Anaesthesia最新文献

{"title":"Erector spinae plane block vs. rectus sheath block.","authors":"Guanyu Yang","doi":"10.1111/anae.16466","DOIUrl":"10.1111/anae.16466","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"216"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandatory training for rare anaesthetic events or mandatory safety preparedness - the beatings will continue until morale improves, or is it time for a carrot and not a stick?","authors":"Tim Murphy","doi":"10.1111/anae.16480","DOIUrl":"10.1111/anae.16480","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"219-220"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of out-of-hours elective surgery: is it worth the risk?","authors":"Emer Scanlon, Hilary Leeson, Nikki Higgins","doi":"10.1111/anae.16458","DOIUrl":"10.1111/anae.16458","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"215"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric ultrasound performance time and difficulty: a prospective observational study.","authors":"Mark G Filipovic, Sascha J Baettig, Monika Hebeisen, Roman Meierhans, Michael T Ganter","doi":"10.1111/anae.16472","DOIUrl":"10.1111/anae.16472","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care gastric ultrasound is an emerging tool in peri-operative practice. However, data on the technical challenges of gastric ultrasound, which are essential for optimised training, remain scarce. We analysed gastric ultrasound examinations performed after basic training to identify factors associated with difficulty.</p><p><strong>Methods: </strong>This was an analysis of data from a prospective observational study evaluating the potential impact of routine pre-operative gastric ultrasound on peri-operative management in adult patients undergoing elective or emergency surgery at a single centre. Before initiation, physicians received extensive structured training with at least 30 supervised gastric sonograms before independent practice. We then used regression models to identify factors associated with deviation from a predefined sonography algorithm, performance time and scan difficulty.</p><p><strong>Results: </strong>Seventy-three trained physicians performed 2003 ultrasound scans. Median (IQR [range]) performance time was 5 (4-6 [1-20]) min, which was achieved after 20-27 scans following structured training. Patient characteristics associated with more difficult and longer duration scans were: increase in BMI per 5 kg.m^-2 (odds ratio (95%CI) 1.57 (1.35-1.83), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.03 (1.02-1.05), p < 0.001 for duration); and male sex (odds ratio (95%CI) 3.31 (2.28-4.88), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.08 (1.04-1.12), p < 0.001, for duration). Trauma surgery (odds ratio (95%CI) 3.26 (1.88-5.68), p < 0.001), ASA physical status of 3 or 4 (odds ratio (95%CI) 1.86 (1.21-2.88), p = 0.0049) and emergency surgery (odds ratio (95%CI) 1.86 (1.20-2.89), p = 0.006) were associated with deviation from the predefined sonography algorithm.</p><p><strong>Discussion: </strong>Approximately 50 scans are required to achieve a baseline performance of 5 min per gastric ultrasound. Future training programmes should focus on patients with obesity, male sex, higher ASA physical status and trauma.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"161-169"},"PeriodicalIF":7.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confounders in anaesthesia-related depression outcomes","authors":"Chi-Jen Hsu, Mei Na Fok, James Cheng-Chung Wei","doi":"10.1111/anae.16557","DOIUrl":"https://doi.org/10.1111/anae.16557","url":null,"abstract":"<p>We read with great interest the study by Ho et al., which provides valuable insights into the long-term effects of anaesthesia choice on postoperative outcomes [<span>1</span>]. However, several potential confounders influencing the link between anaesthetic techniques and postoperative depression were not specifically addressed in the analysis.</p>\u0000<p>First, pre-existing mental health conditions, such as a history of depression or anxiety, are established risk factors for postoperative depression. These conditions may also impact the choice of anaesthesia due to concerns around peri-operative psychological stress [<span>2</span>]. Additionally, socio-economic status, another crucial determinant of health, could confound the relationship between anaesthesia type and depression. Patients with lower socio-economic status may have limited access to certain anaesthesia options or an increased baseline risk of depression, irrespective of surgical factors [<span>3</span>].</p>\u0000<p>Second, chronic pain and the severity of pre-operative pain are important considerations. Over half of surgical patients experience inadequate postoperative pain management. Certain pre-operative psychological interventions can mitigate acute postoperative pain scores and reduce opioid consumption [<span>4</span>]. Social support and living conditions, although unmeasured confounders, also play a significant role. Social isolation and limited support networks are indirectly linked to surgical outcomes through their association with depression, which is itself associated with poorer outcomes [<span>5</span>]. These psychosocial factors may also impact the choice of anaesthesia.</p>\u0000<p>Finally, reliance on ICD-10 codes for diagnosing depression may result in an underestimation of its true incidence, as mental health disorders are frequently underdiagnosed or misclassified in clinical settings. This potential underreporting could distort the observed differences between anaesthesia groups, particularly if diagnostic practices vary among contributing institutions.</p>\u0000<p>To strengthen future research, incorporating validated mental health assessments pre- and post-surgery, as well as collecting data on socio-economic factors and social support networks could provide a more nuanced understanding of anaesthesia's role in postoperative depression. Although the authors used propensity score matching, residual confounding from unobserved variables remains possible. Future research should include these factors to improve validity.</p>\u0000<p>We commend Ho et al. for their contribution and hope our discussion helps in the planning of future research, such as multicentre cohort studies that could include psychosocial factors such as social support and economic status.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"40 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Puncturing the dura: a true clinical benefit or a distraction?","authors":"Annie C. H. Fung, Anna Preston","doi":"10.1111/anae.16555","DOIUrl":"https://doi.org/10.1111/anae.16555","url":null,"abstract":"&lt;p&gt;The comparison of dural puncture epidural (DPE) labour analgesia with other accepted techniques including combined spinal-epidural (CSE) and epidural alone is an interesting and debated topic. The recent paper by Zang et al. attempts to address this and concludes there were no significant differences in the quality of labour analgesia for DPE compared with the CSE technique [&lt;span&gt;1&lt;/span&gt;]. We have concerns regarding the methodology and results of this paper and its clinical significance for DPE-related trials.&lt;/p&gt;\u0000&lt;p&gt;First, the sample size calculation was assumed to detect a reduction in the composite primary outcome from 50% in the CSE group to 22.5% in the DPE group, based on previous calculations published by Chau et al. [&lt;span&gt;2&lt;/span&gt;]. The most effective clinical interventions are, at most, modest in effect size [&lt;span&gt;3&lt;/span&gt;], thus we argue that the authors used an overly optimistic prediction to calculate the minimum required sample size, which was done arbitrarily. A CSE vs. DPE would intuitively be a small effect size, thus using a small sample size would have insufficient power to evaluate this. Smaller effect sizes were most likely missed in this study due to the small sample size.&lt;/p&gt;\u0000&lt;p&gt;Second, the primary and secondary outcomes were all focused on parameters affecting an anaesthetist's workload, except for the final secondary outcome which was the satisfaction of the mother with labour analgesia. The satisfaction scores for both CSE and DPE groups ranged from 0 to 10, which we argue is a crude and non-discriminating outcome measure. Currently, there is a lack of patient-reported outcome measure (PROM) questionnaires to capture the quality of maternity care, especially during labour [&lt;span&gt;4&lt;/span&gt;]. Future studies investigating the quality of analgesia will need to include maternity PROMs, specifically focused on the intrapartum period. Furthermore, Zang et al. did not capture the rate of caesarean deliveries after neuraxial labour analgesia, which is a key outcome concerning the patient, obstetrician and anaesthetist. We argue that future clinical trials need to include a core outcome set for holistic and accurate measurements, which also allows for meta-analysis and homogeneity in data collection between individual trials [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Finally, approaching the topic of labour analgesia from a holistic perspective, should we focus on the impact of an intentional dural puncture or access to labour analgesia? The clinical benefits of labour analgesia (regardless of technique) are well documented. Yet there are still disparities in access to labour analgesia, especially in socio-economically deprived parturients. A recent population-based study in Scotland found the utilisation of epidurals for labour analgesia was 22%, and women in the most deprived areas were 16% less likely to receive epidural analgesia compared with the most affluent [&lt;span&gt;6&lt;/span&gt;]. When formulating research questions, do we aim for improving ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"124 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-operative corticosteroid supplementation guideline adherence","authors":"Lynn A. Miggelbrink, Marije Marsman, Juul van de Wetering, Wilton A. van Klei, Teus H. Kappen","doi":"10.1111/anae.16556","DOIUrl":"https://doi.org/10.1111/anae.16556","url":null,"abstract":"&lt;p&gt;Corticosteroids are prescribed commonly to patients with autoimmune or pulmonary diseases, post-transplant and neurosurgery, as well as to patients with adrenal insufficiency [&lt;span&gt;1, 2&lt;/span&gt;]. These patients are at risk of tertiary adrenal gland insufficiency, for which supplementation of corticosteroids during stress, such as surgery, is advised [&lt;span&gt;3, 4&lt;/span&gt;]. The Peri-operative Replacement of Exogenous Steroids (PREdS) study performed an audit of compliance to guidelines for supplemental corticosteroids in patients with possible adrenal insufficiency in the UK [&lt;span&gt;5&lt;/span&gt;]. A total of 21,411 adult patients undergoing surgery under the care of an anaesthetist were screened, of whom 277 (1.3%) used corticosteroids (i.e. they were considered at risk of tertiary adrenal gland insufficiency). Peri-operative prescription of supplementation was fully compliant in only 9% of the patients and 14% received none.&lt;/p&gt;\u0000&lt;p&gt;In a retrospective cohort study, we investigated guideline adherence for such patients in our academic centre. The local clinical guideline is based on a Dutch nationwide guideline, comparable with the one used in the UK (Table 1). Patients are deemed at risk if they are using prednisolone ≥ 7.5 mg or equivalent. Supplementation dosage depends on surgical risk, so we documented compliance based on a patient's surgical procedure risk.&lt;/p&gt;\u0000&lt;div&gt;\u0000&lt;header&gt;&lt;span&gt;Table 1. &lt;/span&gt;Corticosteroid supplementation guidelines.&lt;/header&gt;\u0000&lt;div tabindex=\"0\"&gt;\u0000&lt;table&gt;\u0000&lt;thead&gt;\u0000&lt;tr&gt;\u0000&lt;th&gt;Type of surgery*\u0000&lt;/th&gt;\u0000&lt;th&gt;Pre-operative&lt;/th&gt;\u0000&lt;th colspan=\"3\"&gt;Postoperative&lt;/th&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;&lt;/td&gt;\u0000&lt;th style=\"top: 41px;\"&gt;Day of surgery&lt;/th&gt;\u0000&lt;th style=\"top: 41px;\"&gt;Day 1&lt;/th&gt;\u0000&lt;th style=\"top: 41px;\"&gt;Day 2&lt;/th&gt;\u0000&lt;th style=\"top: 41px;\"&gt;Day 3&lt;/th&gt;\u0000&lt;/tr&gt;\u0000&lt;/thead&gt;\u0000&lt;tbody&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Low-risk&lt;/td&gt;\u0000&lt;td&gt;100 mg hydrocortisone i.v. or i.m. 1 h before surgery&lt;/td&gt;\u0000&lt;td&gt;n/a&lt;/td&gt;\u0000&lt;td&gt;n/a&lt;/td&gt;\u0000&lt;td&gt;n/a&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td rowspan=\"3\"&gt;Intermediate/high-risk&lt;/td&gt;\u0000&lt;td&gt;100 mg hydrocortisone i.v. or i.m. 1 h before surgery&lt;/td&gt;\u0000&lt;td&gt;3 × 40 mg hydrocortisone orally or 3 × 50 mg hydrocortisone i.v. or i.m.&lt;/td&gt;\u0000&lt;td&gt;1 × 40 mg and 2 × 20 mg hydrocortisone orally&lt;/td&gt;\u0000&lt;td&gt;3 × 20 mg hydrocortisone orally&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;100 mg hydrocortisone i.v. during induction&lt;/td&gt;\u0000&lt;td&gt;&lt;/td&gt;\u0000&lt;td&gt;&lt;/td&gt;\u0000&lt;td&gt;Taper to pre-operative dose&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;2 × 50 mg hydrocortisone i.v. or i.m with a 6-h interval&lt;/td&gt;\u0000&lt;td&gt;&lt;/td&gt;\u0000&lt;td&gt;&lt;/td&gt;\u0000&lt;td&gt;&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;/tbody&gt;\u0000&lt;/table&gt;\u0000&lt;/div&gt;\u0000&lt;div&gt;\u0000&lt;ul&gt;\u0000&lt;li&gt; i.v., intravenous; i.m., intramuscular; n/a, not applicable. &lt;/li&gt;\u0000&lt;li title=\"Footnote 1\"&gt;&lt;span&gt;* &lt;/span&gt; The dosages of this local translation of the national guidelines, are the same for all patients with continuation of the pre-operative corticosteroids. The local guideline was implemented in August 2013, and the latest update was February 2019. &lt;/li&gt;\u0000&lt;/ul&gt;\u0000&lt;/div&gt;\u0000&lt;div&gt;&lt;/div&gt;\u0000&lt;/div&gt;\u0000&lt;p&gt;A total of 15,246 patients undergoing elective non-cardiac surgery under general or spinal anaesthesia between January 2017 and","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"62 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout in anaesthesia: the UK and beyond","authors":"Hanlie du Plessis","doi":"10.1111/anae.16551","DOIUrl":"https://doi.org/10.1111/anae.16551","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"16 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143055307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incomplete Optiflow™ switching and the potential for confusion","authors":"Rosalyn Boyd, James E. Dinsmore","doi":"10.1111/anae.16547","DOIUrl":"https://doi.org/10.1111/anae.16547","url":null,"abstract":"&lt;p&gt;As the evidence base supporting the use of peri-intubation high-flow nasal oxygen (HFNO) continues to expand [&lt;span&gt;1&lt;/span&gt;], there have been advances in the design of the latest generation of systems for use in operating theatres. We would like to highlight several practice point considerations relating to use of such systems.&lt;/p&gt;\u0000&lt;p&gt;A limitation of previous designs is that applying a tight-fitting anaesthetic facemask over the incompressible nasal prongs is contraindicated due to the risks of gastric insufflation and barotrauma. The Fisher and Paykel Optiflow™ Switch (Fisher and Paykel, Auckland, New Zealand) modification [&lt;span&gt;2&lt;/span&gt;] incorporates a flow-regulated pressure relief valve and a compressible inflow to the nasal prongs so that there is interruption of the 100% oxygen nasal prong gas flow when a tight-fitting facemask is applied. This allows safe and seamless transitions from anaesthetic mask pre-oxygenation and facemask ventilation to HFNO and vice versa.&lt;/p&gt;\u0000&lt;p&gt;The user should be aware that, even when a firmly applied facemask is applied over the nasal prongs, the nasal oxygen flow is not completely ‘switched off’. It is likely to be variable but with Optiflow Switch flows above 10 l.min&lt;sup&gt;-1&lt;/sup&gt; it is apparent that there is ongoing oxygen ingress via the nasal prongs into the facemask during pre-oxygenation and facemask ventilation. The product literature details that the pressure delivered to the patient will be limited to 30 cmH&lt;sub&gt;2&lt;/sub&gt;O between flows of 30–70 l.min&lt;sup&gt;-1&lt;/sup&gt; [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Figure 1 shows the gas analyser data observed when a firmly applied facemask connected to a circle anaesthetic circuit with flow rates 10 l.min&lt;sup&gt;-1&lt;/sup&gt; of room air (F&lt;sub&gt;I&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt; 0.21) is applied over the Optiflow Switch nasal prongs and the HFNO flow rate is increased. The analyser measures increasing levels of inspired and end-tidal oxygen consistent with increasing oxygen ingress via the nasal prongs. Additionally, the capnography trace is attenuated, the extent of which is related to the HFNO flow rate. It does not appear to make a significant difference if the mask is a cushion design (e.g. Ambu® King; Ambu A/S, Ballerup, Denmark) or anatomical (e.g. Meditech Anatomical Eco; Meditech Systems Limited, Shaftesbury, UK).&lt;/p&gt;\u0000&lt;figure&gt;&lt;picture&gt;\u0000&lt;source media=\"(min-width: 1650px)\" srcset=\"/cms/asset/4281cadf-7e16-42ba-9ad4-786dd478abb4/anae16547-fig-0001-m.jpg\"/&gt;&lt;img alt=\"Details are in the caption following the image\" data-lg-src=\"/cms/asset/4281cadf-7e16-42ba-9ad4-786dd478abb4/anae16547-fig-0001-m.jpg\" loading=\"lazy\" src=\"/cms/asset/89be1ca2-6d77-48de-8576-478a34442fb5/anae16547-fig-0001-m.png\" title=\"Details are in the caption following the image\"/&gt;&lt;/picture&gt;&lt;figcaption&gt;\u0000&lt;div&gt;&lt;strong&gt;Figure 1&lt;span style=\"font-weight:normal\"&gt;&lt;/span&gt;&lt;/strong&gt;&lt;div&gt;Open in figure viewer&lt;i aria-hidden=\"true\"&gt;&lt;/i&gt;&lt;span&gt;PowerPoint&lt;/span&gt;&lt;/div&gt;\u0000&lt;/div&gt;\u0000&lt;div&gt;Photos stitched together show representative gas analyser readi","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"34 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent pain six months after breast cancer surgery: a multicentre follow-up study","authors":"Chin Wen Tan, Rehena Sultana, Mary C. Wright, Ban Leong Sng, Ashraf S. Habib","doi":"10.1111/anae.16546","DOIUrl":"https://doi.org/10.1111/anae.16546","url":null,"abstract":"&lt;p&gt;Persistent postoperative pain, defined as surgical site pain lasting beyond 3 months with other causes of pain excluded, can have adverse physical and psychological consequences [&lt;span&gt;1&lt;/span&gt;]. We developed a multivariable model for persistent pain at 4 months after breast cancer surgery based on baseline and peri-operative factors [&lt;span&gt;2&lt;/span&gt;]. A significant number of women who develop persistent pain 4 months after surgery may continue to have persistent pain at 6 months. Hence, we further evaluated risk factors for persistent pain at 6 months, encompassing patients' characteristics and information available from the 4-month follow-up.&lt;/p&gt;\u0000&lt;p&gt;This study is a secondary analysis of a prospective study investigating factors for persistent pain after breast cancer surgery at 4 months at two specialist centres (KK Women's and Children's Hospital, Singapore and Duke University Medical Centre, Durham, NC, USA), from January 2018 to March 2021 [&lt;span&gt;2&lt;/span&gt;]. After ethical approval, written informed consent was obtained from English-speaking patients scheduled for elective breast cancer surgery. Patients with a history of intravenous drug abuse, chronic opioid use, receiving chronic corticosteroid therapy or who were pregnant were not studied. Pre-operative baseline information was collected and is available in online Supporting Information Tables S1 and S2. Patients were further assessed for postoperative pain and analgesic use in the post-anaesthesia care unit and at 24–72 h post-surgery. Patients were followed-up via telephone or online survey at 4 and 6 months using a validated pain questionnaire [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;The primary outcome of persistent pain at 6 months was defined as the presence of one of either a pain score ≥ 3 on a numerical pain rating scale of 0 (no pain) to 10 (worst pain imaginable); or pain affecting daily life activities via indication of ‘yes’ on any of the seven questions that evaluated the impact of pain at 6 months on daily life activities in the Brief Pain Inventory Short-Form [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;The main objective was to develop a multivariable model for factors associated with persistent pain 6 months after breast cancer surgery. We also identified factors associated with persistent pain at both 4 and 6 months. The multivariable model was finalised using a stepwise variable selection method, incorporating clinically relevant variables with a p value &lt; 0.20 from the univariable logistic regression analyses.&lt;/p&gt;\u0000&lt;p&gt;Among the 233 recruited patients, 209 completed the follow-up at 6 months with an incidence of persistent pain of 57.4% (95%CI 50.4–64.2, n = 120). By selecting factors with p &lt; 0.20 in the univariable analysis, we identified the optimal multivariable model for the primary outcome, which contained the following independent risk factors: pain at 4 months after surgery; history of hypertension; axillary surgery; lower pain pressure threshold; and greater pre-operative perceived stress ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"56 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}