Subpectineal obturator nerve block reduces opioid consumption after hip arthroscopy: a triple-blind, randomized, placebo-controlled trial.

BACKGROUND: Hip arthroscopy causes severe pain during the first few hours in the postoperative care unit. This is probably due to the intraoperative stretching of the hip joint capsule. Pain relief requires high doses of opioids which may prolong recovery and may cause opioid-related adverse events.The majority of hip joint capsule nociceptors are located anteriorly. The obturator nerve innervates the anteromedial part of the hip joint capsule. We hypothesized that a subpectineal obturator nerve block using 15 ml bupivacaine 5 mg/mL with added epinephrine 5 µg/mL would reduce the opioid consumption after hip arthroscopy. METHODS: 40 ambulatory hip arthroscopy patients were enrolled in this randomized, triple-blind controlled trial. All patients were allocated to a preoperative active or placebo subpectineal obturator nerve block. The primary outcome was opioid consumption for the first 3 hours in the postanesthesia care unit. Secondary outcomes were pain, nausea, and hip adductor strength. RESULTS: 34 patients were analyzed for the primary outcome. The mean intravenous morphine equivalent consumption in the subpectineal obturator nerve block group was 11.9 mg vs 19.7 mg in the placebo group (p<0.001). The hip adductor strength was significantly reduced in the active group. No other intergroup differences were observed regarding the secondary outcomes. CONCLUSION: We found a significant reduction in the opioid consumption for patients receiving an active subpectineal obturator nerve block. The postoperative intravenous morphine equivalent reduction the first painful 3 hours was reduced by 40% for patients receiving a subpectineal obturator nerve block in this randomized, triple-blind trial. TRIAL REGISTRATION NUMBER: EudraCT database 2021-006575-42.

How flash mobs can be used for data collection in healthcare? A scoping review protocol.

BACKGROUND: Traditional research methods often involve a lengthy process, but the emergence of flash mobs as an innovative data collection method offers the potential to gather substantial data within a short time frame. Flash mobs draw inspiration from the concept of large groups organizing through the internet or mobile devices to perform a prearranged action in public. In healthcare research, flash mobs serve as research organizing method to investigate clinically relevant questions on a large scale within a limited period. AIMS: This study aims to present a study protocol for a scoping review that comprehensively maps the existing literature on the use of flash mobs as a data collection method in healthcare research. METHODS: The review will follow established guidelines and include steps such as identifying the research question, identifying relevant studies, selecting studies, charting the data, and collating and summarizing the results. The review will utilize databases, manual screening of additional sources, and covidence for study selection and data charting. The findings will be summarized using descriptive statistics and a descriptive synthesis of qualitative data. The review protocol has been registered with the Open Science Framework. RESULTS: The results of this scoping review will provide insights into different flash mob designs, motivations, and the data collection process, contributing to the development of high-quality flash mob data collections in healthcare research.

Efficacy of iliopsoas plane block for patients undergoing hip arthroscopy: a prospective, triple-blind, randomized, placebo-controlled trial.

BACKGROUND: Intraoperative stretching of the hip joint capsule often generates severe pain during the first 3 hours after hip arthroscopy. The short-lived severe pain mandates high opioid consumption, which may result in adverse events and delay recovery. The femoral nerve nociceptors are located anteriorly in the hip joint capsule. A femoral nerve block reduces pain and opioid demand after hip arthroscopy. It impedes, however, ambulation and home discharge after outpatient surgery. The iliopsoas plane block selectively anesthetizes the femoral sensory nerve branches innervating the hip joint capsule without compromising ambulation. We aimed to assess reduction of opioid consumption after iliopsoas plane block during the short-lived painful postsurgical period of time after hip arthroscopy. METHODS: In a randomized, triple-blind trial, 50 patients scheduled for hip arthroscopy in general anesthesia were allocated to active or placebo iliopsoas plane block. The primary outcome was opioid consumption during the first three postoperative hours in the postanesthesia care unit. Secondary outcomes included pain, nausea, and ability to ambulate. RESULTS: Forty-nine patients were analyzed for the primary outcome. The mean 3-hour intravenous morphine equivalent consumption in the iliopsoas plane block group was 10.4 mg vs 23.8 mg in the placebo group (p<0.001). No intergroup differences were observed for the secondary outcomes during the postoperative follow-up. CONCLUSION: An iliopsoas plane block reduces opioid consumption after hip arthroscopy. The reduction of opioid consumption during the clinically relevant 3-hour postsurgical period of time was larger than 50% for active versus placebo iliopsoas plane block in this randomized, triple-blind trial.

Root-cause Analysis of 762 Danish Post-colonoscopy Colorectal Cancer Patients.

BACKGROUND & AIMS: The term post-colonoscopy colorectal cancer (PCCRC) refers to colorectal cancer (CRC) diagnosed after a negative colonoscopy. Using the root-cause algorithm proposed by the World Endoscopy Organization, we aimed to investigate plausible explanations for PCCRCs and potential changes in plausible explanations for PCCRCs over time in a Danish Region. METHODS: During 1995 to 2021, we used national health registries and electronic medical records in the Central Denmark Region to identify PCCRC cases, defined as CRCs recorded within 6 to 48 months after a colonoscopy. We then applied the World Endoscopy Organization algorithm to categorize explanations for PCCRC as follows: (A) possible missed lesion, prior examination adequate; (B) possible missed lesion, prior examination inadequate; (C) detected lesion, not resected; or (D) likely incomplete resection of previously identified lesion. PCCRCs were identified before (1995-2013) and after (2014-2021) implementation of nationwide fecal immunochemical test-based CRC screening and quality indicators for colonoscopy. RESULTS: We identified 762 PCCRCs, 53.5% among males and 57% among individuals ≥70 years. Forty-five percent were located in the proximal colon. We identified 616 (80.8%; 95% confidence interval [CI], 74.6%-87.5%) category A PCCRCs; 36 (4.7%; 95% CI, 3.3%-6.5%) category B PCCRCs; 26 (3.4%; 95% CI, 2.2%-4.9%) category C PCCRCs; and 84 (11%; 95% CI, 8.8%-13.6%) category D PCCRCs. Similar patterns were observed during the early (1995-2013) and late (2014-2021) study periods. CONCLUSIONS: Most PCCRCs originate from possible missed lesions and incompletely resected lesions during the complete study period. These findings indicate the importance of quality assurance of colonoscopy procedures and polypectomy techniques.

Problems in self-management of analgesics after outpatient shoulder surgery.

INTRODUCTION: Surgical outpatients are instructed in the use of analgesics post-operatively, but many fail to obtain adequate pain control at home. This study describes how the medication taken related to the prescribed medication and to pain intensity to improve recommendations of drug choice and scheduling. Also, we describe which errors occurred to suggest improvements in patient education and adherence. METHODS: Data were extracted from a study of dexamethasone in day-case arthroscopic shoulder surgery. Patients were recommended paracetamol 1 g four times daily and as needed: ibuprofen 600 mg up to 1,800 mg daily and morphine 10 mg up to 60 mg daily. Patients reported pain intensity and analgesic use until the third post-operative day. RESULTS: A total of 75 patients were available for analysis, and 33 patients (44%) reported an average pain intensity less-than 3 (by numerical rating scale 0-10) during the first three days. Paracetamol was taken as recommended by less-than 50%, and adherence was poorer in patients with higher average pain scores. The maximal daily dose was exceeded for paracetamol (n = 7) and ibuprofen (n = 14) due to too many daily doses or medication of other brand names or strengths than the patients were used to. In total, 32 patients had rescue doses between midnight and 6 a.m. Intolerance was seen for paracetamol (n = 1), ibuprofen (n = 7) and opioid (n = 2). CONCLUSION: Problems in analgesic use after outpatient surgery include undertreatment, poor compliance, overdosage, nightly breakthrough pain and poor tolerance due to side effects. Interventional studies should target these areas. FUNDING: none. TRIAL REGISTRATION: not relevant.

Effect of music intervention in colonoscopy-naïve adults: a randomised controlled trial.

BACKGROUND: Previous studies have evaluated music interventions before and during a colonoscopy, but the results are contradictory and inconclusive. AIMS: The aims of the present study were to evaluate the effect of a music intervention with MusiCure music, both before and during colonoscopy. METHODS: The study was a two-armed, prospective, randomised, controlled trial and 337 patients undergoing colonoscopy were included. Patients were allocated to receive relaxing music (MusiCure) before and during the colonoscopy or standard care (no music). Outcome measures included pain intensity, duration of the colonoscopy, consumption of alfentanil and midazolam, vital signs, patient satisfaction and caecal intubation rates (CIR). FINDINGS: Men in the music group had a lower middle arterial blood pressure compared with men in the no music group. The majority of patients in the music group would prefer to listen to music if they need a colonoscopy in the future. No differences were found between groups regarding pain intensity, duration of the colonoscopy, consumption of alfentanil and midazolam, vital signs, patient satisfaction and CIR. CONCLUSION: The researchers were unable to show an effect on the primary endpoints. However, a high patient satisfaction was found in the music group and a decrease in the blood pressure during the colonoscopy, indicating a reduced stress level. Music before and during a colonoscopy may improve the patient experience.

Patient-Experienced Quality During Postoperative Pain Management - A Phenomenological-Hermeneutic Study.

PURPOSE: The aim of this study was to describe an in-depth understanding of patients' experiences and perspectives after use of the erector spinae plane block (ESP) in patients undergoing laparoscopic hemicolectomy due to malignant disease. Knowledge gained throughout the study aimed to ensure increased patient-experienced quality, patient safety and adequate post-surgery pain treatment. DESIGN: A qualitative approach based on a phenomenological-hermeneutic framework inspired by Paul Ricoeur's perspectives was used. METHODS: The empirical material consisted of 11 semi-structured individual interviews with patients, who underwent laparoscopic hemicolectomy and received an ESP block as postoperative pain treatment. FINDINGS: Four themes emerged during the analysis and represent the findings: (1)"The significance of the pain for everyday life", in which everyday life and social relations emerged as fundamental for patients' experience of pain and pain management; (2) "Joy and anxiety - two opposites" showed experiences of conflicting feelings causing uncertainty and insecurity (3); The theme "Painlessness - or not?" showed experiences of satisfaction with the ESP block and how patients considered the time perspective of having pain as an element of further insecurity; (4)"Losing control over one's own life" demonstrated how patients tried regaining control over their own lives during pain and after surgery. CONCLUSIONS: The findings indicate that the majority of patients were happy with the ESP block because among other things, it reduced the need for rescue medicine including side-effects. Because of an acceptable pain intensity, patients paid more attention to other factors associated with their surgical intervention. Adequate pain management was described as of great importance for their experience of well-being and increased quality of life.

Split-Dose Regimen With Bisacodyl Increases the Quality of Bowel Preparation for Colonoscopy.

The aim of the present study was to compare 2 different bowel preparations procedures (split-dose with PicoPrep and bisacodyl vs. same-day preparation with PicoPrep) in patients undergoing colonoscopy with regard to quality of bowel preparation, compliance, and willingness to repeat. A retrospective quasi-experimental investigation was conducted. Adults with outpatient diagnostic and surveillance colonoscopies were included. A total of 540 patients participated: group 'split-dose with bisacodyl' (n = 293) and group 'same-day' (n = 247). Patients in group 'split-dose with bisacodyl' had a higher chance for having an excellent quality of bowel preparation (21.2%; 95% CI [13.5, 28.9]) and a reduced risk of an incomplete colonoscopy (4.1%; 95% CI [1.2, 7.0]). Group 'split-dose with bisacodyl' drank more fluid, had more nightly visits to the bathroom, and had more bathroom stops on the way to the endoscopic site. No differences were found between groups regarding adenoma detection rate, withdrawal time, overall time of colonoscopy, well-being during cleansing, patient satisfaction, the professional's assessment of the patient's tolerability of colonoscopy, and willingness to repeat the bowel preparation process. The split-dose regimen with PicoPrep and bisacodyl is now the standard bowel preparation procedure for patients undergoing elective colonoscopy as it is superior to the same-day regimen with PicoPrep regarding colon cleansing and incomplete colonoscopy. Hence, the written and verbal information at our institution regarding the bowel preparation procedure was altered according to the split-dose regimen, emphasizing the importance of adequate oral fluid intake and complete intake of the solution in order to ensure a safe and effective procedure.

High prevalence of persistent pain 6 months after arthroscopic subacromial decompression and/or acromioclavicular joint resection.

PURPOSE: The aims of this prospective study were to determine the prevalence of pain 6 months after arthroscopic subacromial decompression (ASD) and/or acromioclavicular joint resection (AC resection), to reveal causes of the pain, and to identify risk factors for persistent pain. METHODS: Preoperatively, patients were tested for their endogenous capacity to modulate pain and completed questionnaires concerning psychological vulnerability. Patients with pain 6 months after surgery were examined by an experienced orthopaedic surgeon to reveal any shoulder pathology responsible for the pain. RESULTS: Data from 101 patients were available for analysis 6 months after surgery. Thirty-six patients had persistent pain: 32 underwent examination by the surgeon who identified shoulder pathology in ten patients, but not in the remaining 22 in whom ongoing insurance case, unemployment, and a general tendency to worry were risk factors for persistent pain. CONCLUSION: The prevalence of persistent pain 6 months after ASD and/or AC resection was 35.6% (95% CI 26.1-45.8%) and the proportion of patients with shoulder pathology was 9.9%. An association between ongoing insurance case, unemployment, general tendency to worry (t-STAI), and unexplained persistent pain 6 months after surgery was found.

Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy: A Randomized Study.

PURPOSE: The purpose of this study was to compare two anesthetic techniques for postoperative pain after ambulatory operative hysteroscopy. DESIGN: A randomized trial. METHODS: Women (N = 153) scheduled for ambulatory operative hysteroscopy were assigned to receive either paracervical local anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S: n = 69; GA: n = 75). There were no significant differences in worst pain intensity between groups in the PACU (P = .13) or after discharge from PACU (P = .40). In group LA + S, fewer patients received treatment with intravenous fentanyl intraoperatively (P < .01) and time until discharge from PACU was shorter (P < .01). More patients in group LA + S experienced vomiting after discharge (P < .05). CONCLUSIONS: Local anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy.