British journal of anaesthesia
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Review Meta Analysis
Efficacy and safety of intraoperative controlled hypotension: a systematic review and meta-analysis of randomised trials.
Intraoperative controlled hypotension improves surgical field visibility by reducing blood loss (efficacy) but poses potential risks linked to organ hypoperfusion (safety). The use of controlled hypotension persists despite increasing evidence of associations between intraoperative inadvertent hypotension and adverse outcomes. Therefore, we tested the hypothesis that the focus and results of intraoperative controlled hypertension research differ across anaesthesia and surgery investigators because of differing priorities. ⋯ PROSPERO (CRD42023450397).
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Review Meta Analysis
Effectiveness of pain medication tapering in chronic pain patients: a systematic review and meta-analysis.
This systematic review and meta-analysis aimed to inventory all outcome measures that are affected by tapering in chronic noncancer pain and to investigate the effectiveness of tapering. ⋯ CRD42023416343 (PROSPERO).
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Randomized Controlled Trial Multicenter Study
From pain level to pain experience: redefining acute pain assessment to enhance understanding of chronic postsurgical pain.
Chronic postsurgical pain (CPSP) significantly impairs quality of life and poses a substantial healthcare burden, affecting up to a quarter of patients undergoing surgery. Although acute pain is recognised as a predictor for CPSP development, the role of patient experience remains underexplored. This study examines the predictive value of patient experience alongside traditional risk factors for CPSP after orthopaedic surgery. ⋯ This study underscores the role of patient-reported outcomes, specifically the pain experience dimension captured by the EVAN-G scale, in prediction of CPSP 90 days after surgery. It suggests a shift from conventional assessments of pain intensity to a comprehensive understanding of pain experience, advocating for tailored pain management approaches that could reduce chronic pain, thereby improving patient quality of life and functional recovery.
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Editorial Review
Talk before they sleep: strategies for patient-centred communication in anaesthesiology.
Patient-physician communication is an integral part of daily anaesthetic practice. Although it is an undeniably powerful means of building a solid therapeutic alliance, several of its fundamental aspects are often overlooked, which can hinder successful communication in the preoperative period. We outline these underexploited elements by analysing the various phases of preoperative patient-physician interactions to provide the practising anaesthesiologist with a useful framework for achieving thoughtful and patient-centred communication.
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Hip fractures are a serious health concern and a major contributor to healthcare resource utilisation. We aimed to investigate nationwide trends in the USA in patient characteristics and outcomes in patients after hip fracture repair surgery. ⋯ Over the 6-yr period from 2016 to 2021, a majority of hip fracture repairs continued to be performed under general anaesthesia but with that percentage declining over time. Notable trends included a lower percentage of female patients, an increase in femoral neck fractures, a higher comorbidity burden among patients, and a decrease in complications.