Qualitative and quantitative gastric ultrasound assessment in highly skilled regional anesthesiologists.

BACKGROUND: Pulmonary aspiration is a major complication in anesthesia, and various studies have shown that gastric sonography can reliably provide valuable information relative to both the qualitative and quantitative aspects of gastric content. This study aimed to determine the accuracy of ultrasound assessment of gastric content compared between two novice anesthesiologist gastric sonographers. METHODS: This prospective cohort study of two anesthesiologists learning to perform qualitative and quantitative ultrasound assessment of gastric content on healthy volunteers was conducted at Siriraj Hospital (Bangkok, Thailand). This trial was registered with ClinicalTrials.gov (reg. no. NCT04760106). RESULTS: Of the 50 enrolled participants, three were excluded due to study protocol violation. Each anesthesiologist performed a qualitative assessment on 47 participants for an overall total of 94 scans. There were 15 males and 32 females (age 42 ± 11.7 years, weight 61.2 ± 13.1 kg, height 160.7 ± 7.3 cm, and BMI 23.6 ± 4.3 kg/m2). The overall success rate for all gastric content categories was approximately 96%. From antral cross-sectional area measurement, as the ingested volume increased, there was a tendency toward increased deviation from the actual ingested volume. Interrater agreement between anesthesiologists was analyzed using intraclass correlation coefficients (ICCs). A larger fluid volume was found to be associated with a lower level of agreement between the two anesthesiologists. The ICCs were 0.706 (95% CI: -0.125 to 0.931), 0.669 (95% CI: -0.254 to 0.920), 0.362 (95% CI: -0.498 to 0.807) for the 100 ml, 200 ml, and 300 ml fluid volumes, respectively. The mean duration to perform an ultrasound examination for each gastric content category and for the entire examination did not differ significantly between anesthesiologists (p > 0.05). CONCLUSION: Our results indicate that qualitative ultrasound assessment of gastric content is highly accurate and can be easily learned. In contrast, quantification of gastric volume by novice gastric sonographers is more complex and requires more training. TRIAL REGISTRATION: ClinicalTrials.gov no. NCT04760106 Date registered on Feb 11, 2021. Prospectively registered.

Bilateral posterior Quadratus Lumborum block for pain relief after cesarean delivery: a randomized controlled trial.

BACKGROUND: Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB. METHODS: Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared. RESULTS: Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period was significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04-3.96) in Group IT vs. 7.75 (5.67-9.83) in IT+QLB vs. 1.75 (0.75-2.75) in QLB (p < 0.001)]. The median (min, max) amount of morphine required during 24 h was 5.5 (0-25) in Group IT vs. 5.0 (0-36) in IT+QLB vs. 17.5 (1-40) mg in Group QLB (p < 0.001). In the final analysis the median pain-free period was 2.50 (1.23-3.77) hours (95%CI) in Group IT (n = 27) vs. 8.02 (5.96-10.07) in IT+QLB (n = 28). (p = 0.027). CONCLUSION: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB could provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period. TRIAL REGISTRATION: ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

Postoperative Pain Management and the Risk Factors in Major Operation: A Baseline Study of Acute Pain Service, Siriraj Hospital.

BACKGROUND: Acute pain service (APS) has been set up at Siriraj Hospital with the aim of providing postoperative pain management for patients receiving anesthetic pain control and other complicated cases undergoing major operations. OBJECTIVE: To identify the incidence of moderate to severe postoperative pain and its risk factors. To describe the techniques used and adverse effects in patients under APS care. MATERIAL AND METHOD: A prospective study in 340 surgical patients under APS care from January to September 2008 was performed. Data were obtained from medical records and patients' answers during 48 hours postoperatively. RESULTS: The incidences of postoperative pain scores 4-10 at 24 and 48 hours were 28.8% and 7.4%, with median pain intensity (0-10, [interquartile range]) of 2.5 [1.0-4.0] and 1.0 [0.0-2.0], respectively. The risk factors related to pain score 4-10 included analgesic intake for > 2 consecutive weeks prior to operation, type of surgery with severe degree of pain and age 65 years (odds ratios [95% CI] of 7.12 [1.92, 26.44], 6.17 [1.37, 27.77], and 1.87 [1.07, 3.29], respectively). Of the patients, 67.9% received epidural block for postoperative analgesia. The incidences of nausea/vomiting and itching that needed treatment were 12.4% and 9.4%, respectively. CONCLUSION: Risk factors that should be concerned were age ≤ 65 years, pre-operative prolonged analgesic use and surgeries with expected severe degree of pain.