epidural bolus or patient-controlled epidural analgesia using ropivacaine 0.12% with sufentanil 0.75 µg·ml-1 . The programmed intermittent epidural bolus group had a programmed bolus of 10 ml every hour, with on-demand patient-controlled epidural analgesia boluses of 5 ml with a 20 min lockout, and the patient-controlled epidural analgesia group had a 5 ml bolus with a 12 min lockout interval; the potential maximum volume per hour was the same in both groups. The patients in the programmed intermittent epidural bolus group had less frequent breakthrough pain compared with the patient-controlled epidural analgesia group, 7 (10.9%) vs. 38 (62.3%; p < 0.0001), respectively. There was a significant difference in motor block (modified Bromage score ≤ 4) frequency between groups, programmed intermittent epidural bolus group 1 (1.6%) vs. patient-controlled epidural analgesia group 8 (13.1%); p = 0.015. The programmed intermittent epidural bolus group had greater local anaesthetic consumption with fewer patient-controlled epidural analgesia boluses. Patient satisfaction scores and obstetric or neonatal outcomes were not different between groups. In conclusion, we found that a programmed intermittent epidural bolus technique using 10 ml programmed boluses and 5 ml patient-controlled epidural analgesia boluses was superior to a patient-controlled epidural analgesia technique using 5 ml boluses and no background infusion.
Collapse
Affiliation(s)
- E Roofthooft
- Department of Anaesthesiology, GZA Sint Augustinus Hospital, Antwerp, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - A Barbé
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - J Schildermans
- Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - S Cromheecke
- Department of Anaesthesiology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - S Devroe
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - S Fieuws
- Department of I-Biostat, KU Leuven, Belgium
| | - S Rex
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Belgium
| | - C A Wong
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Belgium
| |
Collapse
|
24
|
Foubert R, Devroe S, Foubert L, Van de Velde M, Rex S. Anesthetic neurotoxicity in the pediatric population: a systematic review of the clinical evidence. Acta Anaest Belg 2020. [DOI: 10.56126/71.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Background: Exposure to general anesthesia (GA) in early life is known to be neurotoxic to animals.
Objectives: To evaluate the risk of GA inducing long-term neurodevelopmental deficits in human children.
Design: Systematic review.
Methods: We included observational and randomized studies that compared the long-term neurodevelopment of postnatal children exposed to GA to the long-term neurodevelopment of children not exposed to GA. We searched MEDLINE, Embase and Web of Science for relevant studies published in the year 2000 or later. We screened all the identified studies on predetermined inclusion and exclusion criteria. A risk of bias assessment was made for each included study. We identified 9 neurodevelopmental domains for which a sub-analysis was made: intelligence; memory; learning; language/speech; motor function; visuospatial skills; development/emotions/behavior; ADHD/attention; autistic disorder.
Results: We included 26 studies involving 605.391 participants. Based on AHRQ-standards 11 studies were of poor quality, 7 studies were of fair quality and 8 studies were of good quality. The major causes of potential bias were selection and comparability bias. On 2 neurodevelopmental domains (visuospatial skills and autistic disorder), the available evidence showed no association with exposure to GA. On 7 other neurodevelopmental domains, the available evidence showed mixed results. The 4 studies that used a randomized or sibling-controlled design showed no association between GA and neurodevelopmental deficits in their primary endpoints.
Limitations: The absence of a meta-analysis and funnel plot.
Conclusions: Based on observational studies, we found an association between GA in childhood and neuro-developmental deficits in later life. Randomized and sibling-matched observational studies failed to show the same association and therefore no evidence of a causal relationship exists at present. Since GA seems to be a marker, but not a cause of worse neurodevelopment, we argue against delaying or avoiding interventional or diagnostic procedures requiring GA in childhood based on the argument of GA-induced neurotoxicity.
Collapse
|
25
|
Jacobs A, Lemoine A, Joshi GP, Van de Velde M, Bonnet F. PROSPECT guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 75:664-673. [PMID: 31984479 PMCID: PMC7187257 DOI: 10.1111/anae.14964] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 12/17/2022]
Abstract
Analgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta-analysis guidance with procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty-nine studies were found, of which 53 randomised controlled trials and nine meta-analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra-operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non-steroidal anti-inflammatory drugs) administered pre-operatively or intra-operatively and continued postoperatively. In addition, pre-operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.
Collapse
Affiliation(s)
- A. Jacobs
- Department of Cardiovascular SciencesKULeuven and University Hospital LeuvenLeuvenBelgium
| | - A. Lemoine
- Service d'Anesthésie – Réanimation et Médecine Péri‐opératoireHopital TenonAPHPParis, France/Médecine‐Sorbonne UniversitéParisFrance
| | - G. P. Joshi
- Department of Anesthesiology and Pain ManagementUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - M. Van de Velde
- Department of Cardiovascular SciencesKULeuven and University Hospital LeuvenLeuvenBelgium
| | - F. Bonnet
- Service d'Anesthésie – Réanimation et Médecine Péri‐opératoireHopital TenonAPHPParis, France/Médecine‐Sorbonne UniversitéParisFrance
| |
Collapse
|
26
|
Toma O, Persoons B, Pogatzki-Zahn E, Van de Velde M, Joshi GP. PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2019; 74:1320-1331. [PMID: 31392721 PMCID: PMC6771830 DOI: 10.1111/anae.14796] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 12/28/2022]
Abstract
Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. Out of 322 eligible studies identified, 59 randomised controlled trials and one systematic review met the inclusion criteria. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol, cyclo‐oxygenase‐2 inhibitors, intravenous dexamethasone, regional analgesia techniques including interscalene block or suprascapular nerve block (with or without axillary nerve block) and arthroscopic surgical technique. Limited evidence was found for pre‐operative gabapentin, perineural adjuncts (opioids, glucocorticoids, or α‐2‐adrenoceptor agonists added to the local anaesthetic solution) or postoperative transcutaneous electrical nerve stimulation. Inconsistent evidence was found for subacromial/intra‐articular injection, and for surgical technique‐linked interventions, such as platelet‐rich plasma. No evidence was found for stellate ganglion block, cervical epidural block, specific postoperative rehabilitation protocols or postoperative compressive cryotherapy. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non‐steroidal anti‐inflammatory drugs, dexamethasone and a regional analgesic technique (either interscalene block or suprascapular nerve block with or without axillary nerve block), with opioids as rescue analgesics. Further randomised controlled trials are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.
Collapse
Affiliation(s)
- O Toma
- Institute for Anaesthesiology, Spital STS AG, Thun, Switzerland.,University of East Anglia, Norwich, UK
| | - B Persoons
- Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Belgium
| | - E Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Germany
| | - M Van de Velde
- Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Belgium
| | - G P Joshi
- Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | |
Collapse
|
27
|
Devroe S, Bleeser T, Van de Velde M, Verbrugge L, De Buck F, Deprest J, Devlieger R, Rex S. Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: a 16-year retrospective, matched case-control, cohort study. Int J Obstet Anesth 2019; 39:74-81. [DOI: 10.1016/j.ijoa.2019.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/22/2018] [Accepted: 01/07/2019] [Indexed: 11/28/2022]
|
28
|
Joshi GP, Van de Velde M, Kehlet H. Development of evidence-based recommendations for procedure-specific pain management: PROSPECT methodology. Anaesthesia 2019; 74:1298-1304. [PMID: 31292953 PMCID: PMC6916581 DOI: 10.1111/anae.14776] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 01/21/2023]
Abstract
Effective peri‐operative pain management is a prerequisite for optimal recovery after surgery. Despite published evidence‐based guidelines from several professional groups, postoperative pain management remains inadequate. The procedure‐specific pain management (PROSPECT) collaboration consists of anaesthetists and surgeons with broad international representation that provide healthcare professionals with practical and evidence‐based recommendations formulated in a way that facilitates clinical decision‐making across all stages of the peri‐operative period on a procedure‐specific basis. The aim of this manuscript is to provide a detailed description of the current PROSPECT methodology with the intention of providing the rigour and transparency in which procedure‐specific pain management recommendations are developed. The high methodological standards of the recommendations should improve the quality of clinical practice.
Collapse
Affiliation(s)
- G P Joshi
- Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Van de Velde
- Department of Anesthesiology, UZLeuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium
| | - H Kehlet
- Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium.,Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | | |
Collapse
|
29
|
Missant C, Teunkenst A, Vandermeersch E, Van de Velde M. Patient-controlled Epidural Analgesia following Combined Spinal-epidural Analgesia in Labour: The Effects of Adding a Continuous Epidural Infusion. Anaesth Intensive Care 2019; 33:452-6. [PMID: 16119485 DOI: 10.1177/0310057x0503300405] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient-controlled epidural analgesia (PCEA) is used to maintain epidural analgesia following initial intrathecal analgesia. This trial investigated whether a continuous background infusion with PCEA provides superior analgesia to PCEA alone among patients who received combined spinal-epidural (CSE) analgesia during labour. Eighty parturients were randomized to either PCEA alone (PCEA) or PCEA with a background infusion of ropivacaine 0.15% with sufentanil 0.75 μg/ml at 2 ml/h (PCEA+CEI). PCEA settings were a bolus of 4 ml of the same analgesic solution with a lockout interval of 15 minutes. Significantly more patients in the PCEA group required at least one anaesthetist intervention for breakthrough pain (27 [71%] vs 10 [25%] in the PCEA+CEI group, P<0.05). Consumption of local anaesthetic (excluding manually administered boluses) was similar between the groups. If anaesthetist-administered boluses were included, more local anaesthetic was consumed by the PCEA group (47.1±19.4 mg vs 35.6±12.0 mg in the PCEA+CEI group, P<0.05). We conclude that PCEA with a background infusion provides effective analgesia with less anaesthetist workload and reduced local anaesthetic consumption as compared with PCEA without a background infusion.
Collapse
MESH Headings
- Adult
- Amides/administration & dosage
- Analgesia, Epidural/adverse effects
- Analgesia, Epidural/methods
- Analgesia, Obstetrical/adverse effects
- Analgesia, Obstetrical/methods
- Analgesia, Patient-Controlled/adverse effects
- Analgesia, Patient-Controlled/methods
- Analgesics, Opioid/administration & dosage
- Anesthetics, Combined/administration & dosage
- Anesthetics, Combined/therapeutic use
- Anesthetics, Local/administration & dosage
- Double-Blind Method
- Female
- Humans
- Infusions, Intravenous/methods
- Injections, Spinal/methods
- Pain/prevention & control
- Pain Measurement/statistics & numerical data
- Ropivacaine
- Sufentanil/administration & dosage
- Sufentanil/adverse effects
- Time Factors
- Treatment Outcome
Collapse
Affiliation(s)
- C Missant
- Department of Anaesthesiology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | |
Collapse
|
30
|
Barazanchi A, MacFater W, Rahiri JL, Tutone S, Hill A, Joshi G, Kehlet H, Schug S, Van de Velde M, Vercauteren M, Lirk P, Rawal N, Bonnet F, Lavand'homme P, Beloeil H, Raeder J, Pogatzki-Zahn E. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 2018; 121:787-803. [DOI: 10.1016/j.bja.2018.06.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/19/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023] Open
|
31
|
Smits K, Roels K, Ververs C, Van de Velde M, Govaere J, Van Soom A. Fluorinert as an Alternative for Mercury in Piezo Drill Assisted ICSI in the Horse. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.05.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Govaere J, Roels K, Ververs C, Van de Velde M, De Lange V, Gerits I, Hoogewijs M, Van Soom A. Ascending placentitis in the mare. VLAAMS DIERGEN TIJDS 2018. [DOI: 10.21825/vdt.v87i3.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ascending placentitis in the mare, which affects 3 to 7% of pregnancies, is a common cause of abortion, premature birth and delivery of compromised foals (Troedsson, 2003; LeBlanc, 2010). Since the infection ascends from the caudal genital tract, the first and most distinct lesions are seen near the caudal pole area of the allantochorion adjacent to the cervix. The symptoms are not always obvious or will be exhibited only at a later stage of the disease process, which renders timely adequate treatment difficult. Moreover, experimental models of placentitis in the mare are difficult to maintain and double-blind, controlled studies are scarce, making it hard to formulate clear science-based advice. In this paper, the diagnosis is discussed on the basis of the symptoms, the ultrasound examinations and the endocrinological parameters, and the therapeutic and prognostic considerations are evaluated.
Collapse
|
33
|
Nijs K, Nulens K, Dubois J, Van de Velde M, Stessel B. In reply: steroids, atosiban and pulmonary oedema; are or may be a cause? Int J Obstet Anesth 2018. [PMID: 29534949 DOI: 10.1016/j.ijoa.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Nijs
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.
| | - K Nulens
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - J Dubois
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - M Van de Velde
- Department of Anesthesiology and Pain Medicine, University Hospitals Leuven, Leuven, Belgium
| | - B Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium; Limburg Clinical Research Program, Hasselt University and Jessa Hospital, Belgium; Department of Anesthesiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| |
Collapse
|
34
|
Nijs K, Nulens K, Dubois J, Van de Velde M, Stessel B. The combination of corticosteroid and tocolytic therapy in a preeclamptic patient is a risk factor for the development of acute pulmonary oedema. Int J Obstet Anesth 2018; 34:113-114. [PMID: 29343418 DOI: 10.1016/j.ijoa.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 12/17/2017] [Accepted: 12/22/2017] [Indexed: 11/16/2022]
Affiliation(s)
- K Nijs
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.
| | - K Nulens
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - J Dubois
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - M Van de Velde
- Department of Anesthesiology and Pain Medicine, University Hospitals Leuven, Leuven, Belgium
| | - B Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium; Limburg Clinical Research Program, Hasselt University and Jessa Hospital, Belgium; Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
35
|
Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia 2017; 73:71-92. [DOI: 10.1111/anae.14080] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. M. Kinsella
- Department of Anaesthesia; St Michael's Hospital; Bristol UK
| | - B. Carvalho
- Department of Anesthesiology; Stanford University School of Medicine; Stanford CA USA
| | - R. A. Dyer
- Department of Anaesthesia and Perioperative Medicine; University of Cape Town; South Africa
| | - R. Fernando
- Department of Anaesthesia; Hamad Women's Hospital; Doha Qatar
| | - N. McDonnell
- Department of Anaesthesia and Pain Medicine; King Edward Memorial Hospital for Women; Subiaco Australia
| | - F. J. Mercier
- Département d'Anesthésie-Réanimation; Hôpital Antoine Béclère; Clamart France
| | - A. Palanisamy
- Department of Anesthesiology; Washington University School of Medicine; St. Louis MO USA
| | - A. T. H. Sia
- Department of Women's Anaesthesia; KK Women's and Children's Hospital; Singapore
| | - M. Van de Velde
- Department of Anesthesiology; UZ Leuven; Leuven Belgium
- Department of Cardiovascular Sciences; KU Leuven; Leuven Belgium
| | - A. Vercueil
- Department of Anaesthesia and Intensive Care Medicine; King's College Hospital NHS Foundation Trust; London UK
| | | |
Collapse
|
36
|
Joshi G, Kehlet H, Beloeil H, Bonnet F, Fischer B, Hill A, Joshi G, Kehlet H, Lavandhomme P, Lirk P, Pogatzki-Zhan E, Raeder J, Rawal N, Schug S, Van de Velde M. Guidelines for perioperative pain management: need for re-evaluation. Br J Anaesth 2017; 119:703-706. [DOI: 10.1093/bja/aex304] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
37
|
De Lange L, Roels K, Ververs C, Van de Velde M, Corty P, Govaere J. Diagnostische benadering van cryptorchidie bij de hengst. VLAAMS DIERGEN TIJDS 2017. [DOI: 10.21825/vdt.v86i3.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
De diagnose van cryptorchidie bij het paard is vaak een uitdaging aangezien niet altijd definitief uitsluitsel kan gegeven worden op basis van de anamnese, het klinische onderzoek en het rectaal en echografisch onderzoek. Verschillende endocrinologische diagnostische testen zoals de bepaling van het testosteron-, androstenedione-, oestrogenen-, urinaire steroïden- en het antimülleriaans hormoongehalte, die de aanwezigheid van testiculair weefsel aantonen, zijn beschreven. In dit artikel wordt getracht om de voor- en nadelen van deze testen te vergelijken, zodat practici een idee krijgen welke testen in de praktijk gebruikt kunnen worden.
Collapse
|
38
|
Dewinter G, Moens P, Fieuws S, Vanaudenaerde B, Van de Velde M, Rex S. Systemic lidocaine fails to improve postoperative morphine consumption, postoperative recovery and quality of life in patients undergoing posterior spinal arthrodesis. A double-blind, randomized, placebo-controlled trial. Br J Anaesth 2017; 118:576-585. [DOI: 10.1093/bja/aex038] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 02/06/2023] Open
|
39
|
Van de Velde M, Carvalho B. In reply. Int J Obstet Anesth 2016; 28:96. [PMID: 27836392 DOI: 10.1016/j.ijoa.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/19/2022]
Affiliation(s)
- M Van de Velde
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven and Department of Anaesthesiology, University Hospitals Gasthuisberg, Leuven, Belgium.
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, California, USA
| |
Collapse
|
40
|
Van de Velde M, Carvalho B. In reply. Int J Obstet Anesth 2016; 27:92-3. [PMID: 27432691 DOI: 10.1016/j.ijoa.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M Van de Velde
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven and Department of Anaesthesiology, University Hospitals Gasthuisberg, Leuven, Belgium.
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, CA, USA
| |
Collapse
|
41
|
Keller P, Dufourni A, Van de Velde M, Bauwens C, Van Loon G. Phenylephrine-induced epistaxis in a six-year-old Quarter horse with nephrosplenic entrapment. VLAAMS DIERGEN TIJDS 2016. [DOI: 10.21825/vdt.v85i3.16343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left dorsal displacement of the large colon is a common cause of colic in horses. Treatment consists of surgery, rolling the horse under general anesthesia or intravenous administration of phenylephrine. Treatment with phenylephrine, an α1-adrenergic drug, is often associated with sweating and trembling. Especially in horses of more than 15 years old, fatal hemorrhage may occur due to hemothorax or hemoperitoneum. Therefore, phenylephrine treatment is generally not given in horses over 15 years of age. In this report, severe epistaxis in a six-year-old Quarter horse is described after intravenous administration of 22.5 μg/kg BW phenylephrine, and it is highlighted that hemorrhage may also occur in younger horses.
Collapse
|
42
|
Affiliation(s)
- M Van de Velde
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Department of Anaesthesiology, University Hospitals Gasthuisberg, Leuven, Belgium.
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, CA, USA
| |
Collapse
|
43
|
Maas E, Pieters B, Van de Velde M, Rex S. General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis. Curr Pharm Des 2016; 22:1868-78. [DOI: 10.2174/1381612822666151208121825] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/07/2015] [Indexed: 11/22/2022]
|
44
|
Van de Velde M, Carvalho B. Remifentanil for labor analgesia: an evidence-based narrative review. Int J Obstet Anesth 2016; 25:66-74. [DOI: 10.1016/j.ijoa.2015.12.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/25/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022]
|
45
|
Teunkens A, Cootjans K, Vermeulen K, Peters M, Van de Velde M, Rex S. Intraoperative administered tramadol reduces the need for piritramide in the immediate postoperative period in children undergoing adenotonsillectomy: A retrospective observational study. Acta Anaesthesiol Belg 2016; 67:175-181. [PMID: 29873987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Adenotonsillectomy is a frequently performed procedure in pediatric day-case surgery causing significant pain for which adequate analgesia is required. Our aim was to investigate if the intraoperative administration of IV tramadol decreases the need for postoperative pain medication in children. Because tramadol has well-known pro-emetic effects, we also assessed the incidence of postoperative nausea and vomiting (PONV). METHODS We performed a retrospective observational study in 314 children aged 1-13 years undergoing elective adenotonsillectomy. We identified 160 children who had received standard pain medication consisting of IV paracetamol and ketorolac and compared them with a group of 154 children who had received in addition a perioperative infusion of tramadol. RESULTS 32.5% of the patients in the tramadol group versus 83.8% of the patients in the standard group required postoperative administration of piritramide (p < 0.0001). Groups did not differ with respect to the postoperative need for anti-emetics but in the tramadol group more patients had received prophylactic therapy with odansetron or dexamethasone (P < 0.0001). CONCLUSION The results of this retrospective study indicate that intraoperative tramadol administration in combination with prophylactic antiemetic therapy decreases the need for piritramide in the immediate postoperative period without increasing the incidence of PONV after tonsillectomy in children.
Collapse
|
46
|
Van de Velde M, Devroe S, Roofthooft E. Remifentanil PCIA for labour analgesia: a world of caution. Acta Anaesthesiol Belg 2016; 67:149-150. [PMID: 29873984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
47
|
Al tmimi L, Van Hemelrijck J, Van de Velde M, Sergeant P, Meyns B, Missant C, Jochmans I, Poesen K, Coburn M, Rex S. Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial †. Br J Anaesth 2015; 115:550-9. [DOI: 10.1093/bja/aev303] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
48
|
Devroe S, Van de Velde M, Demaerel P, Van Calsteren K. Spinal subdural haematoma after an epidural blood patch. Int J Obstet Anesth 2015; 24:288-9. [DOI: 10.1016/j.ijoa.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/12/2015] [Accepted: 05/26/2015] [Indexed: 11/25/2022]
|
49
|
Desmet M, Vanneste B, Reynvoet M, Van Cauwelaert J, Verhelst L, Pottel H, Missant C, Van de Velde M. A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery. Anaesthesia 2015; 70:1180-5. [PMID: 26082203 DOI: 10.1111/anae.13156] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 11/27/2022]
Abstract
We recruited patients scheduled for shoulder rotator cuff repair or subacromial decompression under general anaesthesia and interscalene brachial plexus blockade (30 ml ropivacaine 0.5%). We allocated 240 participants into four groups of 60 that were given pre-operative saline 0.9% or dexamethasone 1.25 mg, 2.5 mg or 10 mg, intravenously. We recorded outcomes for 48 h. The median (IQR [range]) time to first postoperative analgesic request after saline was 12.2 (11.0-14.1 [1.8-48]) h, which was extended by intravenous dexamethasone 2.5 mg and 10 mg to 17.4 (14.9-21.5 [7.2-48]) h, p < 0.0001, and 20.1 (17.2-24.3 [1.3-48]) h, p < 0.0001, respectively, but not by dexamethasone 1.25 mg, 14.0 (12.1-17.7 [2.1-48]) h, p = 0.05. Postoperative analgesia was given sooner after rotator cuff repair than subacromial decompression, hazard ratio (95% CI) 2.2 (1.6-3.0), p < 0.0001, but later in older participants, hazard ratio (95% CI) 0.98 (0.97-0.99) per year, p < 0.0001.
Collapse
Affiliation(s)
- M Desmet
- Department of Anaesthesiology, AZ Groeninge, Kortrijk, Belgium
| | - B Vanneste
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - M Reynvoet
- Department of Anaesthesiology, AZ Groeninge, Kortrijk, Belgium
| | - J Van Cauwelaert
- Department of Orthopaedic Surgery, AZ Groeninge, Kortrijk, Belgium
| | - L Verhelst
- Department of Orthopaedic Surgery, AZ Groeninge, Kortrijk, Belgium
| | - H Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - C Missant
- Department of Anaesthesiology, UZ Leuven, Leuven, Belgium
| | - M Van de Velde
- Department of Anaesthesiology, UZ Leuven, Leuven, Belgium
| |
Collapse
|
50
|
Verstraete S, Walters MA, Devroe S, Roofthooft E, Van de Velde M. Lower incidence of post-dural puncture headache with spinal catheterization after accidental dural puncture in obstetric patients. Acta Anaesthesiol Scand 2014; 58:1233-9. [PMID: 25307708 DOI: 10.1111/aas.12394] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Accidental dural puncture (ADP) and post-dural puncture headache (PDPH) are important complications of obstetric regional anesthesia. Inserting the catheter intrathecally after ADP to prevent PDPH has gained popularity. Nonetheless, data on the effect of an intrathecal catheter on PDPH and epidural blood patch (EBP) rates are mixed. Our primary objective was to examine if spinal catheterization reduces the incidence of PDPH after ADP in obstetric patients. METHODS Anesthetic records of 29,749 regional blocks performed between January 1997 and July 2013 were analyzed retrospectively. In all blocks containing an epidural component, 18-gauge epidural needles were used. All patients who experienced a witnessed ADP or PDPH without ADP were identified. Data from patients with or without a prolonged spinal catheter were compared. RESULTS There were 128 events of witnessed ADP (0.43%). Following known ADP, 39 women had an epidural catheter placed at a different level and 89 had an intrathecal catheter (20-gauge) for at least 24 h. Sixty-one patients developed PDPH after observed ADP (48%). Prolonged intrathecal catheter placement significantly reduced the incidence of PDPH after ADP to 42% compared with 62% in those who have the catheter re-sited epidurally [odds ratio = 2.3 (95% confidence interval 1.04-4.86); P = 0.04]. CONCLUSIONS The incidence of ADP, PDPH and blood patching is similar with previously published studies. After witnessed ADP, inserting the epidural catheter intrathecally significantly reduced the incidence of PDPH.
Collapse
Affiliation(s)
- S Verstraete
- Department of Anesthesiology, University Hospitals Gasthuisberg, Leuven, Belgium
| | | | | | | | | |
Collapse
|