Abstract 1 - DASAIM · 3 Abstract 9 Korresponderende forfatter Ask Tybjærg Nordestgaard Afdeling...
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1 FOREDRAGSKONKURRENCE Abstract 1 Korresponderende forfaer Chrisan Kruse Hansen Afdeling Anæstesiologisk Afdeling Hospital/instuon Sjællands Universitetshospital, Roskilde Medforfaere Mee Dam, Thomas Bendtsen, Jens Børglum Titel Ultrasound-guided Transmuscular Quadratus Lumborum block for Elecve Cesarean Secon significantly reduces postoperave opioid consumpon. A double blind randomized, controlled trial Introducon The new mother should take opmal care of the newborn with the lowest level of pain and the least adverse events from postoperave opioids aſter Elecve Cesarean Secon (ECS). A retrospecve survey revealed a vast opioid co- sumpon despite a mulmodal pain regimen. We aimed to invesgate the efficacy of bilateral Ultrasound-guided (USG) Transmuscular Quadratus Lumborum (TQL) block on postoperave opioid consumpon following ECS compared to placebo. Methods A randomised controlled and double blind trial was conducted. Seventy-two parturients were included. ECS was conducted under spinal anaesthesia including 2.5 µg sufentanil. Parcipants received bilateral TQL block with 2 x 30 ml ropivacaine 0.375% (Group-RO) or Saline (Group-SA) immediately aſter surgery. Morphine consumpon was recorded via PCA-pumps and electronic paent-files. Injectate was deposited in the plane between the QL and psoas major muscles, posterior to the transversalis fascia (Figure 1). Study was approved by Ethics Commiee, Danish Medicines Agency & Data Protecon Agency and monitored by GCP-unit. EudraCT-number 2016-004594-41, Clinical- Trials.gov ID: NCT03068260. Results We found stascally significant and clinically relevant reducon of opioid consumpon at all 6-hour-intervals unl 24 hours postoperavely. Aſter 24 postoperave hours, the mean difference between groups was 29 mg oral morp- hine equivalents. (Confidence interval (CI): 3-55, p-value<0.04). Group-RO paents experienced prolonged me to first opioid compared to Group-SA (Figure 2) (p<0.005). Three out of 34 Group RO-paents did not receive any opioi- ds at all. Pain NRS score maximum was significantly reduced in Group-RO paents at 0-6 hours (p<0.005). PONV was reduced in Group-RO (3/34) vs. Group-SA (9/34). None of the parcipants experienced lower limb or bladder paraly- sis, nor detectable affecon of hemodynamics. Discussion Bilateral TQL block resulted in significant reducon in opioid consumpon in paents undergoing ECS during the first 24 postoperave hours, a significant prolongaon of me to first opioid and a significant reducon in pain NRS sco- res during the first six postoperave hours. Importantly, none of the 72 parcipants experienced lower limb or blad- der paralysis, nor hemodynamic instability or signs of LA systemic toxicity. The few adverse events described by the parcipants were all related to the administraon of opioids. With the TQL block, LA spreads cephalad into the TPVS through the diaphragmac openings to reach and anaesthese the thoracic segmental nerves and segmental parts of the thoracic sympathec trunk. Below the diaphragm, LA exerts its’ direct effect by anaesthesing the ilioinguinal, iliohypogastric and subcostal nerves, and to some extent the genitofemoral and lateral femoral cutaneous nerves. Conclusions Morphine consumpon was significantly reduced at a clinically relevant level unl 24 postoperave hours.
Transcript of Abstract 1 - DASAIM · 3 Abstract 9 Korresponderende forfatter Ask Tybjærg Nordestgaard Afdeling...
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FOREDRAGSKONKURRENCE
Abstract 1
Korresponderende forfatter ChristianKruseHansenAfdeling AnæstesiologiskAfdelingHospital/institution SjællandsUniversitetshospital,RoskildeMedforfattere MetteDam,ThomasBendtsen,JensBørglumTitel Ultrasound-guidedTransmuscularQuadratusLumborumblockforElectiveCesarean Sectionsignificantlyreducespostoperativeopioidconsumption. Adoubleblindrandomized,controlledtrial
IntroductionThenewmothershouldtakeoptimalcareofthenewbornwiththelowestlevelofpainandtheleastadverseeventsfrompostoperativeopioidsafterElectiveCesareanSection(ECS).Aretrospectivesurveyrevealedavastopioidco-sumptiondespiteamultimodalpainregimen.WeaimedtoinvestigatetheefficacyofbilateralUltrasound-guided(USG)TransmuscularQuadratusLumborum(TQL)blockonpostoperativeopioidconsumptionfollowingECScomparedtoplacebo.
MethodsArandomisedcontrolledanddoubleblindtrialwasconducted.Seventy-twoparturientswereincluded.ECSwasconductedunderspinalanaesthesiaincluding2.5µgsufentanil.ParticipantsreceivedbilateralTQLblockwith2x30mlropivacaine0.375%(Group-RO)orSaline(Group-SA)immediatelyaftersurgery.MorphineconsumptionwasrecordedviaPCA-pumpsandelectronicpatient-files.InjectatewasdepositedintheplanebetweentheQLandpsoasmajormuscles,posteriortothetransversalisfascia(Figure1).StudywasapprovedbyEthicsCommittee,DanishMedicinesAgency&DataProtectionAgencyandmonitoredbyGCP-unit.EudraCT-number2016-004594-41,Clinical-Trials.govID:NCT03068260.
ResultsWefoundstatisticallysignificantandclinicallyrelevantreductionofopioidconsumptionatall6-hour-intervalsuntil24hourspostoperatively.After24postoperativehours,themeandifferencebetweengroupswas29mgoralmorp-hineequivalents.(Confidenceinterval(CI):3-55,p-value<0.04).Group-ROpatientsexperiencedprolongedtimetofirstopioidcomparedtoGroup-SA(Figure2)(p<0.005).Threeoutof34GroupRO-patientsdidnotreceiveanyopioi-dsatall.PainNRSscoremaximumwassignificantlyreducedinGroup-ROpatientsat0-6hours(p<0.005).PONVwasreducedinGroup-RO(3/34)vs.Group-SA(9/34).Noneoftheparticipantsexperiencedlowerlimborbladderparaly-sis,nordetectableaffectionofhemodynamics.
DiscussionBilateralTQLblockresultedinsignificantreductioninopioidconsumptioninpatientsundergoingECSduringthefirst24postoperativehours,asignificantprolongationoftimetofirstopioidandasignificantreductioninpainNRSsco-resduringthefirstsixpostoperativehours.Importantly,noneofthe72participantsexperiencedlowerlimborblad-derparalysis,norhemodynamicinstabilityorsignsofLAsystemictoxicity.Thefewadverseeventsdescribedbytheparticipantswereallrelatedtotheadministrationofopioids.WiththeTQLblock,LAspreadscephaladintotheTPVSthroughthediaphragmaticopeningstoreachandanaesthetisethethoracicsegmentalnervesandsegmentalpartsofthethoracicsympathetictrunk.Belowthediaphragm,LAexertsits’directeffectbyanaesthetisingtheilioinguinal,iliohypogastricandsubcostalnerves,andtosomeextentthegenitofemoralandlateralfemoralcutaneousnerves.
ConclusionsMorphineconsumptionwassignificantlyreducedataclinicallyrelevantleveluntil24postoperativehours.
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Korresponderende forfatter AskTybjærgNordestgaardAfdeling Anæstesi4231,HovedOrtoCentretHospital/institution RigshospitaletMedforfattere LarsS.Rasmussen,MartinH.Sillesen,JacobSteinmetz,HaythamKaafarani, GeorgeC.VelmahosTitel RedBloodCellTransfusioninSurgery:TrendsintheUnitedStatesfrom2011to2016
IntroductionBloodtransfusionmaybelife-saving,butaliberalstrategyisnon-superiortoconservativetransfusionstrategiesinmostsettings.1-3Weexaminedwhetherratesofredbloodcelltransfusionsforsurgicaldiseasehaddeclinedfrom2011to2016intheUnitedStates.
MethodsWeincludeddataonallsurgicalsubspecialtiesfromtheAmericanCollegeofSurgeonsNationalSurgicalQualityIm-provementProgramfrom2011to2016.Aredbloodcelltransfusionwasatransfusionofatleastoneunitintraope-rativelyto72hourspostoperatively.First,weexaminedtheratesoftransfusionsoverthestudyperiod.Second,weexaminedtheparalleltrendsinpreoperativeredbloodcelltransfusions,bleedingdisorders,coagulationimbalances,andminimallyinvasiveprocedures.Third,toaccountforchangesinpopulationandprocedurecharacteristics,weusedmultivariablelogisticregressionstoassesswhethertheriskofreceivingredbloodcelltransfusionshaddecli-ned.Finally,wedeterminedtheoccurrenceofintra-andpostoperativemyocardialinfarctionandstroke.
Results4,273,168patientswereincluded.Redbloodcelltransfusionratesdeclinedfrom8.4%(95%confidenceinterval8.3-8.5)in2011to4.6%(4.6-4.7)(pfortrend<0.001)in2016,consistentinallsubspecialties(Figure1).Preoperati-veredbloodcelltransfusionratesandtheprevalenceofbleedingdisordersdecreasedwhilehematocritlevelsandminimallyinvasiveproceduresincreased.Comparedto2011,theadjustedoddsratiosforredbloodcelltransfusionsdecreasedgraduallyfrom0.88(0.86-0.90)in2012to0.51(0.50-0.51)in2016(pfortrend<0.001)(Figure2).Thecorrespondinghazardratiosforintra-andpostoperativemyocardialinfarctionandstrokewere0.96(0.90-1.02)and0.91(0.83-0.99)in2012and1.05(0.99-1.11)and0.99(0.92-1.07)in2016.
Discussion and conclusionRedbloodcelltransfusionsforsurgicaldiseasedeclinedfrom2011to2016intheUnitedStates.Thiswasconsistentinallsurgicalsubspecialties,andwhenaccountingforvariationinpopulationandprocedurescharacteristics.Weobservednoincreaseintheriskofintra-andpostoperativeischemicoutcomesduringthestudyperiod.
References1)CarsonJLStanworthSJRoubinianN,etal.Transfusionthresholdsandotherstrategiesforguidingallogeneicredbloodcelltransfusion.TheCochranedatabaseofsystematicreviews.2016;(10):CD0020422)AmericanSocietyofAnesthesiologistsTaskForceonPerioperativeBloodM.Practiceguidelinesforperioperativebloodmanagement:anupdatedreportbytheAmericanSocietyofAnesthesiologistsTaskForceonPerioperativeBloodManagement.Anesthesiology.2015;122:241-75.3)CarsonJLGuyattGHeddleNM,etal.ClinicalPracticeGuidelinesFromtheAABB:RedBloodCellTransfusionThres-holdsandStorage.JAMA.2016;316:2025-35.
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Figure1.Redbloodcelltransfusionrates.
Figure2.Oddsratiosforredbloodcelltransfusionsversus2011.
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Korresponderende forfatter JannieBisgaardAfdeling AnæstesiologiskAfdelingHospital/institution AalborgUniversitetshospital,OdenseUniversitetshospital,OPENOdensePatient dataExplorativeNetworkMedforfattere R.Madsen,L.Dybdahl,MBMortensen,JTLauridsen,AGJensenTitel Humanalbuminversuskrystalloidvedøvreabdominalcancerkirurgi.
Introduktion Vedøvreabdominalkirurgimedetableringafanastomoserersåvelhyper-somhypovolæmiforbundetmedkompli-kationer.Goal-directedtherapy(GDT),væsketerapivejledtafdynamiskeparametre,bliverbredtanvendtindenforanæstesitilhøjrisikoprocedurer.1Metodenerbaseretpåindgiftafvæskebolusvejledtafpulsepressurevariation(PPV)ogslagvolumen(SV),fremforfastinfusionshastighedellervæskebalance.Istudier,derunderstøttereffektenafGDT,harmantypiskanvendtkolloidtilvæskebolus.Deterdogikkeklart,omboluskrystalloideristandtilatforbed-reoutcomeisammegrad.2EffektenafGDTkanmålessomændringeriindexeretsystemiskiltleverance(sDO2I).Denmesenterielleiltleverance(mDO2I)kanmålesviaDopplerflowia.mesentericasuperior.3ViharundersøgteffektenafGDTmedbolusRingerfundin(RF)versusbolushumanalbumin5%(HA)påsDO2IogmDO2I.
Metoder Randomiseretkliniskstudie,godkendtafVidenskabsetiskKomité(S-20130021).60patientertilelektivøvreabdo-minalcancerkirurgiblevinkluderetograndomiserettilentenbolusHAellerRF.AllepatienterblevmonitoreretmedLiDCOplus-systemetidenintraoperativeperiode.VedtegnpåhypoperfusionogPPV>14%gavmanvæskebolus250ml.Ved<10%stigningiSVeftervæskebolusogfortsattegnpåhypoperfusiongavmanvasopressorellerinotropi.Væsketypenvarblindetforalle,undtagendensygeplejerske,deradministreredevæsken.PrimæreendepunktvarændringerisDO2IogmDO2I.Sekundæreendepunktervarændringeriøvrighæmodynamik,væskebalance,transfusi-oner,komplikationerogindlæggelsestidpåintensivoghospital.
Resultater Viinkluderede60patienterframaj2014tiljuni2015.ResultaterneerpræsenteretiTabel1ogFigur1.DervaringenforskelpåsDO2IellermDO2I.Øvrighæmodynamikvarhellerikkesignifikantafficeret,frasetpuls,dervarmarginaltlavereiHA-gruppen.DerblevgivetmerebolusvæskeiRF-gruppen.Dervarikkeforskelpåtransfusionsbehovet,fore-komstenafkomplikationerellerindlæggelsestidpåintensivellerhospital.
Konklusion GDTmedbolusHAgavikkebedresystemiskellermesenterieliltleveranceendbolusmedRF.TrodsmindreindgiftafbolusvæskeHA-gruppen,varderikkeeffektpåantalletafkomplikationerellerindlæggelsestid.VifinderderforikkeanledningtilatanbefaleHAfremforRFvedGDTtiløvreabdominalcancerkirurgi.
Referencer1.CecconiMetal.Clinicalreview:Goal-directedtherapy-whatistheevidenceinsurgicalpatients?Theeffectondifferentriskgroups.CritCare.2013;17:209.2.RaimanMetal.ComparisonofhydroxyethylstarchcolloidswithcrystalloidsforsurgicalpatientsAsystematicreviewandmeta-analysis.EurJAnaesthesiol.2016;33:42.3.IvaturyRRetal.Aprospectiverandomizedstudyofendpointsofresuscitationaftermajortrauma:globaloxygentransportindicesversusorgan-specificgastricmucosalpH.JAmCollSurg1996,183:145.
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Korresponderende forfatter KasperH.ThyboAfdeling AnæstesiologiskafdelingHospital/institution NæstvedSygehusMedforfattere Hägi-PedersenD,DahlJB,WetterslevJ,PedersenNA,OvergaardS,BülowHH, SchrøderH,BjørckJG,MathiesenO;onbehalfofallinvestigatorsTitel ParacetamolandNSAIDincombinationforpostoperativeanalgesiaafterprimaryhip arthroplasty:Therandomised,blinded,parallel4-groupPANSAIDclinicaltrial
IntroductionMultimodalpostoperativeanalgesiaisaleadingprincipleformanagementofacutepostoperativepain.Paracetamolandnon-steroidalanti-inflammatorydrugsarefrequentlyusedbutwithnofirmevidenceofbenefitsandharmsoftheircombination.ThePANSAIDtrial’saimwastoinvestigatetheanalgesicandharmfuleffectsoffourmultimodalanalgesicregimenswithparacetamoland/oribuprofenaftertotalhiparthroplasty.
MethodsPANSAIDwasamulticenter,randomized,blinded,placebo-controlled,trialwith90daysfollow-up[1,2].ParticipantswererandomizedtoGroupA:paracetamol1gandibuprofen400mg;B:paracetamol1gandplacebo;C:ibuprofen400mgandplacebo;orD:paracetamol0.5gandibuprofen200mgq.i.d.for24hourspostoperatively,startingonehourpreoperatively.Theco-primaryoutcomeswere:24-hourspatientcontrolledanalgesiamorphineconsumptioninpairwisecomparisonsbetweenthefourgroups;andproportionofpatientswithoneormoremodifiedseriousad-verseevent(SAEs)within90daysingroupsA,CandD(whoallreceivedibuprofen)combinedversusgroupB(recei-vingparacetamolonly).Theminimalimportantdifferencewassetto10mgmorphine(0-24hpostoperatively).
ResultsAll556patientswereanalyzed.Themedian24-hourmorphineconsumptioningroupA,B,C,andDwas20,36,26,and28mg,respectively.Mediandifferencewas16mg(99.6%CI:6.5to24,P<0.001)betweengroupAandB;and8mg(99.6%CI:-1to14,P=0.0011)betweengroupBandD,and6mg(99.6%CI:-2to16,P=0.0024)betweengroupAandC.ThedifferencesbetweengroupAandD(8mg(99.6%CI:-2to16,P=0.0051))andgroupBandC(10mg(99.6%CI:-2to16,P=0.0044))werenotstatisticallysignificantadjustedformultiplecomparisonsandtwoco-primaryout-comes.GroupsCandDdidnotdiffersignificantly.TheproportionofpatientswithSAEsingroupsA+C+Dwas15%(97.5%CI:12to20),and11%(97.5%CI:6to18)ingroupB.TherelativeriskofSAEinthegroupsA+C+DcomparedwithgroupBwas1.44(97.5%CI:0.79to2.45,P=0.18).
Discussion and conclusionGroupA(paracetamol1g+ibuprofen400mg)comparedwithgroupB(paracetamol1g)reducedmorphinecon-sumptionmorethantheminimalimportantdifference.Usingibuprofenthefirstpostoperativedaydoesnotstatisti-callysignificantincreasetheproportionofSAEs(Clinicaltrials.govnumber,NCT02571361).
References1.ThyboKH,Hagi-PedersenD,WetterslevJ,etal.PANSAID-PAracetamolandNSAIDincombination:studyprotocolforarandomisedtrial.Trials2017;18:11.2.ThyboKH,JakobsenJC,Hagi-PedersenD,etal.PANSAID-PAracetamolandNSAIDincombination:detailedstatisti-calanalysisplanforarandomised,blinded,parallel,four-groupmulticentreclinicaltrial.Trials2017;18:465.
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Korresponderende forfatter TobiasLyngeraaAfdeling AnæstesiologiskafdelingHospital/institution NordsjællandsHospitalMedforfattere PiaJæger,BoGottschau,BenGraungaard,AnjaRossen-Jørgensen,IbenToftegaard, UlrikGrevstadTitel Analgesiceffectofanadductorcanalblockusingasuture-methodcathetervsa standardperineuralcathetervsasinglebolus:ablinded,randomized,controlled study
Background and AimsWeaimedtoinvestigatetheanalgesiceffectoftwodifferentcathetersforacontinuousadductorcanalblock(ACB)—anewsuture-methodcatheterandastandardperineuralcatheter—comparedwithasinglebolusACB.
MethodsWeperformedarandomized,blinded,controlledstudy,includingadultpatientsscheduledforprimarykneearthrop-lastywithspinalanesthesia.AllpatientsreceivedanACBwithaninitialbolusof20ml0.75%ropivacaine,followedbynobolus(singlebolusgroup)or20mlof0.2%ropivacaineevery8hours(standardandsuture-methodcathetergroups).Theprimaryoutcomewastotalopioidconsumptionfromendofsurgeryuntilpostoperativeday(POD)2.Secondaryoutcomeswerepainscores,musclestrengthandambulation.EthicsCommitteesapproval:H-17001589.Clinicaltrial.gov.ID:NCT03142789.
ResultsWerandomized153patientsofwhom153wereanalyzed.TotalopioidconsumptiononPOD2wasamedian(ran-ge)of37mg(0–158)inthesinglebolusgroup,38mg(0–123)inthestandardgroupand24mg(0–148)inthesu-ture-methodgroup(P=0.049),buttherewerenostatisticallysignificantdifferencesintheindividualanalysesafterBonferronicorrection(α=0.05/3).TherewerenodifferencesbetweengroupsonPOD1.OnPOD2therewerenodifferencesbetweenthecathetergroups,butambulationandmusclestrengthwereimprovedcomparedwiththebolusgroup(P<0.05/18,table1).
ConclusionsProvidingrepeatedbolusesviaacatheterdidnotdecreaseopioidconsumptionorpaincomparedwithasinglebolus,butdidimproveambulationandmusclestrengthonPOD2.Therewerenostatisticallysignificantdifferencesbet-weenthetwotypesofcatheters.
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Abstract2
Korresponderende forfatter MetteDamAfdeling AnæstesiologiskafdHospital/institution SjællandsuniversitetshospitalRoskildeMedforfattere HansenCK,PoulsenTD,AzawiNHM,WolmaransM,ChanV,LaierGH,BendtsenTF, BørglumJTitel UnilateralTransmuscularQuadratusLumborum(TQL)blockreducesopioid consumptionandfacilitatesearlydischargefromhospitalafterpercutaneous operationforlargekidneystones;Adouble-blindRCT
BackgroundPercutaneousNephrolithotomy(PNL)surgeryisoftenassociatedwithseverepostoperativepain.Theaimofthecurrentstudywastoinvestigatetheanalgesicefficacyoftransmuscularquadratuslumborum(TQL)blockforpatientsundergoingPNLsurgery.
MethodsApprovedbyRegionalEthicsCommittee&DanishMedicineAgency.RegisteredatClinicalTrialsNCT02818140.60patientsASA1-3wereenrolledinthestudy.AllpatientsscheduledforelectivePNLundergeneralanaesthesiawithpropofolandremifentanil.Allpatientsreceivedastandardizedmultimodalanalgesicregimeconsistingoforalaceta-minophen1g,dexamethasone4mg&0.25µg/kgsufentanilI.V.30minutespriortoemergence.AllpatientshadaPatientControlledAnalgesic(PCA)pumpinthestudyperiod:thefirst24postoperativehours.PatientswereallocatedtoapreoperativeTQLblockwitheitherropivacaine30ml0.75%or30mlsaline.Primaryoutcome:Morphinecon-sumption0-6postoperativehours.Secondaryoutcomes:Morphineconsumption6-12,12-18,18-24postoperativehours,accumulatedopioidconsumption24hourspostoperatively,timetofirstopioid,ambulationtime,lengthofstay(LOS)Dischargetime.
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ResultsOralmorphineequivalentsadministered0-6hourmean±SD7.5(8.7)vs.90.6(69.9)mg,p<0.0001wassignificantlyreducedintheinterventiongroupcomparedtocontrol.Asignificantreductioninaccumulatedoralmorphineequiva-lentsininterventiongroupfor24hourswasrecorded(Table1).Timetofirstopioidmean±SD647.3(402.7)vs.39.1(23.7)minutes,p<0.0001wassignificantlyprolongedininterven-tiongroup(Figure1),andinterventiongroupwasabletoambulatesignificantlyearliermean±SD365.7(254.5)vs.636.2(366.2)minutes,p<0.004).LOSwassignificantlyshorterintheinterventiongroupmean(days)±SD2.00(0.78)vs3.03(1.25)p=0.001comparedtocontrol.
ConclusionUnilateralTQLblocksignificantlyreducesthepostoperativeopioidconsumptionandfacilitatessignificantlyearlierdischargefromhospital.
Legend Figure 1Kaplan-Meiersurvivalplotoftimetofirstopioid(minutes),definedastimefromT0untilfirstrequestforopioid.
![Abstract 7 - DASAIM · [1] Arendt-Nielsen et al, Sensitization in patients with painful knee osteoarthritis, Pain 2010;149:573-581. [2] Grosu et al, Pain after knee arthroplasty:](https://static.fdocuments.net/doc/165x107/5ee0b227ad6a402d666bd65f/abstract-7-1-arendt-nielsen-et-al-sensitization-in-patients-with-painful-knee.jpg)
