Liposomal Bupivacaine Injection for Analgesia During Minimally Invasive Supracervical Hysterectomy.

Objective: To evaluate the efficacy of intracervical injection of liposomal bupivacaine for postoperative pain control among women undergoing minimally invasive supracervical hysterectomy. Methods: A randomized double-blinded placebo-controlled trial of intracervical injection of combination liposomal bupivacaine and bupivacaine for postoperative pain among patients undergoing laparoscopic and robotic supracervical hysterectomy. Patients were enrolled between October 1, 2018 and April 30, 2019. The primary outcome was pain at 12 hours postoperatively using a numeric rating scale from zero to 10. Pain scores were also recorded pre-operatively, immediately postoperatively, at 12, 24, and 48 hours postoperatively. The secondary outcome was the number of patients who required opioid analgesic medications up to 48 hours postoperatively. Results: Sixty participants were randomized into the control (n = 30) and intervention (n = 30) groups. Pain scores were 1 and 1.75 (p = 0.89) immediately postoperatively, 3 and 3.5 (p = 0.85) at 12 hours, 3.5 and 5 (p = 0.22) at 24 hours, and 2.75 and 4 (p = 0.18) at 48 hours for the control and intervention groups, respectively. Within the first 24 hours, 10 patients in the control and 14 patients in the intervention group used narcotics (p = 0.37). From the 24 to 48 hours window, 6 and 8 patients in the control and intervention groups used narcotics (p = 0.74), respectively. Conclusion: There was no statistically significant difference in pain scores between patients receiving combination liposomal bupivacaine and bupivacaine intracervical block and those receiving placebo in the first 48 hours after surgery. There was no difference in analgesic use between the two study groups.

Clinical Correlates of Posterior Reversible Encephalopathy Syndrome in Pregnancy.

The authors aimed to determine whether clinical findings of preeclampsia predict magnetic resonance imaging (MRI) diagnosis of posterior reversible encephalopathy syndrome (PRES). The course among preeclamptics/eclamptics with clinically suspected PRES with vs without MRI diagnosis of PRES was compared. Of 46 patients who underwent MRI (eight eclamptics, 38 preeclamptics), five eclamptics (62.5%) and four preeclamptics (10.5%) had confirmed PRES (P=.004). Patients with PRES were younger (26 years vs 31 years, P=.008) and had a higher prevalence of thrombocytopenia (33% vs 8%, P=.04), a greater prevalence of proteinuria (100% vs 61%, P=.04), and higher peak systolic and diastolic blood pressures (P<.05). As opposed to findings from previous reports, PRES was not seen uniformly among eclamptic women and was found in 10.5% of preeclamptics with clinical suspicion of PRES in this study. Given that no single or set of findings were reliable predictors of PRES, consideration for rigorous management of hypertension should be applied to all patients with preeclampsia and eclampsia.

The relationship of praise/criticism to learning during obstetrical simulation: a randomized clinical trial.

AIMS: The effect of positive vs. negative comments (praise vs. criticism) on trainees' subsequent cognitive and technical performance is unknown, but of potential importance. We performed a randomized trial of giving either praise or criticism during simulated normal vaginal deliveries (using a high-fidelity birthing simulator) to assess the differential effect of these types of comments on students' cognitive and technical performance, and perceived confidence after their learning experience. METHODS: Medical and nursing students underwent stratified randomization to praise or criticism. Students (n=59) initially participated in a teaching demonstration and practiced normal spontaneous vaginal delivery using a birthing simulator. A baseline assessment of cognitive and technical skills, and of self-confidence, was followed by a second simulation during which positive or negative comments were given using standardized scripts. Cognitive performance, technical performance and confidence measures were then scored again. RESULTS: Cognitive and technical performance scores in the "praise" group improved significantly by 2.5 (P=0.007) and 1.8 (P=0.032), respectively, while those in the "criticism" group remained unchanged. The self-reported confidence scores did not show any significant change from baseline in either group. CONCLUSIONS: Praise strengthens students' cognitive and technical performances, while criticism does not.

Nonclinical parameters affecting primary cesarean rates in the United States.

OBJECTIVE: Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population. STUDY DESIGN: We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.S. hospitals between 2005 and 2007 (Consortium on Safe Labor Database), which included 145,764 term, singleton, nonanomalous, vertex, live births that included labor. The impact of nonclinical parameters (patient and provider characteristics, time of delivery, institutional policies, and insurance type) was investigated using modified Poisson regression methodology and classification and regression tree analysis. RESULTS: There were 125,517 vaginal and 20,247 cesarean deliveries. Using the multivariable model, the nonclinical parameters with statistical significance for primary cesarean were delivery during evening hours, a male provider, public insurance, and nonwhite race (p < 0.001). CONCLUSIONS: Cesarean rates are associated with several nonclinical factors. Further investigation into these factors might help to develop strategies to reduce their influence and hence the rates of cesarean.