Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.423
Steven González Rosario, Andrea Virginia Ruiz-Ramírez, Lucia Elizabeth Alvarez Palazuelos, Font Britany, Kevin Jose Gonzalez Acevedo, Marilis Charity Gonzalez Santos, Sheila Marie Gonzalez Soto, Lismari Charity Gonzalez Santos
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Fabry disease is an X-linked disorder caused by mutations in the GLA gene, leading to globotriaosylceramide (Gb3) accumulation on the lysosome. Patients experience numerous forms of pain, including evoked and chronic pain. The exact cause of the pain has yet to be entirely understood. Still, the peripheral nervous system, cardiac, renal, sensory, and autonomic ganglion cells are particularly affected by the deposits of Gb3.
Methods
A bioinformatic analysis of likely genes related to and signaling pathways involved in the manifestation of pain in Fabry disease was performed. A literature review on possible physiopathogenesis of pain mechanisms was also carried out.
Results
In the bioinformatic analysis, we identified through the DisGeNET database around 207 genes related to chronic pain, 266 genes in inflammatory pain, and 24 genes in peripheral neuropathic pain. The Venny 2.1 online platform was used to find common genes between these pathologies, identifying around 78 common genes. An interaction network was built on the STRING platform for these 78 genes. The pathways discovered through this analysis include inflammatory mediator regulation of TRP channels, the VEGF pathway, neuroinflammation, and the relationship between COX2 and EGFR. Among the principal explanations for the physiopathogenesis in the literature, the accumulation of Gb3 in the sacral plexus, the activation of the Notch 1 pathway, and the function of ion channels (KCa3.1 channels) are involved in the mechanism of initiation.
Conclusions
This analysis aims to explain unresolved key pathophysiologic features of pain without discarding the possibility of additional genomics factors and providing future investigation opportunities.
{"title":"#35825 Key pathophysiologic pathways implicated in fabry´s pain crises","authors":"Steven González Rosario, Andrea Virginia Ruiz-Ramírez, Lucia Elizabeth Alvarez Palazuelos, Font Britany, Kevin Jose Gonzalez Acevedo, Marilis Charity Gonzalez Santos, Sheila Marie Gonzalez Soto, Lismari Charity Gonzalez Santos","doi":"10.1136/rapm-2023-esra.423","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.423","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Fabry disease is an X-linked disorder caused by mutations in the GLA gene, leading to globotriaosylceramide (Gb3) accumulation on the lysosome. Patients experience numerous forms of pain, including evoked and chronic pain. The exact cause of the pain has yet to be entirely understood. Still, the peripheral nervous system, cardiac, renal, sensory, and autonomic ganglion cells are particularly affected by the deposits of Gb3. <h3>Methods</h3> A bioinformatic analysis of likely genes related to and signaling pathways involved in the manifestation of pain in Fabry disease was performed. A literature review on possible physiopathogenesis of pain mechanisms was also carried out. <h3>Results</h3> In the bioinformatic analysis, we identified through the DisGeNET database around 207 genes related to chronic pain, 266 genes in inflammatory pain, and 24 genes in peripheral neuropathic pain. The Venny 2.1 online platform was used to find common genes between these pathologies, identifying around 78 common genes. An interaction network was built on the STRING platform for these 78 genes. The pathways discovered through this analysis include inflammatory mediator regulation of TRP channels, the VEGF pathway, neuroinflammation, and the relationship between COX2 and EGFR. Among the principal explanations for the physiopathogenesis in the literature, the accumulation of Gb3 in the sacral plexus, the activation of the Notch 1 pathway, and the function of ion channels (KCa3.1 channels) are involved in the mechanism of initiation. <h3>Conclusions</h3> This analysis aims to explain unresolved key pathophysiologic features of pain without discarding the possibility of additional genomics factors and providing future investigation opportunities.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686585","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.418
Stephanie Cheng, Pa Thor, Haoyan Zhong, Andrew Moreno, Miriam Sheetz, Marko Popovic
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Nosocomephobia, a type of PTSD, is an extreme fear of hospitals. Hospital phobia is usually caused by a traumatic hospital experience. If untreated, nosocomephobia can hinder medical care. There is little research on how nosocomephobia affects elective surgery and how acupuncture can help patients cope with it. Using the transactional model of stress and coping, this qualitative case study examines acupuncture’s role in nosocomephobia patients‘ elective surgery appraisal process.
Methods
Individual interviews were conducted with participants to inquire about their nosocomephobia and prior hospital experiences. Six reviewers coded the interview transcripts line-by-line. Reviewers labeled meaningful words, phrases, and sentences and produced over 600 codes. All reviewers discuss and identify themes by grouping similar codes and resolving discrepancies. A thematic analysis was used to develop final themes for this study. The coding process was conducted in Dedoose.
Results
Sophie had avascular necrosis in both hips and suffered PTSD from a previous traumatic event. Intraoperative acupuncture calmed her hospital anxiety, allowing her to have both hips replaced. Olivia has PTSD and a hospital phobia since age 12. Acupuncture reduced her anxiety about a total knee arthroscopy. Thematic analysis showed how nosocomephobia impacted patients‘ views of surgery and distinguished between their unique fear rationale. The transactional model of stress and coping illustrated patients‘ appraisal process from surgery (stressor) to coping (acupuncture) to reappraisal (mental state).
Conclusions
Compared to other hospital visits, surgery can be stressful. Acupuncture is a safe, non-invasive way for nosocomephobia patients to manage preoperative anxiety and undergo elective surgery.
{"title":"#35044 A qualitative analysis of intraoperative acupuncture for nosocomephobia: the unseen patient","authors":"Stephanie Cheng, Pa Thor, Haoyan Zhong, Andrew Moreno, Miriam Sheetz, Marko Popovic","doi":"10.1136/rapm-2023-esra.418","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.418","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Nosocomephobia, a type of PTSD, is an extreme fear of hospitals. Hospital phobia is usually caused by a traumatic hospital experience. If untreated, nosocomephobia can hinder medical care. There is little research on how nosocomephobia affects elective surgery and how acupuncture can help patients cope with it. Using the transactional model of stress and coping, this qualitative case study examines acupuncture’s role in nosocomephobia patients‘ elective surgery appraisal process. <h3>Methods</h3> Individual interviews were conducted with participants to inquire about their nosocomephobia and prior hospital experiences. Six reviewers coded the interview transcripts line-by-line. Reviewers labeled meaningful words, phrases, and sentences and produced over 600 codes. All reviewers discuss and identify themes by grouping similar codes and resolving discrepancies. A thematic analysis was used to develop final themes for this study. The coding process was conducted in Dedoose. <h3>Results</h3> Sophie had avascular necrosis in both hips and suffered PTSD from a previous traumatic event. Intraoperative acupuncture calmed her hospital anxiety, allowing her to have both hips replaced. Olivia has PTSD and a hospital phobia since age 12. Acupuncture reduced her anxiety about a total knee arthroscopy. Thematic analysis showed how nosocomephobia impacted patients‘ views of surgery and distinguished between their unique fear rationale. The transactional model of stress and coping illustrated patients‘ appraisal process from surgery (stressor) to coping (acupuncture) to reappraisal (mental state). <h3>Conclusions</h3> Compared to other hospital visits, surgery can be stressful. Acupuncture is a safe, non-invasive way for nosocomephobia patients to manage preoperative anxiety and undergo elective surgery.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686593","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.389
Natalie Strand
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Over 50% of physicians in the U.S. experience burnout. Burnout is one of the leading causes of reducing workload or leaving medicine altogether. Flexibility can mean flexible work places and/or flexible work times. Flexibility has been shown to help reduce burnout. A recent article revealed that up to 1/3 of newly graduated physicians ranks flexibility as more important than salary. Thus, it is important not only for physician retention, but also recruitment. We designed and implemented an 8 week pilot in an outpatient pain management practice to evaluate the feasibility of a flexible template. Staff were surveyed before and after the pilot.
Methods
An 8 week pilot was designed to alter work templates. Physicians could treat patients one hour earlier or one hour later than the typical start times. They could also see patients over the lunch hour. For some, this resulted in being finished with their work day 2-3 hours earlier than normal. Each physician was allowed to modify their template on the non-teaching procedure calendar only. Surveys were distributed to nursing staff, scheduling staff, and physicians before and after the 8-week pilot.
Results
1. There was no decline in productivity 2. There was no decline in patient experience/quality 3. There was a large increase in physician satisfaction. 4. Physicians reported improvement in self care and wellness
Conclusions
Flexible templates are rarely used in the United States in academic settings. We showed that an interventional pain practice could successfully apply a flexible schedule without affecting productivity or quality of care.
{"title":"#33971 Flexibility pilot in academic pain","authors":"Natalie Strand","doi":"10.1136/rapm-2023-esra.389","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.389","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Over 50% of physicians in the U.S. experience burnout. Burnout is one of the leading causes of reducing workload or leaving medicine altogether. Flexibility can mean flexible work places and/or flexible work times. Flexibility has been shown to help reduce burnout. A recent article revealed that up to 1/3 of newly graduated physicians ranks flexibility as more important than salary. Thus, it is important not only for physician retention, but also recruitment. We designed and implemented an 8 week pilot in an outpatient pain management practice to evaluate the feasibility of a flexible template. Staff were surveyed before and after the pilot. <h3>Methods</h3> An 8 week pilot was designed to alter work templates. Physicians could treat patients one hour earlier or one hour later than the typical start times. They could also see patients over the lunch hour. For some, this resulted in being finished with their work day 2-3 hours earlier than normal. Each physician was allowed to modify their template on the non-teaching procedure calendar only. Surveys were distributed to nursing staff, scheduling staff, and physicians before and after the 8-week pilot. <h3>Results</h3> 1. There was no decline in productivity 2. There was no decline in patient experience/quality 3. There was a large increase in physician satisfaction. 4. Physicians reported improvement in self care and wellness <h3>Conclusions</h3> Flexible templates are rarely used in the United States in academic settings. We showed that an interventional pain practice could successfully apply a flexible schedule without affecting productivity or quality of care.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686999","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}
Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Frailty is a syndrome characterized by multi-system dysfunction and poor stress response, leading to falls, disability, increased morbidity, and mortality. This study aims to determine the prevalence of frailty in elderly patients undergoing spinal anesthesia for lower limb fractures and identify key frailty factors to optimize them preoperatively.
Methods
Over a 4-month period, 64 eligible patients undergoing surgery for fractures due to falls were included. Following informed consent, patients completed a pre-designed questionnaire including socio-demographic information, medical history, and the Tilburg Frailty Indicator (TFI), a validated tool for use in Greece that assesses physical, psychological, and social frailty factors. TFI scores ≥5 indicate frailty (statistical analysis: SPSS 26, p≤0.5).
Results
The mean age was 82.06 ± 9.26 years. Of the participants, 62.5% were female, 76.6% had <9 years of education, 90.6% were retired, 57.8% were married, 42.2% were widowed. 71.9% reported prior falls, while 70.3% feared future falls. 40.6% used ≥5 medications/day, and 21.9% had ≥5 coexisting diseases. According to the TFI, 57.8% of patients were frail. Frailty was significantly associated with older age, lower education level, widowhood, fear of falling, polypharmacy (≥5 medications/day), and multimorbidity.
Conclusions
A considerable proportion of elderly patients with lower limb fractures were identified as frail. It is crucial to implement preoperative interventions on a large scale (e.g., empowerment programs, psychological support, exercise, a healthy diet, and minimizing polypharmacy) to reduce frailty and optimize patient conditions before surgery, in order to promote healthy aging and ensure that patients are in the best possible condition prior to surgery
{"title":"#35997 The prevalence of frailty among elderly undergoing surgery for lower limb fractures under spinal anaesthesia","authors":"Aliki-Danai Souleimani, Christos Exarchos, Panagiota Panagiotou, Paraskevi Mavridou, Frideriki Steliou","doi":"10.1136/rapm-2023-esra.403","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.403","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Frailty is a syndrome characterized by multi-system dysfunction and poor stress response, leading to falls, disability, increased morbidity, and mortality. This study aims to determine the prevalence of frailty in elderly patients undergoing spinal anesthesia for lower limb fractures and identify key frailty factors to optimize them preoperatively. <h3>Methods</h3> Over a 4-month period, 64 eligible patients undergoing surgery for fractures due to falls were included. Following informed consent, patients completed a pre-designed questionnaire including socio-demographic information, medical history, and the Tilburg Frailty Indicator (TFI), a validated tool for use in Greece that assesses physical, psychological, and social frailty factors. TFI scores ≥5 indicate frailty (statistical analysis: SPSS 26, p≤0.5). <h3>Results</h3> The mean age was 82.06 ± 9.26 years. Of the participants, 62.5% were female, 76.6% had <9 years of education, 90.6% were retired, 57.8% were married, 42.2% were widowed. 71.9% reported prior falls, while 70.3% feared future falls. 40.6% used ≥5 medications/day, and 21.9% had ≥5 coexisting diseases. According to the TFI, 57.8% of patients were frail. Frailty was significantly associated with older age, lower education level, widowhood, fear of falling, polypharmacy (≥5 medications/day), and multimorbidity. <h3>Conclusions</h3> A considerable proportion of elderly patients with lower limb fractures were identified as frail. It is crucial to implement preoperative interventions on a large scale (e.g., empowerment programs, psychological support, exercise, a healthy diet, and minimizing polypharmacy) to reduce frailty and optimize patient conditions before surgery, in order to promote healthy aging and ensure that patients are in the best possible condition prior to surgery <h3>Attachment</h3> Ethics Committee Approval.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686532","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}
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Formal Regional Anaesthesia (RA) training in our hospital was established 20 years ago. A survey was conducted on the experience of formal RA training delivered over this period.
Methods
We identified 78 anaesthetists who completed formal RA training at the Nuffield Orthopaedic Centre (NOC), Oxford since 2003. 65 anaesthetists, whose contact details were confirmed, were emailed an anonymous survey via Survey Monkey or Microsoft Forms. Phase 1 spans 2003 – February 2020, before WHO declared Covid-19 Pandemic [February 2023 and included questions concerning the impact of the Covid-19 Pandemic (17- vs 27-questions).
Results
Most respondents identified their main aim in RA training was to gain practical skills. Anaesthetists were most confident in performing single-shot ultrasound guided RA limb blocks and central neuraxial blocks. 81% of those working as consultant anaesthetists (25/31) agreed RA training in Oxford helped secure their desired consultant post. Since Covid-19 Pandemic, a higher level of direct supervision was provided. 76% (16/21) respondents’ RA training was affected, with less clinical exposure and educational events being the main reasons.
Conclusions
Our survey suggested high quality of RA training was provided in a supportive environment, rising to the challenge of Covid-19 Pandemic [2]. Some respondents significantly enhanced their non-technical skills leading to successful career progression. The new 2021 RCoA Training Curriculum emphasizes a wide range of ultrasound guided RA training during stage 2 [3]. It is too early to determine the effect of new curriculum on RA training locally and nationally, which needs further evaluation.
{"title":"#36241 Survey of trainees’ experiences with regional anaesthesia (RA) training programme in a teaching hospital over 20 years: 2003–2023","authors":"Haili Yu, Orlaith McMahon, Samantha Perera, Svetlana Galitzine","doi":"10.1136/rapm-2023-esra.416","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.416","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Formal Regional Anaesthesia (RA) training in our hospital was established 20 years ago. A survey was conducted on the experience of formal RA training delivered over this period. <h3>Methods</h3> We identified 78 anaesthetists who completed formal RA training at the Nuffield Orthopaedic Centre (NOC), Oxford since 2003. 65 anaesthetists, whose contact details were confirmed, were emailed an anonymous survey via Survey Monkey or Microsoft Forms. Phase 1 spans 2003 – February 2020, before WHO declared Covid-19 Pandemic [February 2023 and included questions concerning the impact of the Covid-19 Pandemic (17- vs 27-questions). <h3>Results</h3> Most respondents identified their main aim in RA training was to gain practical skills. Anaesthetists were most confident in performing single-shot ultrasound guided RA limb blocks and central neuraxial blocks. 81% of those working as consultant anaesthetists (25/31) agreed RA training in Oxford helped secure their desired consultant post. Since Covid-19 Pandemic, a higher level of direct supervision was provided. 76% (16/21) respondents’ RA training was affected, with less clinical exposure and educational events being the main reasons. <h3>Conclusions</h3> Our survey suggested high quality of RA training was provided in a supportive environment, rising to the challenge of Covid-19 Pandemic [2]. Some respondents significantly enhanced their non-technical skills leading to successful career progression. The new 2021 RCoA Training Curriculum emphasizes a wide range of ultrasound guided RA training during stage 2 [3]. It is too early to determine the effect of new curriculum on RA training locally and nationally, which needs further evaluation.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686009","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.434
Keable Samuel Nigel, Stolady Daniel, Fox Benjamin, Ivanov Ognyan
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Total Knee Arthroplasty (TKA) remains a painful procedure, requiring a multi-modal analgesic approach. There is a push for day case surgery due to the associated poorer mortality and morbidity that comes with increased length of stay; as well as the greater cost. To facilitate day case TKA, long- acting analgesic strategies such as perineural catheters and modified release opioids are looked upon. Exparel is a long-acting liposomal bupivacaine that has the potential to take the place of these aforementioned techniques. As part of a service improvement project we introduced Exparel in patients receiving a TKA and assessed impact upon length of stay.
Methods
At our hospital patients undergoing elective knee arthroplasty are normally given spinal or general anaesthetic plus a combination of blocks; sub- sartorial +/- anterior-cutaneous nerves of the thigh +/- iPACK, adductor hiatus blocks or posterior surgical infiltration. We substituted 20mls of levobupivacaine for 20mls of Exparel. We then looked at post-operative length of stay.
Results
10 patients undergoing elective total knee arthroplasty received levobupivacaine/Exparel mixture and had an average length of stay of 1.8 days. This is in contrast to our Model Hospital data for 2022/23 which shows an average length of stay of 3.4 days.
Conclusions
The addition of Exparel reduced our average length of stay which is in keeping with a study by Malige et al. We plan to continue the TKA service improvement project in an attempt to find the best analgesic strategy that facilitates same day discharge.
{"title":"#36155 The use of exparel in knee arthroplasty: a service improvement project","authors":"Keable Samuel Nigel, Stolady Daniel, Fox Benjamin, Ivanov Ognyan","doi":"10.1136/rapm-2023-esra.434","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.434","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Total Knee Arthroplasty (TKA) remains a painful procedure, requiring a multi-modal analgesic approach. There is a push for day case surgery due to the associated poorer mortality and morbidity that comes with increased length of stay; as well as the greater cost. To facilitate day case TKA, long- acting analgesic strategies such as perineural catheters and modified release opioids are looked upon. Exparel is a long-acting liposomal bupivacaine that has the potential to take the place of these aforementioned techniques. As part of a service improvement project we introduced Exparel in patients receiving a TKA and assessed impact upon length of stay. <h3>Methods</h3> At our hospital patients undergoing elective knee arthroplasty are normally given spinal or general anaesthetic plus a combination of blocks; sub- sartorial +/- anterior-cutaneous nerves of the thigh +/- iPACK, adductor hiatus blocks or posterior surgical infiltration. We substituted 20mls of levobupivacaine for 20mls of Exparel. We then looked at post-operative length of stay. <h3>Results</h3> 10 patients undergoing elective total knee arthroplasty received levobupivacaine/Exparel mixture and had an average length of stay of 1.8 days. This is in contrast to our Model Hospital data for 2022/23 which shows an average length of stay of 3.4 days. <h3>Conclusions</h3> The addition of Exparel reduced our average length of stay which is in keeping with a study by Malige et al. We plan to continue the TKA service improvement project in an attempt to find the best analgesic strategy that facilitates same day discharge. <h3>Attachment</h3> Exparel – HRA decision tool – not research.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686156","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.429
David Silva Meireles, Alexandrina Jardim Silva, Francisco Valente, Alexandre Carrilho
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Percutaneous vertebroplasty (PV) is a minimally invasive procedure for treating vertebral compression fractures. It may be done simultaneously to several vertebrae and these are often described under general anaesthesia. However, sedoanalgesia can be an effective alternative in cases where anaesthesia poses higher risks.
Methods
A 55-year-old female with osteoporotic vertebral fractures from T11 to L3 with severe chronic lower back pain was proposed for PV. She had a history of autoimmune hepatitis waiting liver transplantation and Crohn’s disease. PV was performed under remifentanil perfusion (0,15mcg/kg/min), midazolam bolus (1mg) and skin infiltration with lidocaine.
Results
The patient remained comfortable with stable vital signs and adequate pain relief. The use of remifentanil and midazolam provided effective sedoanalgesia, allowing successful completion of the five-level vertebroplasty with fast recovery. This case report highlights the feasibility and safety of analgesia of short-acting opioids even when combined with benzodiazepines for vertebroplasty and in patients with advanced chronic liver disease.
Conclusions
Analgesia with remifentanil for procedural sedation may be considered in selected cases, particularly for patients who are not suitable for general anaesthesia or intolerant to other sedatives, such as those with severe chronic liver disease. It may reduce procedure time, improve patient comfort and decrease recovery time.
{"title":"#35939 Taming the tiger: sedation with remifentanil and midazolam for a five level vertebroplasty – a case report","authors":"David Silva Meireles, Alexandrina Jardim Silva, Francisco Valente, Alexandre Carrilho","doi":"10.1136/rapm-2023-esra.429","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.429","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Percutaneous vertebroplasty (PV) is a minimally invasive procedure for treating vertebral compression fractures. It may be done simultaneously to several vertebrae and these are often described under general anaesthesia. However, sedoanalgesia can be an effective alternative in cases where anaesthesia poses higher risks. <h3>Methods</h3> A 55-year-old female with osteoporotic vertebral fractures from T11 to L3 with severe chronic lower back pain was proposed for PV. She had a history of autoimmune hepatitis waiting liver transplantation and Crohn’s disease. PV was performed under remifentanil perfusion (0,15mcg/kg/min), midazolam bolus (1mg) and skin infiltration with lidocaine. <h3>Results</h3> The patient remained comfortable with stable vital signs and adequate pain relief. The use of remifentanil and midazolam provided effective sedoanalgesia, allowing successful completion of the five-level vertebroplasty with fast recovery. This case report highlights the feasibility and safety of analgesia of short-acting opioids even when combined with benzodiazepines for vertebroplasty and in patients with advanced chronic liver disease. <h3>Conclusions</h3> Analgesia with remifentanil for procedural sedation may be considered in selected cases, particularly for patients who are not suitable for general anaesthesia or intolerant to other sedatives, such as those with severe chronic liver disease. It may reduce procedure time, improve patient comfort and decrease recovery time.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686240","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.408
Paul Moody, Drew Weir
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
The importance of regional anaesthesia (RA) training has recently been recognised by changes to the RCoA curriculum. Where previously trainees could finish training without necessarily achieving competency in ‘Plan A’ blocks, the requirement now is to perform these blocks independently and to manage any complications. We surveyed the confidence of current West Midlands anaesthesia trainees in Plan A blocks and explored what barriers are encountered in their training.
Methods
An anonymised survey was emailed to West Midlands anaesthetic trainees recording stage of training, awareness of Plan A blocks, level of experience in these, and barriers to training in RA.
Results
A total of 51 trainees responded. Only 62% were aware of the concept of Plan A blocks. Exposure was greatest for upper limb blocks, and was particularly low for rectus sheath and erector spinae blocks. Almost all senior trainees undertaking advanced training in RA were confident performing blocks independently. This contrasts with only 20% of Stage 3, and no Stage 1-2 trainees. The most common barriers to training were ‘a lack of frequent opportunities’, ‘case mix’, ‘no suitable trainers’ and ‘insufficient access to formal training’.
Conclusions
This survey has highlighted key issues in RA training in this cohort. There is a reassuring improvement in confidence as trainees progress in training, with trainees undertaking advanced training getting more experience and more confidence to practice independently. However, achieving this for all trainees will require focus from trainers within the region including providing more access to training, courses and increasing the frequency of clinical opportunities.
{"title":"#36101 Training in plan A blocks – a regional trainee survey and quality improvement project","authors":"Paul Moody, Drew Weir","doi":"10.1136/rapm-2023-esra.408","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.408","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> The importance of regional anaesthesia (RA) training has recently been recognised by changes to the RCoA curriculum. Where previously trainees could finish training without necessarily achieving competency in ‘Plan A’ blocks, the requirement now is to perform these blocks independently and to manage any complications. We surveyed the confidence of current West Midlands anaesthesia trainees in Plan A blocks and explored what barriers are encountered in their training. <h3>Methods</h3> An anonymised survey was emailed to West Midlands anaesthetic trainees recording stage of training, awareness of Plan A blocks, level of experience in these, and barriers to training in RA. <h3>Results</h3> A total of 51 trainees responded. Only 62% were aware of the concept of Plan A blocks. Exposure was greatest for upper limb blocks, and was particularly low for rectus sheath and erector spinae blocks. Almost all senior trainees undertaking advanced training in RA were confident performing blocks independently. This contrasts with only 20% of Stage 3, and no Stage 1-2 trainees. The most common barriers to training were ‘a lack of frequent opportunities’, ‘case mix’, ‘no suitable trainers’ and ‘insufficient access to formal training’. <h3>Conclusions</h3> This survey has highlighted key issues in RA training in this cohort. There is a reassuring improvement in confidence as trainees progress in training, with trainees undertaking advanced training getting more experience and more confidence to practice independently. However, achieving this for all trainees will require focus from trainers within the region including providing more access to training, courses and increasing the frequency of clinical opportunities.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686397","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}
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Introduction Pruritus is a disabling, irritating sensation common to patients with variable skin and systemic disorders [1]. We describe the case of a young patient with disabling cholestatic pruritus, relived by infusion of naloxone.
Methods
Présentation of case A 34-year-old patient presents with sclerosing cholangitis symptoms that appeared 15 days after neurosurgery for atypical Grade II meningioma; requiring additional radiotherapy which was not done before the onset of cholestasis. initially attached to the phenobarbital prescribed postoperatively but it continued to progress relentlessly. MRI has objective Cholangitis, no inflammatory syndrome, normal Gamma globulins, negative hepatic autoimmune balance sheet. liver biopsy puncture: cholestasis without signs of inflammation, without granulomas. the pruritus is resistant to cholestyramine, ursolvan (at 25 mg/kg/d), and antihistamines. the patient presents with intense pruritus figures 1, 2, with repercussions on her quality of life. In the intensive care unit, she received a Naloxone infusion. Favorable evolution of the symptomatology and relief of the patient from the first hour of infusion without side effects during 48 hours spent in intensive care.
Results
Discussion A stepwise therapeutic approach is recommended for the management of cholestatic itch. Cholestyramine is considered first-line, followed by rifampin, naltrexone [2] The hypothesis that increased central opioidergic tone contributes to the pruritus of cholestasis justifies the treatment of this form of pruritus with opioid antagonists.
Conclusions
Naloxone has relieved the unpleasant sensation that leads to the urge to scratch from cholestatic pruritus, the symptomatic treatment of which is not very effective at the present time
{"title":"#36259 Naloxone infusion for the relief of cholestatic pruritus: presentation of a clinical case","authors":"Karima Bouguerra, Nabil Yahiouche, Mahfoud Djebien","doi":"10.1136/rapm-2023-esra.393","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.393","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Introduction Pruritus is a disabling, irritating sensation common to patients with variable skin and systemic disorders [1]. We describe the case of a young patient with disabling cholestatic pruritus, relived by infusion of naloxone. <h3>Methods</h3> Présentation of case A 34-year-old patient presents with sclerosing cholangitis symptoms that appeared 15 days after neurosurgery for atypical Grade II meningioma; requiring additional radiotherapy which was not done before the onset of cholestasis. initially attached to the phenobarbital prescribed postoperatively but it continued to progress relentlessly. MRI has objective Cholangitis, no inflammatory syndrome, normal Gamma globulins, negative hepatic autoimmune balance sheet. liver biopsy puncture: cholestasis without signs of inflammation, without granulomas. the pruritus is resistant to cholestyramine, ursolvan (at 25 mg/kg/d), and antihistamines. the patient presents with intense pruritus figures 1, 2, with repercussions on her quality of life. In the intensive care unit, she received a Naloxone infusion. Favorable evolution of the symptomatology and relief of the patient from the first hour of infusion without side effects during 48 hours spent in intensive care. <h3>Results</h3> Discussion A stepwise therapeutic approach is recommended for the management of cholestatic itch. Cholestyramine is considered first-line, followed by rifampin, naltrexone [2] The hypothesis that increased central opioidergic tone contributes to the pruritus of cholestasis justifies the treatment of this form of pruritus with opioid antagonists. <h3>Conclusions</h3> Naloxone has relieved the unpleasant sensation that leads to the urge to scratch from cholestatic pruritus, the symptomatic treatment of which is not very effective at the present time","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135687090","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.421
Vasyl Katerenchuk, Afonso Borges de Castro, Idalina Rodrigues
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Pain management for Vertical Rectus Abdominis Musculocutaneous (VRAM) Flap can be challenging due to a large surgical incision. We present a case of a 65-year-old female admitted for correction of recidivate complex uterovaginal prolapse and VRAM Flap. We aim to demonstrate the benefits of combined anesthesia for this type of surgery.
Methods
An epidural catheter was placed at L3/L4 level with an initial bolus of 10ml of 0.75% ropivacaine administered without relevant hemodynamic instability. After induction of total intravenous anesthesia (propofol and remifentanil), 2mg of epidural morphine was administered to spread the analgesia. Another bolus of 7 ml of 0.2% ropivacaine was administered only 5h after. The maintenance dose of remifentanil was low (up to less than 0,05-0,10 mcg/kg/min). Analgesia was complemented with cetorolac 30mg, paracetamol 1g and metamizol 2g. The procedure lasted for 7 hours and at the end, a patient-controlled epidural infusion (PCEA) was connected with 0,1% ropivacaine with a continuous infusion of 5ml/h and 4ml patient-controlled bolus with a lockout of 20min.
Results
Post-operative pain was well controlled, 2 out of 10 (numerical rating scale pain) at rest and movement at 0h and 12h without bolus attempts in the PCEA nor opioid rescue analgesia.
Conclusions
Patient-controlled epidural infusion limited postoperative opioids necessities and their associated side effects while providing controlled analgesia in VRAM flap surgeries.
{"title":"#35961 Combined anesthesia for transabdominal vertical rectus abdominis musculocutaneous flap","authors":"Vasyl Katerenchuk, Afonso Borges de Castro, Idalina Rodrigues","doi":"10.1136/rapm-2023-esra.421","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.421","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Pain management for Vertical Rectus Abdominis Musculocutaneous (VRAM) Flap can be challenging due to a large surgical incision. We present a case of a 65-year-old female admitted for correction of recidivate complex uterovaginal prolapse and VRAM Flap. We aim to demonstrate the benefits of combined anesthesia for this type of surgery. <h3>Methods</h3> An epidural catheter was placed at L3/L4 level with an initial bolus of 10ml of 0.75% ropivacaine administered without relevant hemodynamic instability. After induction of total intravenous anesthesia (propofol and remifentanil), 2mg of epidural morphine was administered to spread the analgesia. Another bolus of 7 ml of 0.2% ropivacaine was administered only 5h after. The maintenance dose of remifentanil was low (up to less than 0,05-0,10 mcg/kg/min). Analgesia was complemented with cetorolac 30mg, paracetamol 1g and metamizol 2g. The procedure lasted for 7 hours and at the end, a patient-controlled epidural infusion (PCEA) was connected with 0,1% ropivacaine with a continuous infusion of 5ml/h and 4ml patient-controlled bolus with a lockout of 20min. <h3>Results</h3> Post-operative pain was well controlled, 2 out of 10 (numerical rating scale pain) at rest and movement at 0h and 12h without bolus attempts in the PCEA nor opioid rescue analgesia. <h3>Conclusions</h3> Patient-controlled epidural infusion limited postoperative opioids necessities and their associated side effects while providing controlled analgesia in VRAM flap surgeries.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686050","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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