Regional anaesthesia research – where to now?

Kearns, Rachel; Womack, Jonathan; Macfarlane, Alan

doi:10.1177/20494637221091139

Cited by 9 publications

(7 citation statements)

References 24 publications

(23 reference statements)

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“…A survey among 121 hospitals in 2011 showed that all hospitals use PCIA and PCEA 53 . Epidural anaesthesia has diminished in popularity and regional blocks and/or infusions have gained favour 54 . The use of continuous wound blocks facilitates early discharge and forms part of ‘Enhanced recovery after surgery’ (ERAS) protocols 55 .…”

Section: Resultsmentioning

confidence: 99%

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Perioperative pain management models in four European countries

van den Heuvel,

van Boekel,

Cox

et al. 2023

European Journal of Anaesthesiology

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There is general agreement that acute pain management is an important component of perioperative medicine. However, there is no consensus on the best model of care for perioperative pain management, mainly because evidence is missing in many aspects. Comparing the similarities and differences between countries might reveal some insights into different organisational models and how they work. Here, we performed a narrative review to describe and compare the structures, processes and outcomes of perioperative pain management in the healthcare systems of four European countries using Donabedian's framework as a guide. Our comparison revealed many similarities, differences and gaps. Different structures of acute pain services in the four countries with no common definition and standards of care were found. Protocols have been implemented in all countries and guidelines in some. If outcome is assessed, it is mainly pain intensity, and many patients experiencing more intense pain than others have common risk factors (e.g. preoperative pain, preoperative opioid intake, female sex and young age). Outcome assessment beyond pain intensity (such as pain-related physical function, which is important for early rehabilitation and recovery) is currently not well implemented. Developing common quality indicators, a European guideline for perioperative pain management (e.g. for patients at high risk for experiencing severe pain and other outcome parameters) and common criteria for acute pain services might pave the way forward for improving acute pain management in Europe. Finally, the education of general and specialist staff should be aligned in Europe, for example, by using the curricula of European Pain Federation (EFIC).

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Section: Resultsmentioning

confidence: 99%

“…53 Epidural anaesthesia has diminished in popularity and regional blocks and/or infusions have gained favour. 54 The use of continuous wound blocks facilitates early discharge and forms part of 'Enhanced recovery after surgery' (ERAS) protocols. 55 Some institutions discharge patients with elastomeric infusions.…”

Section: Processmentioning

confidence: 99%

Perioperative pain management models in four European countries

van den Heuvel,

van Boekel,

Cox

et al. 2023

European Journal of Anaesthesiology

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“…This and the lack of definitive evidence of the superiority of some novel RA techniques lead to underutilisation of the upcoming techniques. [ 1 ] All this means that there is an urgent need to educate and improve the technical proficiency of anaesthesiologists in our country in ultrasound-guided regional anaesthesia (USGRA). This can be done through departmental heads encouraging the use of RA and setting up of more USGRA regional training centres in all parts of our country, especially in medical colleges and civil hospitals.…”

Section: Ongoing Challenges In the Field Of Regional Anaesthesiamentioning

confidence: 99%

“…As mentioned by some authors, RA is in the midst of a “renaissance”. [ 1 ] This is mainly due to better understanding of the relevant anatomy for the nerve blocks, microarchitecture of the nerves, the availability of newer equipment with the incorporation of advanced technology, and newer local anaesthetics (LAs) and adjuvants. The present era of multimodal analgesia, the coronavirus disease 2019 (COVID-19) pandemic, and the buzz over enhanced recovery after surgery (ERAS) have brought to the fore the clinical importance of RA.…”

Section: Introductionmentioning

confidence: 99%

Recent advancements in regional anaesthesia

Kurdi

Thakkar

Arora

et al. 2023

Indian Journal of Anaesthesia

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Patient safety, improved quality of care, and better patient satisfaction and functional outcomes are currently the topmost priorities in regional anaesthesia (RA) and all advancements in RA move in this direction. Ultrasonography-guided central neuraxial and peripheral nerve blocks, intracluster and intratruncal injections, fascial plane blocks, diaphragm-sparing blocks, use of continuous nerve block techniques, and continuous local anaesthetic wound infiltration catheters are now topics of popular clinical interest. The safety and efficacy of nerve blocks can be improved with the help of injection pressure monitoring and the incorporation of advanced technology in the ultrasound machine and needles. Novel procedure-specific and motor-sparing nerve blocks have come up. The anaesthesiologist of the current era, with a good understanding of the sonoanatomy of the target area and the microarchitecture of nerves, along with the backup of advanced technology, can be very successful in performing RA techniques. RA is rapidly evolving and revolutionising the practice of anaesthesia.

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“…The advent and widespread availability of point-ofcare ultrasound (POCUS) has proved to be an unparalleled boon and tool in the armamentarium of a RA enthusiast [2,3]. Apart from improving the safety and efficacy of customary blocks; sono visualization of nerves, plexuses and facial planes alongside real-time visualization of needle advancement and drug distribution has opened a Pandora's box full of never ending newer techniques [4]. Though shown to be effective and safe within the closed boundaries of an operation suite, translating their clinical observation into evidence remains a dream of innovators and connoisseurs of RA techniques.…”

mentioning

confidence: 99%

Converting Regional Anaesthesia Database into Publication: A Step-based Approach

Gupta¹,

Jalwal²,

Grewal³

2023

ijra

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The article discusses the benefits of regional anaesthesia (RA) and the role of point-of-care ultrasound (POCUS) in enhancing its safety and efficacy. Conducting randomized controlled trials (RCTs) to establish the efficacy of RA remains a challenge due to resource constraints and ethical considerations. The author suggests that focusing solely on RCTs can be counterproductive and advocates for the importance of other forms of research, such as case series, practice audits, and prospective observational cohort studies. These forms of research can provide a background and rationale for designing future RCTs and can help broaden the scope of research beyond the idealistic RCT paradigm. The passage also includes a table highlighting the pros and cons of different study designs. Overall, the article emphasizes the importance of expanding the scope of research to improve the safety and efficacy of RA. Keywords: Regional anaesthesia, Point-of-care ultrasound, Randomized controlled trials, Case series, Practice audits, Prospective observational cohort studies, Efficacy, Safety

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Regional anaesthesia research – where to now?

Cited by 9 publications

References 24 publications

Perioperative pain management models in four European countries

Perioperative pain management models in four European countries

Recent advancements in regional anaesthesia

Converting Regional Anaesthesia Database into Publication: A Step-based Approach

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