Pub Date : 2025-12-01Epub Date: 2025-11-07DOI: 10.1016/j.pcorm.2025.100585
Leila Sadati, Seyedeh Sanaz Mirrahimi, Rana Abjar
{"title":"Corrigendum to “Evaluation of surgical technologists' performance in laparoscopic instrument decontamination and sterilization by 360-degree appraisal method: an observational study” [Perioperative Care and Operating Room Management 41 (2025) 100551]","authors":"Leila Sadati, Seyedeh Sanaz Mirrahimi, Rana Abjar","doi":"10.1016/j.pcorm.2025.100585","DOIUrl":"10.1016/j.pcorm.2025.100585","url":null,"abstract":"","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100585"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-22DOI: 10.1016/j.pcorm.2025.100594
Brahim Kammoun , Mehdi Borni , Mohammed Atef Azab , Hela Ben-Jemaa , Basma Souissi , Samir Aloulou , Mohamed Zaher Boudawara
Background
Early ventriculoperitoneal shunt (VPS) malfunction can result from intraoperative valve chamber contamination or damage. Contamination can occur with blood from surgical field. The objective of this technical note is to describe a surgical trick to avoid such complications.
Methods
We describe a simple, cost-effective technique using the sterile cap from the ligated distal peritoneal catheter as a temporary cover for the VPS valve chamber outlet during implantation, removed only before final connection.
Results
Our experience with this readily available, no-cost method has shown no early valve chamber-related malfunctions potentially linked to contamination.
Conclusion
Using the peritoneal catheter cap for intraoperative valve chamber protection in VPS is a straightforward measure aligning with contamination prevention, potentially improving shunt integrity and reducing early complications.
{"title":"Technical note: Intraoperative protection of ventriculoperitoneal shunt valve chambers using a peritoneal catheter-derived cap","authors":"Brahim Kammoun , Mehdi Borni , Mohammed Atef Azab , Hela Ben-Jemaa , Basma Souissi , Samir Aloulou , Mohamed Zaher Boudawara","doi":"10.1016/j.pcorm.2025.100594","DOIUrl":"10.1016/j.pcorm.2025.100594","url":null,"abstract":"<div><h3>Background</h3><div>Early ventriculoperitoneal shunt (VPS) malfunction can result from intraoperative valve chamber contamination or damage. Contamination can occur with blood from surgical field. The objective of this technical note is to describe a surgical trick to avoid such complications.</div></div><div><h3>Methods</h3><div>We describe a simple, cost-effective technique using the sterile cap from the ligated distal peritoneal catheter as a temporary cover for the VPS valve chamber outlet during implantation, removed only before final connection.</div></div><div><h3>Results</h3><div>Our experience with this readily available, no-cost method has shown no early valve chamber-related malfunctions potentially linked to contamination.</div></div><div><h3>Conclusion</h3><div>Using the peritoneal catheter cap for intraoperative valve chamber protection in VPS is a straightforward measure aligning with contamination prevention, potentially improving shunt integrity and reducing early complications.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100594"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-02DOI: 10.1016/j.pcorm.2025.100569
Abdallfatah Abdallfatah , Bishoy Beshay , Mark Nasseem , Imad Samman Tahhan , Mohammad Kloub , Riddhi Machchhar , Samaa Daoud , Mohamed Hamed , Hazem Abosheaishaa
Background
Gastrointestinal endoscopy is one of the most performed procedures worldwide, and sedation is often necessary to enhance patient satisfaction and improve procedural outcomes. Although propofol is the preferred sedative due to its rapid onset and recovery, it is associated with adverse effects such as hypotension and respiratory depression. Recently, remimazolam has emerged as a promising alternative sedative. Our aim is to evaluate the efficacy and safety of remimazolam compared to propofol.
Methods
We performed a systematic review and meta-analysis following PRISMA guidelines, and our study was registered in the PROSPERO database (CRD42025635440). We performed a literature search across multiple databases up to January 2025. Two independent reviewers carried out data extraction and quality assessment, with a third author resolving any conflicts. We conducted the SRMA using RevMan version 5.4. The primary outcome was hypotension.
Results
We included 29 Randomized controlled trials; the overall risk of bias was low to moderate. Remimazolam significantly reduced the risk of hypotension (27 studies, OR: 0.26, 95 % CI: 0.21–0.33; P < 0.00001). Additionally, remimazolam was associated with lower rates of respiratory depression (OR: 0.33; P < 0.00001) and bradycardia (OR: 0.36; P < 0.00001), and reduced injection site pain (OR: 0.09; P < 0.00001. There was no significant difference in the sedation success rate for remimazolam and propofol (13 studies, OR: 0.44, 95 % CI: 0.28–0.69; P = 0.0004; I² 0 %). Moreover, patients reported higher satisfaction with remimazolam (8 studies; MD: 0.43, 95 % CI: 0.16–0.70; P < 0.00001).
Conclusion
Our systematic review and meta-analysis demonstrated that remimazolam is clinically comparable to propofol for sedation in gastrointestinal endoscopy, offering superior hemodynamic stability, greater safety, and higher patient satisfaction. However, caution is advised in interpreting these findings.
背景胃肠内窥镜检查是世界范围内执行次数最多的手术之一，镇静通常是提高患者满意度和改善手术结果所必需的。虽然异丙酚因其起效快、恢复快而成为首选的镇静剂，但它与低血压和呼吸抑制等不良反应有关。最近，雷马唑仑已成为一种有前途的替代镇静剂。我们的目的是比较雷马唑仑与异丙酚的疗效和安全性。方法我们按照PRISMA指南进行了系统评价和荟萃分析，我们的研究在PROSPERO数据库中注册（CRD42025635440）。我们对截至2025年1月的多个数据库进行了文献检索。两名独立审稿人进行数据提取和质量评估，第三作者解决任何冲突。我们使用RevMan 5.4版本进行SRMA。主要结局是低血压。结果纳入29项随机对照试验；总体偏倚风险为低至中等。雷马唑仑显著降低低血压的风险（27项研究，OR: 0.26, 95% CI: 0.21-0.33; P < 0.00001）。此外，雷马唑仑与较低的呼吸抑制（OR: 0.33; P < 0.00001）和心动过缓（OR: 0.36; P < 0.00001）发生率相关，并减少注射部位疼痛（OR: 0.09; P < 0.00001）。雷马唑仑和异丙酚的镇静成功率无显著差异（13项研究，OR: 0.44, 95% CI: 0.28-0.69; P = 0.0004; I²0 %）。此外，患者对雷马唑仑的满意度更高（8项研究；MD: 0.43, 95% CI: 0.16-0.70; P < 0.00001）。我们的系统回顾和荟萃分析表明，雷马唑仑在胃肠内镜镇静方面的临床效果与异丙酚相当，具有更好的血流动力学稳定性、更高的安全性和更高的患者满意度。然而，在解释这些发现时建议谨慎。
{"title":"Remimazolam versus propofol for gastrointestinal endoscopic sedation: A systematic review and meta-analysis of randomized controlled trials with GRADE assessment","authors":"Abdallfatah Abdallfatah , Bishoy Beshay , Mark Nasseem , Imad Samman Tahhan , Mohammad Kloub , Riddhi Machchhar , Samaa Daoud , Mohamed Hamed , Hazem Abosheaishaa","doi":"10.1016/j.pcorm.2025.100569","DOIUrl":"10.1016/j.pcorm.2025.100569","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal endoscopy is one of the most performed procedures worldwide, and sedation is often necessary to enhance patient satisfaction and improve procedural outcomes. Although propofol is the preferred sedative due to its rapid onset and recovery, it is associated with adverse effects such as hypotension and respiratory depression. Recently, remimazolam has emerged as a promising alternative sedative. Our aim is to evaluate the efficacy and safety of remimazolam compared to propofol.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis following PRISMA guidelines, and our study was registered in the PROSPERO database (CRD42025635440). We performed a literature search across multiple databases up to January 2025. Two independent reviewers carried out data extraction and quality assessment, with a third author resolving any conflicts. We conducted the SRMA using RevMan version 5.4. The primary outcome was hypotension.</div></div><div><h3>Results</h3><div>We included 29 Randomized controlled trials; the overall risk of bias was low to moderate. Remimazolam significantly reduced the risk of hypotension (27 studies, OR: 0.26, 95 % CI: 0.21–0.33; P < 0.00001). Additionally, remimazolam was associated with lower rates of respiratory depression (OR: 0.33; P < 0.00001) and bradycardia (OR: 0.36; P < 0.00001), and reduced injection site pain (OR: 0.09; P < 0.00001. There was no significant difference in the sedation success rate for remimazolam and propofol (13 studies, OR: 0.44, 95 % CI: 0.28–0.69; P = 0.0004; I² 0 %). Moreover, patients reported higher satisfaction with remimazolam (8 studies; MD: 0.43, 95 % CI: 0.16–0.70; P < 0.00001).</div></div><div><h3>Conclusion</h3><div>Our systematic review and meta-analysis demonstrated that remimazolam is clinically comparable to propofol for sedation in gastrointestinal endoscopy, offering superior hemodynamic stability, greater safety, and higher patient satisfaction. However, caution is advised in interpreting these findings.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100569"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibroblastic sleeve (FS) and catheter-related thrombosis (CRT) are two distinct non–infective complications of venous access devices and differentiating between them is essential for decision-making on therapeutic interventions. This study explored the incidence of FS and CRT with the novel midclavicular midline catheters.
Methods
Fifty consecutive mid-clavicular midline catheters during the study period were scanned at the bedside every alternate day using established diagnostic criteria to identify the development and progression of FS and CRT. The presence of forward and backwards flow, types of infusates and signs of local and systemic infections were recorded by the departmental vascular access team.
Results
50 catheters served for 513 catheter days. The FS was identified in 12 catheters on a median catheter day of 7. The detection of FS coincides with the loss of backwards flow, and none of the FS progressed to CRT, and 83 % of FS catheters completed the intended duration of therapy. The CRT was noted in 6 catheters on a median catheter day of 5.5. Among the 6 CRT, 3 were symptomatic necessitating removal on detection, while three asymptomatic CRT were removed on loss of forward flow on median catheter day of 5. All CRTs were resolved on patient discharge without anticoagulant intervention.
Conclusion
The incidence of FS and CRT was 23 and 11.7 per 1000 catheter days, respectively. The incidence of symptomatic CRT was 5.85 per 1000 catheter days. Catheter removal led to thrombus dissolution in all patients without the need for therapeutic anticoagulation.
{"title":"Incidence of fibroblastic sleeve and catheter related thrombosis with novel mid-clavicular midline catheters - a prospective longitudinal observational study","authors":"Ajiba Sabana Rafeekullah Khan , Charulatha Ravindran, Swetha Nallasamy Sivachalam , Sivashanmugam Thiyagarajan","doi":"10.1016/j.pcorm.2025.100586","DOIUrl":"10.1016/j.pcorm.2025.100586","url":null,"abstract":"<div><h3>Background</h3><div>Fibroblastic sleeve (FS) and catheter-related thrombosis (CRT) are two distinct non–infective complications of venous access devices and differentiating between them is essential for decision-making on therapeutic interventions. This study explored the incidence of FS and CRT with the novel midclavicular midline catheters.</div></div><div><h3>Methods</h3><div>Fifty consecutive mid-clavicular midline catheters during the study period were scanned at the bedside every alternate day using established diagnostic criteria to identify the development and progression of FS and CRT. The presence of forward and backwards flow, types of infusates and signs of local and systemic infections were recorded by the departmental vascular access team.</div></div><div><h3>Results</h3><div>50 catheters served for 513 catheter days. The FS was identified in 12 catheters on a median catheter day of 7. The detection of FS coincides with the loss of backwards flow, and none of the FS progressed to CRT, and 83 % of FS catheters completed the intended duration of therapy. The CRT was noted in 6 catheters on a median catheter day of 5.5. Among the 6 CRT, 3 were symptomatic necessitating removal on detection, while three asymptomatic CRT were removed on loss of forward flow on median catheter day of 5. All CRTs were resolved on patient discharge without anticoagulant intervention.</div></div><div><h3>Conclusion</h3><div>The incidence of FS and CRT was 23 and 11.7 per 1000 catheter days, respectively. The incidence of symptomatic CRT was 5.85 per 1000 catheter days. Catheter removal led to thrombus dissolution in all patients without the need for therapeutic anticoagulation.</div><div>Trial Registry number</div><div>Clinical Trial Registry – India</div><div>URL – <span><span>https://ctri.nic.in</span><svg><path></path></svg></span></div><div>Registration number – CTRI/ 2021/ 09/036967</div><div>Date of registration – 29.09.2021</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100586"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-17DOI: 10.1016/j.pcorm.2025.100588
Zohreh Khoshgoftar , Sara Bagheri , Atiyeh Sadat Sajadi , Nasrin Aghazadeh , Vahid Rahmani
This article investigates the essential function of spatial intelligence and visual memory in improving the performance of scrub nurses in the operating room (OR). Cognitive abilities are crucial for the swift and precise handling of surgical tools, significantly influencing surgical efficiency and patient safety. Delays in handing over instruments, especially during critical times, can make surgery take longer, cause more problems, and even put the patient's life at risk. The current programs that train nurses mostly focus on technical skills, while cognitive skills such as spatial intelligence and visual memory are often overlooked. One approach could be to incorporate cognitive skill assessments during the hiring or admissions process to identify candidates with strong cognitive abilities, which could lead to improved performance in the operating room.
The article examines scientific data indicating that spatial intelligence and visual memory may be enhanced using modern educational methods, such as Virtual Reality (VR), Augmented Reality (AR), and microlearning.These technologies offer immersive, interactive environments that allow scrub nurses to practice visualizing and recalling surgical instrument arrangements under simulated high-pressure conditions. The research also suggests an interactive teaching game that simulates real-world surgical problems, allowing nurses to develop cognitive abilities including quick instrument recognition and exact tool delivery. By incorporating cognitive training into scrub nurse education, these methods have the potential to increase performance, minimize medical mistakes, and improve overall surgical results. The article highlights the importance of including cognitive skills in training programs, arguing that doing so could considerably contribute to safer and more efficient surgical operations, eventually leading to improved patient outcomes.
{"title":"Enhancing spatial intelligence and visual memory: Educational gamification to improve operating room scrub nurses' skills","authors":"Zohreh Khoshgoftar , Sara Bagheri , Atiyeh Sadat Sajadi , Nasrin Aghazadeh , Vahid Rahmani","doi":"10.1016/j.pcorm.2025.100588","DOIUrl":"10.1016/j.pcorm.2025.100588","url":null,"abstract":"<div><div>This article investigates the essential function of spatial intelligence and visual memory in improving the performance of scrub nurses in the operating room (OR). Cognitive abilities are crucial for the swift and precise handling of surgical tools, significantly influencing surgical efficiency and patient safety. Delays in handing over instruments, especially during critical times, can make surgery take longer, cause more problems, and even put the patient's life at risk. The current programs that train nurses mostly focus on technical skills, while cognitive skills such as spatial intelligence and visual memory are often overlooked. One approach could be to incorporate cognitive skill assessments during the hiring or admissions process to identify candidates with strong cognitive abilities, which could lead to improved performance in the operating room.</div><div>The article examines scientific data indicating that spatial intelligence and visual memory may be enhanced using modern educational methods, such as Virtual Reality (VR), Augmented Reality (AR), and microlearning.These technologies offer immersive, interactive environments that allow scrub nurses to practice visualizing and recalling surgical instrument arrangements under simulated high-pressure conditions. The research also suggests an interactive teaching game that simulates real-world surgical problems, allowing nurses to develop cognitive abilities including quick instrument recognition and exact tool delivery. By incorporating cognitive training into scrub nurse education, these methods have the potential to increase performance, minimize medical mistakes, and improve overall surgical results. The article highlights the importance of including cognitive skills in training programs, arguing that doing so could considerably contribute to safer and more efficient surgical operations, eventually leading to improved patient outcomes.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100588"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-21DOI: 10.1016/j.pcorm.2025.100568
Farzan Madadizadeh , Sajjad Bahariniya
This tutorial study provides a comprehensive overview of internal consistency measures used in reliability analysis, focusing on six primary models: Cronbach's alpha, Kuder-Richardson methods (KR-20 and KR-21), Guttman's lambda-2, parallel and strict parallel methods, and McDonald's omega coefficient. The methods discussed are applicable primarily to psychometric instruments and questionnaire-based data commonly used in social, behavioral, and educational sciences. Internal consistency is crucial for assessing the reliability of measurement scales in these fields. The study reviews each method, detailing their theoretical underpinnings, assumptions, and practical applications, alongside software guidelines for implementation in SPSS, R, and STATA. It highlights the distinctions between these methods, particularly emphasizing the advantages of McDonald's omega over Cronbach's alpha for more accurate reliability estimates. This work aims to fill the gap in existing literature by providing a thorough comparative analysis and practical guidance for researchers seeking to measure internal consistency effectively.
{"title":"Tutorial on internal consistency assessment by Cronbach's alpha and McDonald’s omega","authors":"Farzan Madadizadeh , Sajjad Bahariniya","doi":"10.1016/j.pcorm.2025.100568","DOIUrl":"10.1016/j.pcorm.2025.100568","url":null,"abstract":"<div><div>This tutorial study provides a comprehensive overview of internal consistency measures used in reliability analysis, focusing on six primary models: Cronbach's alpha, Kuder-Richardson methods (KR-20 and KR-21), Guttman's lambda-2, parallel and strict parallel methods, and McDonald's omega coefficient. The methods discussed are applicable primarily to psychometric instruments and questionnaire-based data commonly used in social, behavioral, and educational sciences. Internal consistency is crucial for assessing the reliability of measurement scales in these fields. The study reviews each method, detailing their theoretical underpinnings, assumptions, and practical applications, alongside software guidelines for implementation in SPSS, R, and STATA. It highlights the distinctions between these methods, particularly emphasizing the advantages of McDonald's omega over Cronbach's alpha for more accurate reliability estimates. This work aims to fill the gap in existing literature by providing a thorough comparative analysis and practical guidance for researchers seeking to measure internal consistency effectively.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100568"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The surgical time-out, a core component of the WHO Surgical Safety Checklist, was introduced to prevent wrong-site surgery, patient misidentification, and other critical perioperative errors. While its theoretical effectiveness is supported by global data, recent evidence suggests that in many operating rooms, the practice has devolved into a symbolic and perfunctory routine. This commentary explores the gap between intention and real-world implementation, and offers practical, evidence-based strategies to reestablish the time-out as a meaningful safeguard in surgical care.
{"title":"Surgical time-outs: Ritual or real safety practice?","authors":"Seyed Abolfazl Hosseini , Bahador Pourdel , Erfan Rajabi , Amirali Alizadeh","doi":"10.1016/j.pcorm.2025.100573","DOIUrl":"10.1016/j.pcorm.2025.100573","url":null,"abstract":"<div><div>The surgical time-out, a core component of the WHO Surgical Safety Checklist, was introduced to prevent wrong-site surgery, patient misidentification, and other critical perioperative errors. While its theoretical effectiveness is supported by global data, recent evidence suggests that in many operating rooms, the practice has devolved into a symbolic and perfunctory routine. This commentary explores the gap between intention and real-world implementation, and offers practical, evidence-based strategies to reestablish the time-out as a meaningful safeguard in surgical care.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100573"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-12DOI: 10.1016/j.pcorm.2025.100552
Ghada Mohammad AboElfadl , Obey Mohamed Shaker , Ismail Elsaid Eldeeb , Mahmoud Mamdouh Ekram , Ahmad Mohamed Aboelfadl
Background
Optimal post-cesarean analgesia remains challenging. We compared the efficacy of erector spinae plane block (ESB), quadratus lumborum block (QL), and intrathecal morphine (ITM) in a randomized trial.
Methods
Patients undergoing cesarean delivery under spinal anesthesia were randomized to three groups 40 patients each. ITM group (hyperbaric bupivacaine + 150 µg morphine), QL group (ITM + bilateral QL block with 0.25 % bupivacaine + dexamethasone), ESB group (ITM + bilateral ESB block with 0.25 % bupivacaine + dexamethasone). The primary outcome was the time to first rescue analgesia. Secondary outcomes included pain scores (NRS at rest and on movement), the amount of analgesics consumption during the first 24 h following surgery, changes in hemodynamics, side effects, and patient satisfaction.
Results
QLB group provided a significantly longer time to the first analgesic request compared to both ESB and ITM (17.53 ± 1.92 h, 12.63 ± 1.19 h, 8.43 ± 1.13 h respectively), with p < 0.001. QLB group also resulted in a significantly lower number of analgesic doses compared to ITM and ESB groups. Numeric Rating Scale (NRS)pain scores at rest & on movement was significantly lower in the QLB and ESB group at various times compared to ITM. Patient satisfaction was highest in the QLB group.
Conclusion
QL and ESB blocks are superior to ITM alone, with QL potentially offering better visceral analgesia.
{"title":"Comparative analgesic efficacy of erector spinae block, quadratus lumborum block, and intrathecal morphine for post-operative pain relief after cesarean section: A randomized study","authors":"Ghada Mohammad AboElfadl , Obey Mohamed Shaker , Ismail Elsaid Eldeeb , Mahmoud Mamdouh Ekram , Ahmad Mohamed Aboelfadl","doi":"10.1016/j.pcorm.2025.100552","DOIUrl":"10.1016/j.pcorm.2025.100552","url":null,"abstract":"<div><h3>Background</h3><div>Optimal post-cesarean analgesia remains challenging. We compared the efficacy of erector spinae plane block (ESB), quadratus lumborum block (QL), and intrathecal morphine (ITM) in a randomized trial.</div></div><div><h3>Methods</h3><div>Patients undergoing cesarean delivery under spinal anesthesia were randomized to three groups 40 patients each. ITM group (hyperbaric bupivacaine + 150 µg morphine), QL group (ITM + bilateral QL block with 0.25 % bupivacaine + dexamethasone), ESB group (ITM + bilateral ESB block with 0.25 % bupivacaine + dexamethasone). The primary outcome was the time to first rescue analgesia. Secondary outcomes included pain scores (NRS at rest and on movement), the amount of analgesics consumption during the first 24 h following surgery, changes in hemodynamics, side effects, and patient satisfaction.</div></div><div><h3>Results</h3><div>QLB group provided a significantly longer time to the first analgesic request compared to both ESB and ITM (17.53 ± 1.92 h, 12.63 ± 1.19 h, 8.43 ± 1.13 h respectively), with <em>p</em> < 0.001. QLB group also resulted in a significantly lower number of analgesic doses compared to ITM and ESB groups. Numeric Rating Scale (NRS)pain scores at rest & on movement was significantly lower in the QLB and ESB group at various times compared to ITM. Patient satisfaction was highest in the QLB group.</div></div><div><h3>Conclusion</h3><div>QL and ESB blocks are superior to ITM alone, with QL potentially offering better visceral analgesia.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100552"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-22DOI: 10.1016/j.pcorm.2025.100557
Uzodinma Yurriens Ezenduka, Debarati Halder
Background
Indian law recognises refusal of life-sustaining treatment and accepts advance directives. The order of 24 January 2023 sets attestation before a notary or a Gazetted Officer, allows authenticity checks through digital health records or named public custodians, and assigns activation to Primary and Secondary Medical Boards. This study asks whether Karnataka’s 2025 measures supply the required custody route and how hospitals can record cross-district verification within existing law.
Methods
Doctrinal analysis of national rules and Karnataka’s 2025 instruments; review of professional guidance on end-of-life decisions and Do-Not-Attempt-Resuscitation (DNAR); and use of migration data to frame document reach. From these sources, a concise verification workflow and audit checks were derived.
Findings
Karnataka names the Joint Commissioner in each Bruhat Bengaluru Mahanagara Palike zone and the Executive Officer of each taluk panchayat as custodians, and standardises Secondary Medical Boards from existing practitioner pools, with judicial acknowledgment of compliance. A three-channel method suits high mobility: consented access to a personal health record, contact with persons named in the directive, and written confirmation from the identified custodian. The file then carries an authenticity note recording version, attestation, source, and times, plus time-stamped minutes from both Boards. Treating authenticity as reach and version control improves reliability across districts and yields clear audit points, including time to first verified copy and concordance across versions.
Conclusions
Karnataka’s measures answer the custody question in the affirmative and allow verification within the national scheme. With attested directives, named contacts, reachable custodians, DNAR where relevant, and brief reasoned minutes, hospitals can produce a reviewable record that supports timely decisions while respecting autonomy and privacy.
{"title":"Operationalising the right to refuse treatment: karnataka’s 2025 response to the 2023 Order","authors":"Uzodinma Yurriens Ezenduka, Debarati Halder","doi":"10.1016/j.pcorm.2025.100557","DOIUrl":"10.1016/j.pcorm.2025.100557","url":null,"abstract":"<div><h3>Background</h3><div>Indian law recognises refusal of life-sustaining treatment and accepts advance directives. The order of 24 January 2023 sets attestation before a notary or a Gazetted Officer, allows authenticity checks through digital health records or named public custodians, and assigns activation to Primary and Secondary Medical Boards. This study asks whether Karnataka’s 2025 measures supply the required custody route and how hospitals can record cross-district verification within existing law.</div></div><div><h3>Methods</h3><div>Doctrinal analysis of national rules and Karnataka’s 2025 instruments; review of professional guidance on end-of-life decisions and Do-Not-Attempt-Resuscitation (DNAR); and use of migration data to frame document reach. From these sources, a concise verification workflow and audit checks were derived.</div></div><div><h3>Findings</h3><div>Karnataka names the Joint Commissioner in each Bruhat Bengaluru Mahanagara Palike zone and the Executive Officer of each taluk panchayat as custodians, and standardises Secondary Medical Boards from existing practitioner pools, with judicial acknowledgment of compliance. A three-channel method suits high mobility: consented access to a personal health record, contact with persons named in the directive, and written confirmation from the identified custodian. The file then carries an authenticity note recording version, attestation, source, and times, plus time-stamped minutes from both Boards. Treating authenticity as reach and version control improves reliability across districts and yields clear audit points, including time to first verified copy and concordance across versions.</div></div><div><h3>Conclusions</h3><div>Karnataka’s measures answer the custody question in the affirmative and allow verification within the national scheme. With attested directives, named contacts, reachable custodians, DNAR where relevant, and brief reasoned minutes, hospitals can produce a reviewable record that supports timely decisions while respecting autonomy and privacy.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100557"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-18DOI: 10.1016/j.pcorm.2025.100591
Ashkan karimi , Jaber Zabihirad , Behzad Imani , Reza Feizi , Ali Gharahzade , Farzad Abaszadeh , Reza Tavakkol
{"title":"Corrigendum to “Evaluation of patient privacy in perioperative care in the operating room of Be’sat hospital in Hamadan city” [Perioperative Care and Operating Room Management 40 (2025), 100523]","authors":"Ashkan karimi , Jaber Zabihirad , Behzad Imani , Reza Feizi , Ali Gharahzade , Farzad Abaszadeh , Reza Tavakkol","doi":"10.1016/j.pcorm.2025.100591","DOIUrl":"10.1016/j.pcorm.2025.100591","url":null,"abstract":"","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100591"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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