Background and objectivesDocumentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia.MethodsFollowing the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%–74% agreement.ResultsSeventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29.ConclusionBy means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.
Study design Prospective randomized placebo controlled double blind trial. Objective To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. Methodology Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). Results In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357 mg in ESP group and 8.607 mg in placebo group ( P = .004). Average VAS during first 24 hour was 3.944 in ESP group and 5.193 in placebo group ( P = .046). Blood loss was 14.8 g per screw in ESP group and 15.4 g in placebo group ( P = .387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group ( P = .008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group ( P = .036). No significant differences in ODI were detected. Conclusion The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing.
• Background: More than 2 billion peripheral vascular cannulas are introduced globally each year. It is the most frequently performed invasive procedure in medicine worldwide. There is a group of patients with difficult intravenous access (DIVA). In experts’ hands, ultrasound guided vascular access appears to be a significantly better method. Investigators hypothesize that UGVA is superior also in short term patency of cannula and even for blood draw through cannula. Repeated cannula pricks in the operating room setting not only puts a lot of stress on patient and medical staff, they also waste OR time.• Methods: This investigator-initiated prospective randomized monocentric controlled trial is designed to randomly allocate 400 patients undergoing elective primary total joint arthroplasty of hip or knee to one of two groups as follows: Group C (control group) – peripheral venous cannula insertion by palpation or Group USG (intervention) – cannula insertion by ultrasound guided vascular access. Our primary endpoint is to compare number of attempts for ultrasound guided insertion of peripheral venous cannula with common palpation insertion of peripheral venous cannula in overweight/obese patients (BMI ≥ 25). The secondary endpoint is failure rate of peripheral venous cannula to administer intravenous therapy up to 5 days postoperatively. Tertiary endpoints include portion of long PVCs that are able to ensure blood draw up to 5 days postoperatively, time needed to insert PVC in each group, number of needle tip redirections in both groups, reinsertion of PVC needed in both groups for any reason.• Discussion: This study is pragmatic and is looking for clinically relevant data. After completion it will answer the question whether it is clinically relevant to use ultrasound guided vascular access in the context of not only short-term benefit of insertion, but also up to 5 days after insertion. Also, if this method can ensure blood draw through peripheral vein cannula, it can save resources in perioperative period - valuable especially considering the ongoing shortage of medical staff worldwide. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of ultrasound guided peripheral vascular access in perioperative period.Trial registration: Registered on clinicaltrials.gov 13.12.2021 under CT number: NCT05156008
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