British journal of anaesthesia
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Why is this important?
Suspicions that anesthetic technique impacts survival after cancer surgery continues to be both unanswered and psychologically weighty: are anesthetic choices undermining patient survival?
What did they do?
This Taiwanese research group conducted a retrospective cohort-study in a single hospital covering 10 years of elective hepatectomy patients, comparing propofol to desflurane anesthesia. Notably, hepatocellular carcinoma is one of the leading causes of cancer death in Taiwan.
And they found...?
TIVA propofol was associated with a dramatically better survival (hazard ratio 0.57 (0.38-0.59)), even in subgroup analysis dependent on staging.
Reality check
Although this finding is consistent with other observational studies across a range of cancers, the apparent size of the benefit (50% mortality reduction!) should give us pause.
Given inconsistent findings from a range of similar observational studies, it is unlikely that there is a real treatment effect of this magnitude.
While we await results from well-powered RCTs, the jury is still out on whether anesthesia choices impact any specific cancer surgery...
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Observational Study
Generalisability of randomised trials of the programmed intermittent epidural bolus technique for maintenance of labour analgesia: a prospective single centre cohort study.
Several randomised controlled trials show that maintenance of labour epidural analgesia with programmed intermittent epidural bolus reduces the maternal motor block compared with maintenance with a continuous infusion. However, these trials were usually restricted to healthy nulliparous parturients. To assess the generalisability of these randomised controlled trials to 'real-world' conditions, we compared maternal motor function (modified Bromage score) over time between healthy nulliparous and parous women using routinely collected quality-control data. ⋯ The results of the randomised controlled trials on a reduced motor block with programmed intermittent epidural bolus seem generalisable to parturients typically not included in these trials.
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There is still insufficient evidence to link particular anaesthetic or analgesic interventions with tumour recurrence following cancer surgery.
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Randomized Controlled Trial Comparative Study
Adductor canal block versus local infiltration analgesia for postoperative pain after anterior cruciate ligament reconstruction: a single centre randomised controlled triple-blinded trial.
Both the adductor canal block (ACB) and local infiltration analgesia (LIA) are effective analgesic techniques after anterior cruciate ligament (ACL) reconstruction, but they have never been compared head-to-head. This randomised controlled triple-blinded trial tested the hypothesis that ACB provides superior analgesia to LIA after ACL reconstruction, with additional focus on postoperative functional outcomes. ⋯ NCT02524652.
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Nociception, in contrast to pain, is not a subjective feeling, but the physiological encoding and processing of nociceptive stimuli. However, monitoring nociception remains a challenge in attempts to lower the incidence of acute postoperative pain and the move towards a more automated approach to analgesia and anaesthesia. To date, several commercialised devices promise a more accurate reflection of nociception than the traditionally used vital signs, blood pressure and heart rate. ⋯ Although firm conclusions about individual methods may be premature, none currently appears to offer a sufficiently broad applicability. Furthermore, there is currently no firm evidence for any clinically relevant influence of such devices on patient outcome. However, the available monitors have significantly aided the understanding of underlying mechanisms and identification of potential pitfalls.