Article Notes

• Hide
  • Pearls
  • Summaries
  • Comments

summary
1
After reviewing available evidence the Neuropathic Pain Special Interest Group could only recommend:
1. Epidural injections for herpes zoster neuropathic pain.
2. Steroid injections for radiculopathy.
3. Spinal cord stimulator for failed back surgery syndrome or Complex Regional Pain Syndrome type 1
Dworkin RH, O'Connor AB, Kent J et al. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain. 2013 Nov 1; 154 (11): 224922612249-2261.
  Daniel Jolley
pearl
1
The NICOM non-invasive cardiac output monitor is non-inferior to oesophageal doppler monitoring for guiding fluid therapy in colorectal surgery.
Waldron NH, Miller TE, Thacker JK et al. A Prospective Comparison of a Noninvasive Cardiac Output Monitor Versus Esophageal Doppler Monitor for Goal-Directed Fluid Therapy in Colorectal Surgery Patients. Anesth. Analg. 2014 May 1;118(5):966-75.
  Daniel Jolley
pearl
1
Epidural fentanyl has direct neuraxial analgesic effects distinct from systemic analgesic effects.
Sadurní M, Beltrán S, Dürsteler C et al. Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design. Acta Anaesthesiol Scand. 2013 Oct 1;57(9):1103-10.
  Daniel Jolley
comment
0
I like that POISE is another example in anaesthesia and peri-operative medicine of where surgery and anaesthesia themselves are not sufficient indications for intervening in a way (ie. starting peri-operative beta-blockers) that is not otherwise medically indicated (ie. as Allan notes, 'requiring beta blockade for cardiac reasons'). Screening coronary angiograms and revascularisation before major surgery are other examples.
There is a bit of "when will we learn?" to the beta-blockade story.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Daniel Jolley
summary
1
If a patient requires beta blockade for cardiac reasons they should have it.
If they do not then they should not.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Allan Palmer
pearl
1
Use of 6% HES solutions in surgical patients is not associated with either harm or benefit in terms of mortality, renal replacement or kidney injury.
Gillies MA, Habicher M, Jhanji S et al. Incidence of postoperative death and acute kidney injury associated with i.v. 6% hydroxyethyl starch use: systematic review and meta-analysis. Br J Anaesth. 2014 Jan 1; 112 (1): 25-34.
  Daniel Jolley
pearl
1
Goal directed fluid and vasoactive therapy using a non-invasive cardiac output monitor does not reduce complications after major abdominal surgery.
Pestaña D, Espinosa E, Eden A et al. Perioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic Trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery). Anesth. Analg. 2014 Sep 1;119(3):579-87.
  Daniel Jolley
comment
0
Interestingly though, despite improved satisfaction and dramatically less morphine consumed, there was no difference in pain scores or common opioid side effects.
Tan TT, Teoh WH, Woo DC et al. A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol. 2012 Feb 1;29(2):88-94.
  Daniel Jolley
pearl
1
Ultrasound guided TAP block significantly reduces morphine consumption and improves satisfaction following general anaesthesia caesarean section.
Tan TT, Teoh WH, Woo DC et al. A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol. 2012 Feb 1;29(2):88-94.
  Daniel Jolley
comment
0
It is important to note that the drivers of growth in Office Based Anesthesia are primarily economic and professional autonomy focused rather than patient care or quality of care. That is not to say these former priorities are in opposition to patient-centered goals, just that the patient is not the primary diver of this shift.
Shapiro FE, Punwani N, Rosenberg NM et al. Office-based anesthesia: safety and outcomes. Anesth. Analg. 2014 Aug 1;119(2):276-85.
  Daniel Jolley