Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2020
Randomized Controlled Trial Comparative StudyComparison of Programmed Intermittent Epidural Boluses With Continuous Epidural Infusion for the Maintenance of Labor Analgesia: A Randomized, Controlled, Double-Blind Study.
What’s so special about Programmed Intermittent Epidural Boluses?
Programmed Intermittent Epidural Bolus (PIEB) techniques have been advocated as an improvement over continuous epidural infusions because of the potential to optimise local anaesthetic spread through the epidural space.
Other studies have suggested that PIEBs result in reduced local anaesthetic consumption, less motor block, fewer instrumental and cesarean deliveries and improved maternal satisfaction – however these have often occured in research environments and with equipment not representative of typical clinical practice.
What did they do?
This Duke University team randomized 120 parturients to epidural ropivacaine 0.1% + fentanyl 2 mcg/mL delivered either as PIEB (6mL q45min) or continuous infusion (8 mL/h). All subjects had access to patient controlled epidural analgesia (PCEA) for breakthrough pain, used as the marker of analgesia efficacy. The study used the commercially-available CADD Solis pump.
And they found...
There was no difference in PCEA volume between groups, or in any secondary outcome (physician interventions, hypotension, pain scores, satisfaction, duration, or delivery mode), EXCEPT for a greater motor block seen with the continuous infusion group (50% vs 28% Bromage < 5).
Bottom-line
This (relatively small) study did not find significant improvement in labor experience or outcome with PIEB using commercially available epidural pumps, although the reduction in motor blockade may
Pause for thought...
The big challenge with identifying benefit from PIEB techniques is that it introduces even more epidural variables (pump type, bolus volume, frequency, concentration & flow rate, lockouts, background infusions...) making it very difficult to compare the conlficting results of PIEB studies.
Read more in the growing Programmed Intermittent Epidural Bolus for Labour Analgesia article collection.
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Anesthesia and analgesia · Feb 2020
Randomized Controlled Trial Comparative StudyProspective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients.
Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. ⋯ The i-gel provided better sealing function than the self-pressurized air-Q supraglottic airway according to the high oropharyngeal leak pressures in elderly patients during general anesthesia. The self-pressurized air-Q supraglottic airway had improved fiberoptic views in elderly patients during general anesthesia.
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Anesthesia and analgesia · Feb 2020
Randomized Controlled Trial Multicenter StudyIntrathecal Drug Delivery Systems for Cancer Pain: An Analysis of a Prospective, Multicenter Product Surveillance Registry.
The safety and efficacy of intrathecal drug delivery systems (IDDSs) for the treatment of cancer-related pain have been demonstrated in randomized controlled clinical trials (RCTs). Despite positive evidence for this therapy, IDDS remains underutilized to treat cancer pain. Real-world registry data augment existing safety and effectiveness data and are presented here to broaden awareness of this therapeutic option, needed for adequate cancer-related pain treatment, and as a viable tool addressing concerns with systemic opioid use. ⋯ Adequate and improved pain control in patients with cancer, even in advanced stages, with concurrent quality of life maintenance is attainable. Results from this large-scale, multicenter, single-group cohort supplement existing RCT data that support IDDS as a safe and effective therapeutic option with a positive benefit-risk ratio in the treatment of cancer pain.