AIMS: This study was done to find out the most suitable anaesthesia for patients with fewer complications and also to look at the trend of anaesthesia being used.
METHODS: A retrospective analysis was done of patients who underwent cataract surgery from 2007 to 2014 in Hospital Melaka. Data were obtained from the National Eye Database and analysed using SPSS. Trend of types of anaesthesia used and the associated complications with each were studied.
RESULTS: The most frequently used anaesthesia was topical anaesthesia, which showed an upward trend followed by subtenon in turn showing a downward trend. Subtenon anaesthesia was associated with more intraoperative and postoperative complications while topical anaesthesia was associated with fewer complications.
CONCLUSIONS: Topical anaesthesia has shown a steady increase in usage and is the ideal anaesthesia, which has been associated with fewer complications.
METHODS: Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.
RESULTS: Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52-0.97, p = 0.03, GRADE: Very low, I2 = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32-11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%).
CONCLUSIONS: This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.
METHODS: This was a cross-sectional study conducted over a period of 18 months. A self-administered questionnaire assessing knowledge and perception regarding neonatal pain was used.
RESULTS: Twenty-four hospitals participated in the study, with 423 respondents. The response rate was 85%. One hundred and ninety-seven respondents (47%) were aware of tools for neonatal pain assessment, but only 6% used them in daily practice. Doctors with >4 years of experience in neonatal care had better awareness of available pain assessment tools (59.4% vs 40.9%, P = 0.001). Sixteen statements regarding knowledge were assessed. Mean score obtained was 10.5 ± 2.5. Consultants/specialists obtained a higher mean score than medical officers (11.9 vs 10.4, P < 0.001). More than 80% of respondents were able to discriminate painful from non-painful procedures.
CONCLUSION: Clinicians involved in neonatal care, especially those with longer experience were knowledgeable about neonatal pain. Gaps between knowledge and its application, however, remain. Implementation of clinical guidelines to improve the quality of assessment and adequate pain management in neonates is recommended.
METHODS: This was a prospective, randomised controlled trial. We recruited diabetic patients aged > 18 years, American Society of Anesthesiologists class II-III, who were scheduled for unilateral diabetic foot surgery below the knee. All patients were assessed for autonomic dysfunction using the Survey of Autonomic Symptoms score. Participants were randomly assigned to receive either PNB or SAB for the surgery. Hemodynamic data, including usage of vasopressors, were recorded at 5-min intervals for up to 1 h after the induction of anesthesia. Pain scores were recorded postoperatively, and follow-up was done via telephone 6 months later.
RESULTS: Compared to the PNB group, the SAB group had a larger number of patients with significant hypotension (14 vs. 1; p = 0.001) and more patients who required vasopressor boluses (6 vs. 0 patients). Compared to SAB group, the patients in the PNB group had a longer postoperative pain-free duration (9 vs. 4.54 h; p = 0.002) and lower pain scores 1 day after surgery (3.63 vs. 4.69; p = 0.01).
CONCLUSION: Peripheral nerve block should be considered, whenever possible, as the first option of anesthesia for lower limb surgery in diabetic patients as it provides hemodynamic stability and superior postoperative pain control compared to SAB.
TRIAL REGISTRATION: Clinical trial registry: ClinicalTrials.gov. ID NCT02727348.
METHODS: Sixty-six (66) patients with unilateral uncomplicated inguinal hernia were randomized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair. The extent of surgical trauma was evaluated by measuring inflammatory markers of C-reactive protein, white blood cell count at 48 h, and ESR at 3 months postoperatively. Postoperative acute and chronic pain was assessed by recording the visual analogue scale scores and surgical complications were recorded over 3 months of the study period.
RESULTS: The median CRP and WBC levels at postoperative 48 h in both groups raised significantly from the baseline values (p 0.05). The median ESR level increased significantly at 3 months postoperatively from baseline in the glue mesh fixation group only (p 0.05). There was no significant difference for VAS scores at all timelines between the tacker and glue mesh fixation group (p > 0.05).
CONCLUSION: Cyanoacrylate glue mesh fixation technique as an alternative method to mechanical fixation in TEP repair is comparable to tacker and can be considered to be safe and feasible.
SUMMARY: Nephrologist-initiated peritoneoscopic PD access programs have had a positive impact on PD penetration. The technique has been associated with a better primary success rate, superior catheter survival, less postoperative pain, shorter hospital stay, and shorter catheter break-in time compared with the conventional surgical technique. The role of interventional nephrologists in peritoneoscope Tenckhoff catheter placement is still perceived to be a relatively new advance, investigational by some, and many nephrologists and surgeons alike remain sceptical of the value of this recent option. Crucial questions often raised are how many procedures one needs to perform before being considered competent and who should be credentialed to perform the procedure or supervise trainees performing it. The evaluation of technical proficiency in a specific operation is difficult and complex. Cumulative summation (CUSUM) analysis is one option for tracking the success and failure of technical skill and examining trends over time. Key Messages: The author's facility has had good outcomes with a nephrologist-initiated peritoneoscopic PD access programme. Quality control of PD catheter insertion can be performed using CUSUM charting to monitor for primary catheter dysfunction, primary leak, and primary peritonitis.
METHODS: A within-subject, repeated-measures, crossover randomized controlled design was conducted among 25 participants (7 males and 18 females) with chronic nonspecific low back pain. All the participants received 3 different types of experimental interventions, which included LPST, the passive automated cycling intervention, and the control intervention randomly, with 48 hours between the sessions. The pressure pain threshold (PPT), hot-cold pain threshold, and pain intensity were estimated before and after the interventions.
RESULTS: Repeated-measures analysis of variance showed that LPST provided therapeutic effects as it improved the PPT beyond the placebo and control interventions (P < 0.01). The pain intensity under the LPST condition was significantly better than that under the passive automated cycling intervention and controlled intervention (P < 0.001). Heat pain threshold under the LPST condition also showed a significant trend of improvement beyond the control (P < 0.05), but no significant effects on cold pain threshold were evident.
CONCLUSIONS: Lumbopelvic stabilization training may provide therapeutic effects by inducing pain modulation through an improvement in the pain threshold and reduction in pain intensity. LPST may be considered as part of the management programs for treatment of chronic low back pain.
OBJECTIVE: This study aims to determine the efficacy of PR in reducing radicular pain among lumbar disc herniation patients compared with conservative treatment.
METHODS: This study was conducted using the before-andafter quasi experimental design. There were 50 subjects that fulfilled the inclusion and exclusion criteria and they were divided into an intervention group (n=25) and control group (n=25). The intervention group was given once PR in the dorsal root ganglion. All subjects were assessed for Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) before treatment, at 1- , 2- and 4-week after treatment.
RESULTS: At1-, 2- and 4-week, the VAS reduction in the intervention group was statistically significant compared to the control group. Four weeks after the intervention, the VAS score decreased in the intervention group (mean VAS -78.5, SD 16.8) more significantly compared to the control group (p<0.001). The ODI score decreased in the intervention group (mean ODI -61.8, SD 20.1) more significantly than in the control group (p<0.001).
CONCLUSION: Finding showed that at1- , 2- and 4-weekPR was more efficacious in reducing radicular pain among lumbar disc herniation patients compared to the conservative therapy.