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Amraoui J, Bordenave L, Leclerc G, Salvignol G, Jarlier M, Fiess C, Philibert L, Fuzier R, Touraine C. Benefits of cardiac coherence combined with medical hypnosis on preoperative anxiety before cancer surgery: the COHEC II study trial protocol. BMJ Open 2023; 13:e072215. [PMID: 38086587 PMCID: PMC10729073 DOI: 10.1136/bmjopen-2023-072215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Preoperative anxiety is a frequent problem that can lead to complications both during anaesthesia and in the postoperative period, especially in oncology. Studies have shown that it can be managed using non-pharmacological approaches, but few works have evaluated psychoeducational programmes. The aim of the COHErence Cardiaque (COHEC) II Study is to evaluate the combination of medical hypnosis (MH) and cardiac coherence (CC) training to manage preoperative anxiety in patients with cancer. METHODS AND ANALYSIS COHEC II is an ongoing multicentre randomised clinical trial carried out in three French comprehensive cancer centres. In total, 296 patients who will undergo surgery for cancer will be recruited during 18 months and will be randomised in the control arm or the intervention arm. Patients in the intervention arm will follow a daily programme that combines MH and CC, starting 7 days before surgery. The control arm will receive the standard treatment to manage preoperative anxiety. The primary endpoint is the anxiety level on surgery day, measured using a Visual Analogue Scale. Secondary endpoints are patient adherence to the programme, satisfaction and postsurgery recovery quality. ETHICS AND DISSEMINATION The study protocol was approved by the French Ethics Committee (Comité de Protection des Personnes EST-II) on 24 November 2021 and will be carried out following the good practice guidelines and the Declaration of Helsinki. Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT05197972.
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Affiliation(s)
- Jibba Amraoui
- Department of Anaesthesia, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Gilles Leclerc
- Department of Anaesthesia, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Marta Jarlier
- Biometrics Unit, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - Catherine Fiess
- Clinical Research and Innovation Department, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - Laurent Philibert
- Department of Pharmacy, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Célia Touraine
- Biometrics Unit, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
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Li J, Qian Y, Lei Y, Huo W, Xu M, Zhang Y, Ji Q, Yang J, Liu H, Hou Y. Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial. BMJ Open 2023; 13:e066541. [PMID: 38011975 PMCID: PMC10685955 DOI: 10.1136/bmjopen-2022-066541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To compare the modified strategy for the right-sided double-lumen tube (R-DLT) placement using a combination of CT measurements and flexible video bronchoscopy guidance with traditional bronchoscopy technique. TRIAL DESIGN, SETTING AND PARTICIPANTS Double-blind, parallel randomised control trial at a tertiary care medical centre in China. 100 patients undergoing video-assisted thoracoscopic surgery and requiring R-DLT were randomly allocated to the control group and the intervention group. INTERVENTION The control group used the traditional bronchoscopy-guided technique. In the intervention group, the length and anteroposterior diameter of the right main bronchus (RMB) were measured on CT images to select the side and size of the Rüsch tube, and then a black depth marker was placed on the tube according to the difference between the length of the RMB and the bronchial cuff. Under the guidance of bronchoscopy, the depth marker should be placed parallel to the tracheal carina and a characteristic white line on the tube should be parallel to the midline of the tracheal carina. MAIN OUTCOMES The primary endpoint was the positioning of right upper lobe (RUL) ventilatory slot and RUL bronchial orifice. The secondary endpoints included intubation data and perioperative adverse events. RESULTS Compared with the control group, our modified strategy significantly increased the optimal and acceptable position rate (76% vs 98%, respectively; p<0.039), decreased the replacement rate (80% vs 94%; p=0.042), shortened the intubation time (101.4±7.3 s vs 75.2±8.1 s; p=0.019) and reduced the incidence of transient hypoxaemia (25% vs 6%; p=0.022), subglottic resistance (20% vs 6%; p=0.037), tracheobronchial injury (35% vs 13%; p=0.037) and postoperative RUL collapse (15% vs 2%; p=0.059). CONCLUSION This study demonstrates the superiority of our strategy and provides a new viable method for R-DLT placement. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900021676).
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Affiliation(s)
- Jian Li
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Yingcong Qian
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Yishan Lei
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wenwen Huo
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Mingzhu Xu
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Yuanyuan Zhang
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Qiuyuan Ji
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Jianping Yang
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Huayue Liu
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yongheng Hou
- Departments of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Departments of Anaesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
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Ji W, Zhang X, Sun G, Wang X, Liu J, Bian J, Bo L. Effect of perioperative intravenous lidocaine on postoperative outcomes in patients undergoing resection of colorectal cancer: a protocol for systematic review and meta-analysis. BMJ Open 2021; 11:e048803. [PMID: 34426465 PMCID: PMC8383864 DOI: 10.1136/bmjopen-2021-048803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Techniques using local anaesthetics provide high-quality analgesia, while the anti-inflammatory properties of these drugs may represent an additional advantage. Perioperative intravenous lidocaine has shown positive effects not only on postoperative pain but also on bowel function and duration of hospital stay, due to its analgesic, anti-inflammatory and opioid-sparing effects. However, these potential benefits are not well established in patients undergoing resection with colorectal cancer. This research aims to determine the effect of perioperative intravenous lidocaine on postoperative outcomes in patients undergoing resection of colorectal cancer. METHODS AND ANALYSIS PubMed, Embase, Web of Science, CNKI, SinoMed and WanFang Data databases were electronically retrieved to include the randomised controlled trials comparing perioperative intravenous lidocaine with placebo infusion in patients undergoing resection of colorectal cancer before August 2021. Registers of clinical trials, potential grey literature and abstracts from conferences will also be searched. Two reviewers will screen literature, extract data and assess risk of bias of studies included independently. The primary outcome variable will be long-term survival outcome, tumour recurrence and metastasis rate, and restoration of intestinal function. The secondary outcome variables will consist of the severity of postoperative pain at 4, 12, 24 and 48 hours after surgery, the incidence of postoperative nausea and vomiting, and the length of hospital stay. A meta-analysis will be performed using RevMan V.5.4 software provided by the Cochrane Collaboration and Stata V.12.0. subgroup and sensitivity analyses will be conducted. ETHICS AND DISSEMINATION Because the data used for this systematic review will be exclusively extracted from published studies, ethical approval and informed consent of patients will not be required. The systematic review will be published in a peer-reviewed journal, presented at conferences and shared on social media platforms. PROSPERO REGISTRATION NUMBER CRD42020216232.
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Affiliation(s)
- Wentao Ji
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Xiaoting Zhang
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Guolin Sun
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Xiandong Wang
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Jia Liu
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Jinjun Bian
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Shanghai, China
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Sakamaki K, Watanabe K, Woo T, Masuda M. Multicentre randomised phase II study of the perioperative administration of flurbiprofen axetil in patients with non-small cell lung cancer: study protocol of the FLAX Study. BMJ Open 2020; 10:e040969. [PMID: 33257489 PMCID: PMC7705564 DOI: 10.1136/bmjopen-2020-040969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In patients with non-small cell lung cancer, surgical treatment with postoperative adjuvant chemotherapy is performed. However, the improvement of overall survival achieved by postoperative adjuvant chemotherapy may be insufficient in consideration of the deterioration of quality of life (QOL). Considering the relationships among surgical treatments, inflammation and carcinogenesis, non-steroidal anti-inflammatory drugs (NSAIDs) are a candidate postoperative treatment for preventing recurrence and maintaining QOL. In this study, we investigate the effects of the perioperative administration of flurbiprofen axetil on postoperative recurrence in patients with non-small cell lung cancer. METHODS AND ANALYSIS This study is a multicentre, parallel group, open label, randomised controlled trial. Patients clinically suspected of non-small cell lung cancer are randomly assigned to the flurbiprofen axetil group or the no-NSAIDs group. A total of 420 patients (210 per group) will be registered. The primary analysis will evaluate the treatment effect of flurbiprofen axetil on postoperative recurrence. ETHICS AND DISSEMINATION The study protocol was approved by the Clinical Research Review Board of Saitama Medical University in September 2019 (No. 192002) and will be approved by each institutional review board of all participating institutions before patient enrolment. This study complies with the latest version of the Declaration of Helsinki, Clinical Trial Act and related notifications. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Japan Registry of Clinical Trials (jRCTs031190167; Pre-results) (https://jrct.niph.go.jp/).
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Affiliation(s)
- Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Katsuya Watanabe
- General Thoracic Surgery, National Hospital Organisation Yokohama Medical Center, Yokohama, Japan
| | - Tetsukan Woo
- Respiratory Center, Yokohama City University Medical Center, Yokohama, Japan
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Wang S, Zhang Q, Chen L, Liu G, Liu PF. Thromboelastography-guided blood transfusion during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: study protocol for a prospective randomised controlled trial. BMJ Open 2020; 10:e042741. [PMID: 33184089 PMCID: PMC7662436 DOI: 10.1136/bmjopen-2020-042741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a well-established treatment for peritoneal cancer (PC). However, this kind of combination therapy is associated with a high incidence of complications. Moreover, relative studies have indicated that traditional laboratory testing is insufficient to demonstrate the overall haemostatic physiology of CRS/HIPEC. Thromboelastography (TEG), administered by monitoring dynamic changes in haemostasis, has been shown to contribute to reducing transfusion requirements and improving survival. However, there is no evidence to verify whether TEG can be applied to guide transfusion strategies during CRS/HIPEC. Therefore, we aim to investigate whether TEG-guided blood product transfusion (TEG-BT) therapy is superior to traditional blood product transfusion (T-BT) therapy for guiding perioperative blood transfusion treatment and improving the prognosis of patients undergoing CRS/HIPEC. METHODS AND ANALYSIS The TEG-BT versus T-BT study is a single-centre, randomised, blinded outcome assessment clinical trial of 162 patients with PC, aged 18-64 years and undergoing CRS/HIPEC. Participants will be randomly allocated to receive TEG-BT or T-BT. The primary outcome will be the evaluation of perioperative blood transfusion, which refers to the total amount of blood transfusion given from the time patients enter the operating room up to 72 hours postoperatively. The secondary outcomes will include the transfusion volume during surgery, total amount of intraoperative infusion, amount of blood lost during the operation, total blood transfusion between 0 and 72 hours after surgery, lowest haemoglobin level within 72 hours after surgery, intensive care unit duration, overall length of stay, total cost of hospitalisation and adverse events. Data will be analysed according to the intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol has been approved by the Scientific Research Ethics Committee of Beijing Shijitan Hospital Affiliated with Capital Medical University (Approval Number: sjtkyll-lx-2020-3). The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2000028835).
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Affiliation(s)
- Shaoheng Wang
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qing Zhang
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Linfeng Chen
- Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Peng Fei Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Abstract
OBJECTIVES Whether epidural analgesia affects cancer outcomes remains controversial. Most previous investigations ignored the confounding potential of important pathological factors on cancer outcomes. This study aimed to assess the association between epidural analgesia and cancer recurrence or death after resections for colon cancer. DESIGN Retrospective cohort study. SETTING A single-medical centre in Taiwan. PARTICIPANTS Patients with stage I through III colon cancer undergoing bowel resection and receiving either epidural analgesia or intravenous opioid analgesia from 2005 to 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was postoperative recurrence-free survival and secondary outcome was overall survival. RESULTS A total of 2748 and 1218 patients were analysed before and after propensity score matching. Cox regression analyses did not demonstrate any association between epidural analgesia and recurrence or death after matching (HR 0.89, 95% CI 0.65 to 1.21 for recurrence; 0.72, 95% CI 0.48 to 1.09 for death). Independent prognostic factors for cancer recurrence and death were higher level of preoperative carcinoembryonic antigen, perioperative blood transfusion, advanced cancer stage and pathological lymphovascular invasion. CONCLUSIONS No definite association was found between epidural analgesia and risk of recurrence or death in patients undergoing colon cancer resection.
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Affiliation(s)
- Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mercedes Susan Mandell
- Department of Anesthesiology, University of Colorado Health Sciences Center, Aurora, Colorado, United States
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Haur Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University Hospital, Ilan, Taiwan
| | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Yang J, Xu G, Yin Z, Cheng Y, Sun SM, Zheng Q, Chen J, Liang FR, Zhao L. Acupuncture for chronic cancer-related pain: a systematic review and network meta-analysis protocol. BMJ Open 2020; 10:e039087. [PMID: 33033027 PMCID: PMC7542929 DOI: 10.1136/bmjopen-2020-039087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Chronic cancer-related pain is one of the most common excruciating symptom that can be caused by the cancer (by the primary tumour or by metastases) or by its treatment (surgery, chemotherapy and radiotherapy). Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating chronic cancer-related pain, the comparative efficacy and safety of these acupuncture methods remains unclear. We, therefore, performed this study to evaluate and rank the efficacy and safety of different acupuncture methods for chronic cancer-related pain. METHODS AND ANALYSIS Seven databases will be searched, including Cochrane Library, MEDLINE, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chongqing VIP Chinese Science and Technology Periodical Database and Chinese Biomedical Literature Database (CBM) from their inception to March 2020. The primary outcome is the change of pain intensity. Bayesian network meta-analysis will be conducted using software R3.5.1. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation System (GRADE) to assess the quality of evidence. ETHICS AND DISSEMINATION Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42020165747.
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Affiliation(s)
- Jiao Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Guixing Xu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zihan Yin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ying Cheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Sheng Ming Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiao Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Pak LM, Haroutounian S, Hawkins WG, Worley L, Kurtz M, Frey K, Karanikolas M, Swarm RA, Bottros MM. Epidurals in Pancreatic Resection Outcomes (E-PRO) study: protocol for a randomised controlled trial. BMJ Open 2018; 8:e018787. [PMID: 29374667 PMCID: PMC5829652 DOI: 10.1136/bmjopen-2017-018787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Epidural analgesia provides an important synergistic method of pain control. In addition to reducing perioperative opioid consumption, the deliverance of analgesia into the epidural space, effectively creating a sympathetic blockade, has a multitude of additional potential benefits, from decreasing the incidence of postoperative delirium to reducing the development of persistent postsurgical pain (PPSP). Prior studies have also identified a correlation between the use of epidural analgesia and improved oncological outcomes and survival. The aim of this study is to evaluate the effect of epidural analgesia in pancreatic operations on immediate postoperative outcomes, the development of PPSP and oncological outcomes in a prospective, single-blind, randomised controlled trial. METHODS The Epidurals in Pancreatic Resection Outcomes (E-PRO) study is a prospective, single-centre, randomised controlled trial. 150 patients undergoing either pancreaticoduodenectomy or distal pancreatectomy will be randomised to receive an epidural bupivacaine infusion following anaesthetic induction followed by continued epidural bupivacaine infusion postoperatively in addition to the institutional standardised pain regimen of hydromorphone patient-controlled analgesia (PCA), acetaminophen and ketorolac (intervention group) or no epidural infusion and only the standardised postoperative pain regimen (control group). The primary outcome was the postoperative opioid consumption, measured in morphine or morphine-equivalents. Secondary outcomes include patient-reported postoperative pain numerical rating scores, trend and relative ratios of serum inflammatory markers (interleukin (IL)-1β, IL-6, tumour necrosis factor-α, IL-10), occurrence of postoperative delirium, development of PPSP as determined by quantitative sensory testing, and disease-free and overall survival. ETHICS AND DISSEMINATION The E-PRO trial has been approved by the institutional review board. Recruitment began in May 2016 and will continue until the end of May 2018. Dissemination plans include presentations at scientific conferences and scientific publications. TRIAL REGISTRATION NUMBER NCT02681796.
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Affiliation(s)
- Linda Ma Pak
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Division of Pain Management, Washington University School of Medicine, St. Louis, Missouri, USA
| | - William G Hawkins
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri, USA
| | - Lori Worley
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri, USA
| | - Monika Kurtz
- Department of Anesthesiology, Division of Pain Management, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Karen Frey
- Department of Anesthesiology, Division of Pain Management, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Menelaos Karanikolas
- Department of Anesthesiology, Division of Pain Management, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert A Swarm
- Department of Anesthesiology, Division of Pain Management, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael M Bottros
- Department of Anesthesiology, Division of Pain Management, Washington University School of Medicine, St. Louis, Missouri, USA
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Zhang Y, Li HJ, Wang DX, Jia HQ, Sun XD, Pan LH, Ye QS, Ouyang W, Jia Z, Zhang FX, Guo YQ, Ai YQ, Zhao BJ, Yang XD, Zhang QG, Yin N, Tan HY, Liu ZH, Yu JB, Ma D. Impact of inhalational versus intravenous anaesthesia on early delirium and long-term survival in elderly patients after cancer surgery: study protocol of a multicentre, open-label, and randomised controlled trial. BMJ Open 2017; 7:e018607. [PMID: 29187413 PMCID: PMC5719291 DOI: 10.1136/bmjopen-2017-018607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Elderly patients who have solid organ cancer often receive surgery. Some of them may develop delirium after surgery and delirium development is associated with worse outcomes. Furthermore, despite all of the advances in medical care, the long-term survival in cancer patients is far from optimal. Evidences suggest that choice of anaesthetics during surgery, that is, either inhalational or intravenous anaesthetics, may influence outcomes. However, the impact of general anaesthesia type on the occurrence of postoperative delirium is inconclusive. Although retrospective studies suggest that propofol-based intravenous anaesthesia was associated with longer survival after cancer surgery when compared with inhalational anaesthesia, prospective studies as such are still lacking. The purposes of this randomised controlled trial are to test the hypotheses that when compared with sevoflurane-based inhalational anaesthesia, propofol-based intravenous anaesthesia may reduce the incidence of early delirium and prolong long-term survival in elderly patients after major cancer surgery. METHODS AND ANALYSIS This is a multicentre, open-label, randomised controlled trial with two parallel arms. 1200 elderly patients (≥65 years but <90 years) who are scheduled to undergo major cancer surgery (with predicted duration ≥2 hours) are randomised to receive either sevoflurane-based inhalational anaesthesia or propofol-based intravenous anaesthesia. Other anaesthetics and supplemental drugs including sedatives, opioids and muscle relaxants are administered in both arms according to routine practice. The primary early outcome is the incidence of 7-day delirium after surgery and the primary long-term outcome is the duration of 3-year survival after surgery. ETHICS AND DISSEMINATION The study protocol has been approved by the Clinical Research Ethics Committees of Peking University First Hospital (2015[869]) and all participating centres. The results of early and long-term outcomes will be analysed and reported separately. TRIAL REGISTRATION NUMBER ChiCTR-IPR-15006209; NCT02662257; NCT02660411.
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Affiliation(s)
- Yue Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Hui-Juan Li
- Project Development and Project Management Department, Peking University Clinical Research Institute, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Hui-Qun Jia
- Department of Anesthesiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xu-De Sun
- Department of Anesthesiology, Tang-Du Hospital Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Ling-Hui Pan
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Qing-Shan Ye
- Department of Anesthesiology, Ningxia People’s Hospital, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Zhen Jia
- Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Fang-Xiang Zhang
- Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Yong-Qing Guo
- Department of Anesthesiology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Yan-Qiu Ai
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bin-Jiang Zhao
- Department of Anesthesiology, Beijing Shijitan Hospital, Beijing, China
| | - Xu-Dong Yang
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Qin-Gong Zhang
- Department of Anesthesiology, Shanxi Provincial Cancer Hospital, Taiyuan, Shanxi, China
| | - Ning Yin
- Department of Anesthesiology, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China
| | - Hong-Yu Tan
- Department of Anesthesiology, Peking University Cancer Hospital&Institute, Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education), Beijing, Beijing, China
| | - Zhi-Heng Liu
- Department of Anesthesiology, Shenzhen Second People’s Hospital, Shenzhen, Guangzhou, China
| | - Jian-Bo Yu
- Department of Anesthesiology, Tianjin Nankai Hospital, Tianjin, China
| | - Daqing Ma
- Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care Section, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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