British journal of anaesthesia
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Multicenter Study Clinical Trial
Peri-partum reference ranges for ROTEM(R) thromboelastometry.
Post-partum haemorrhage (PPH) causes rapidly developing deficiencies in clotting factors and contributes to substantial maternal morbidity and mortality. Rotational thromboelastometry (ROTEM(®)) is increasingly used as a point of care coagulation monitoring device in patients with massive haemorrhage; however, there are limited data on reference ranges in the peri-partum period. These are required due to the haemostatic changes in pregnancy. ⋯ Reference values for ROTEM(®) parameters are reported. The previously published correlation between FIBTEM parameters and plasma fibrinogen levels by the Clauss method is confirmed. Further research is needed to define threshold values for haemostatic therapy in the course of PPH. Clinical trial registration NTR 2515 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2515).
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Awareness during general anaesthesia for Caesarean section (C/S), although uncommon, remains a concern for anaesthesiologists. We examined the relationship between the bispectral index (BIS) and responses to the isolated forearm technique (IFT) to evaluate the adequacy of general anaesthesia in C/S and determine a suitable cut-off point for BIS values based on IFT results. ⋯ The BIS is not reliable for monitoring anaesthesia depth in C/S. Lower than previously recommended values are needed to avoid IFT test responses during laryngoscopy, intubation, and skin incision.
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Randomized Controlled Trial
Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty: a randomized study with individual patient analysis.
Total knee arthroplasty (TKA) is associated with varying degrees of pain. A considerable proportion (25-40%) of patients experience severe pain, despite a comprehensive multimodal analgesic regimen. We hypothesized that adductor canal block (ACB) would reduce pain in this patient category compared with placebo. ⋯ ACB reduced VAS with 32 mm, during active flexion of the knee, in patients with severe pain after TKA, but a large proportion (78%) still had at least moderate, movement-related pain. Clinical trial registration www.clinicaltrials.gov, NCT01549704.
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Practice Guideline
Initial assessment and management of pain: a pathway for care developed by the British Pain Society.
There is wide variation in how pain is managed in the UK. Patients often find themselves caught in a sea of referrals while continuing to suffer with poorly relieved symptoms. The British Pain Society's (BPS) Initial Assessment and Management of Pain care pathway (one of the five new BPS care pathways published by the Map of Medicine(®)) sets out how best to initially manage persistent pain. ⋯ Early identification of people at high risk of chronic disability may allow more intensive management, better use of resources, and reduction in disability. Implementation poses significant challenges; more research is needed to determine the most effective interventions. This article highlights practice points for the non-specialist, discusses areas of controversy, and examines the challenges of implementation.