British journal of anaesthesia
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Randomized Controlled Trial
Analgesic efficacy of systemic lidocaine using lean body mass based dosing regime versus placebo in bariatric surgery: a prospective, randomised, double-blinded, placebo-controlled, single centre study.
Intravenous lidocaine is used as an adjuvant analgesic agent in perioperative settings. It has been investigated in various patient populations and surgical interventions, but there are limited data on its efficacy, particularly for patients undergoing bariatric surgery. Obese patients are at high risk of postoperative respiratory complications and can be expected to benefit from anaesthetic techniques that minimise opioid administration. ⋯ NCT03667001.
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Randomized Controlled Trial
Efficacy of prolonged intravenous lidocaine infusion for postoperative movement-evoked pain following hepatectomy: a double-blinded, randomised, placebo-controlled trial.
The analgesic effect of intravenous lidocaine varies with the duration of lidocaine infusion and surgery type. We tested the hypothesis that prolonged lidocaine infusion alleviates postoperative pain in patients recovering from hepatectomy over the first 3 postoperative days. ⋯ NCT04295330.
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The Model Hospital is an NHS online resource summarising performance data for, amongst other things, operating theatres categorised by NHS Trust and specialty. As an official source of information, it might be assumed that metrics, such as 'average late start time', 'average early finish time', and 'average late finish time', are calculated in a way to reflect performance in these domains, but this is not the case. These values are, respectively, only for those lists that start late, finish early, and finish late, with the number of lists in each category unreported. ⋯ The Model Hospital aggregates utilisations across lists in a mathematically invalid way, which leads to the assumption that small aliquots of unused time on lists can be combined to create larger time blocks, in which to complete more operations. We present alternative, more intuitive, and mathematically conventional methods to derive performance metrics using the same data. The results have implications for hospitals developing their own dashboards and international organisations seeking to create national databases for operating theatre performance.
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Editorial Comment
Postoperative nausea and vomiting: is the big little problem becoming a smaller little problem?
Postoperative nausea and vomiting (PONV) has been identified as a big (very frequently encountered) little (not linked to life-threatening outcomes) problem. Traditional drugs (dexamethasone, droperidol or similar drugs, serotonin receptor antagonists) each have significant but limited effect, leading to an increasing use of combination therapies. High-risk patients, often identified through use of risk scoring systems, remain with a significant residual risk despite combining up to three traditional drugs. ⋯ This disruptive strategy was supported by favourable initial results, absence of side-effects and lower acquisition costs of the added new drugs (aprepitant and palonosetron) because of their recent loss of patent protection. These results are provocative and hypothesis generating, but need confirmation and do not warrant immediate changes in clinical practice. The next steps will also necessitate wider implementation of protocols protecting patients from PONV and a search for additional drugs and techniques aimed at treating established PONV.