Risk Factors for Chronic Postoperative Pain (European IMI PainCare 2 Project)

La douleur est l’un des symptômes postopératoires les plus courants et les plus handicapant. PROMPT (Patient-Reported Outcome Measures in Pain Treatment) est l’un des trois sous-projets du projet IMI-PainCare 2 (Innovative Medicines Initiative Pain Care 2) financé par l’Union européenne et la Fédération européenne des industries et associations pharmaceutiques (EFPIA). Au sein de PROMPT, le groupe de travail 3 (Work Package 3) cherche à détecter et potentiellement prévenir la douleur chronique postopératoire par l’élaboration d’un score de prédiction de douleur chronique (PDC) postopératoire basé sur les résultats de l’étude observationnelle non-interventionnelle-1 (NIT-1). Cette étude a pour objectif le recueil de mesures des résultats rapportées par les patients (Patient-Reported Outcome Measures : PROMs) via des questionnaires regroupant un ensemble d’items tirées de 11 questionnaires validés dans le domaine de recherche dans la douleur et évaluant la douleur avec ses différentes caractéristiques mais également son impact sur la qualité de vie des patients. Préalablement à la mise en place de NIT-1, une revue systématique de la littérature utilisant la méthodologie de la méta-analyse de méta-analyse (aussi appelée umbrella review ou overview of reviews) portant sur quatre modèles chirurgicaux avait pour objectif de recenser les facteurs de risque de développement de la DCPO.Pain is one of the most common and debilitating postoperative symptoms. PROMPT (Patient-Reported Outcome Measures in Pain Treatment) is one of the three sub-projects of the IMI-PainCare 2 (Innovative Medicines Initiative Pain Care 2) project funded by the European Union and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Within PROMPT, working group 3 (Work Package 3) seeks to detect and potentially prevent postoperative chronic pain by developing a postoperative chronic pain prediction score (PDC) based on the results of the observational non-interventional trial-1 (NIT-1). The main objective of this study is to collect patient-reported outcome measures (PROMs) via questionnaires grouping together a set of items drawn from 11 questionnaires validated in the field of research in pain and evaluating pain with its different characteristics but also its impact on the quality of life of patients. Prior to the implementation of NIT-1, a systematic review of the literature using the methodology of meta-analysis of meta-analysis (also called umbrella review or overview of reviews) on four surgical models aimed to identify the risk factors for developing DCPO

Facteurs de risque de douleurs chroniques postopératoires (Projet européen IMI PainCare 2)

Pain is one of the most common and debilitating postoperative symptoms. PROMPT (Patient-Reported Outcome Measures in Pain Treatment) is one of the three sub-projects of the IMI-PainCare 2 (Innovative Medicines Initiative Pain Care 2) project funded by the European Union and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Within PROMPT, working group 3 (Work Package 3) seeks to detect and potentially prevent postoperative chronic pain by developing a postoperative chronic pain prediction score (PDC) based on the results of the observational non-interventional trial-1 (NIT-1). The main objective of this study is to collect patient-reported outcome measures (PROMs) via questionnaires grouping together a set of items drawn from 11 questionnaires validated in the field of research in pain and evaluating pain with its different characteristics but also its impact on the quality of life of patients. Prior to the implementation of NIT-1, a systematic review of the literature using the methodology of meta-analysis of meta-analysis (also called umbrella review or overview of reviews) on four surgical models aimed to identify the risk factors for developing DCPO.La douleur est l’un des symptômes postopératoires les plus courants et les plus handicapant. PROMPT (Patient-Reported Outcome Measures in Pain Treatment) est l’un des trois sous-projets du projet IMI-PainCare 2 (Innovative Medicines Initiative Pain Care 2) financé par l’Union européenne et la Fédération européenne des industries et associations pharmaceutiques (EFPIA). Au sein de PROMPT, le groupe de travail 3 (Work Package 3) cherche à détecter et potentiellement prévenir la douleur chronique postopératoire par l’élaboration d’un score de prédiction de douleur chronique (PDC) postopératoire basé sur les résultats de l’étude observationnelle non-interventionnelle-1 (NIT-1). Cette étude a pour objectif le recueil de mesures des résultats rapportées par les patients (Patient-Reported Outcome Measures : PROMs) via des questionnaires regroupant un ensemble d’items tirées de 11 questionnaires validés dans le domaine de recherche dans la douleur et évaluant la douleur avec ses différentes caractéristiques mais également son impact sur la qualité de vie des patients. Préalablement à la mise en place de NIT-1, une revue systématique de la littérature utilisant la méthodologie de la méta-analyse de méta-analyse (aussi appelée umbrella review ou overview of reviews) portant sur quatre modèles chirurgicaux avait pour objectif de recenser les facteurs de risque de développement de la DCPO

Facteurs de risque de douleurs chroniques postopératoires (Projet européen IMI PainCare 2)

Pain is one of the most common and debilitating postoperative symptoms. PROMPT (Patient-Reported Outcome Measures in Pain Treatment) is one of the three sub-projects of the IMI-PainCare 2 (Innovative Medicines Initiative Pain Care 2) project funded by the European Union and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Within PROMPT, working group 3 (Work Package 3) seeks to detect and potentially prevent postoperative chronic pain by developing a postoperative chronic pain prediction score (PDC) based on the results of the observational non-interventional trial-1 (NIT-1). The main objective of this study is to collect patient-reported outcome measures (PROMs) via questionnaires grouping together a set of items drawn from 11 questionnaires validated in the field of research in pain and evaluating pain with its different characteristics but also its impact on the quality of life of patients. Prior to the implementation of NIT-1, a systematic review of the literature using the methodology of meta-analysis of meta-analysis (also called umbrella review or overview of reviews) on four surgical models aimed to identify the risk factors for developing DCPO.La douleur est l’un des symptômes postopératoires les plus courants et les plus handicapant. PROMPT (Patient-Reported Outcome Measures in Pain Treatment) est l’un des trois sous-projets du projet IMI-PainCare 2 (Innovative Medicines Initiative Pain Care 2) financé par l’Union européenne et la Fédération européenne des industries et associations pharmaceutiques (EFPIA). Au sein de PROMPT, le groupe de travail 3 (Work Package 3) cherche à détecter et potentiellement prévenir la douleur chronique postopératoire par l’élaboration d’un score de prédiction de douleur chronique (PDC) postopératoire basé sur les résultats de l’étude observationnelle non-interventionnelle-1 (NIT-1). Cette étude a pour objectif le recueil de mesures des résultats rapportées par les patients (Patient-Reported Outcome Measures : PROMs) via des questionnaires regroupant un ensemble d’items tirées de 11 questionnaires validés dans le domaine de recherche dans la douleur et évaluant la douleur avec ses différentes caractéristiques mais également son impact sur la qualité de vie des patients. Préalablement à la mise en place de NIT-1, une revue systématique de la littérature utilisant la méthodologie de la méta-analyse de méta-analyse (aussi appelée umbrella review ou overview of reviews) portant sur quatre modèles chirurgicaux avait pour objectif de recenser les facteurs de risque de développement de la DCPO

دور التدقيق الخارجي في عملية الإصلاح الإداري في سورية

يهدف هذا البحث إلى تحديد العلاقة بين التدقيق الخارجي وعملية الإصلاح الإداري في الشركة السورية للاتصالات (فرع اللاذقية). ولتحقيق هدف البحث، اعتمد الباحث على المقاربة الاستنباطيًّة كمنهج عام للبحث، وأسلوب الاستبانة كأداة لجمع البيانات، حيث تم توزيع (55) استبانة على العاملين في الشركة محل الدراسة، وتم استرداد (54) استبانة منها (49) استبانة صالحة للتحليل، ومن ثم إجريت دراسة إحصائية بغرض بيان هذه العلاقة، حيث قام الباحث باستخدام معامل ارتباط بيرسون(Person). وقد خلصت الدراسة إلى وجود علاقة طردية معنوية بين آلية التدقيق الخارجي وعملية الإصلاح الإداري في الشركة السورية للاتصالات فرع اللاذقية: كما توصلت هذه الدراسة إلى مجموعة من التوصيات والمقترحات، والتي من شأنها أن تسهم بشكل إيجابي بتحسين دور عملية الإصلاح الإداري.

Opioid free anaesthesia: myth or reality?

International audienceSince the 1960s, intraoperative administration of opioids is considered a keystone of anaesthesia as well as hypnotics and muscle relaxants. Since then, anaesthesia has changed from inhalation to multimodal anaesthesia with lower doses of hypnotic. In 2018, the intraoperative objectives of hypnosis, haemodynamic stability, immobility and anticipation of postoperative analgesia can be achieved without opioids. Moreover, opioid administration consequences are neither scarce nor benign for the patient. Perioperative opioids are associated with nausea and vomiting, sedation, ileus, confusion/delirium, respiratory depression, increased postoperative pain and morphine consumption, immunodepression, hyperalgesia and chronic postoperative pain. Among these complications, hypoxemia, ileus and confusion/delirium are the most frequent. Opioid-free anaesthesia (OFA) is based on the idea that haemodynamic stability can be achieved without opioids during anaesthesia. OFA is multimodal anaesthesia associating hypnotics, NMDA antagonists, local anaesthetics, anti-inflammatory drugs and alpha-2 agonists (Dexmedetomidine). The first studies on the benefit of OFA reported a significant postoperative morphine sparing, decreased pain and reduction of postoperative nausea and vomiting. However, proofs of the effect of OFA on reducing opioid-related adverse effects surgery are still scarce and more studies are needed

IVG médicamenteuse - IVG chirurgicale (existe-t-il une différence dans le vécu des patientes ?)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Opioid-Free Anesthesia Benefit–Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Opioid-free anesthesia (OFA) is used in surgery to avoid opioid-related side effects. However, uncertainty exists in the balance between OFA benefits and risks. We searched for randomized controlled trials (RCTs) comparing OFA to opioid-based anesthesia (OBA) in five international databases. The co-primary outcomes were postoperative acute pain and morphine consumption at 2, 24, and 48 h. The secondary outcomes were the incidence of postoperative chronic pain, hemodynamic tolerance, severe adverse effects, opioid-related adverse effects, and specific adverse effects related to substitution drugs. Overall, 33 RCTs including 2209 participants were assessed. At 2 h, the OFA groups had lower pain scores at rest MD (0.75 (−1.18; −0.32)), which did not definitively reach MCID. Less morphine was required in the OFA groups at 2 and 24 h, but with very small reductions: 1.61 mg (−2.69; −0.53) and −1.73 mg (p < 0.05), respectively, both not reaching MCID. The reduction in PONV in the OFA group in the PACU presented an RR of 0.46 (0.38, 0.56) and an RR of 0.34 (0.21; 0.56), respectively. Less sedation and shivering were observed in the OFA groups with an SMD of −0.81 (−1.05; −0.58) and an RR of 0.48 (0.33; 0.70), respectively. Quantitative analysis did not reveal differences between the hemodynamic outcomes, although severe side effects have been identified in the literature. No clinically significant benefits were observed with OFA in terms of pain and opioid use after surgery. A clear benefit of OFA use was observed with respect to a reduction in PONV. However, more data on the safe use of OFAs should be collected and caution should be taken in the development of OFA

Qualitative analysis of the organisational response of a university hospital during the first wave of the COVID-19 crisis

International audienceBackground The COVID-19 pandemic has required urgent organisational and managerial adaptation, with hospital medical and administrative leaders under considerable pressure.Methods At a single French university hospital, we performed a sociological analysis of management adaptation by medical and administrative leaders during the first wave of the COVID-19 crisis. Two sociologists performed interviews with representative members of staff from all the structures involved in managing the crisis to analyse adaptation and the solutions found during this period.Results The answers collected during interviews were classified into three main topics describing the organisational adaptations of the hospital staff during the COVID-19 crisis: (1) exceptional mobilisation and collaboration; (2) crisis management based primarily on the principle of subsidiarity; and (3) survival of the administrative structure with interventions to support caregivers.Conclusion This study, focusing on a single hospital, identified a number of factors associated with successful mobilisation in the very specific conditions of this viral pandemic

Two per cent alcoholic chlorhexidine versus alcoholic five per cent povidone-iodine for the prevention of perineural catheter colonisation: The CHLOVEPI randomised, controlled trial

International audienceBackground: Multimodal analgesia, including a regional technique using perineural catheters (PNCs), is recommended for the treatment of moderate-to-severe acute postoperative pain. Perineural catheters are at risk of bacterial colonisation. In this study, we compared the cutaneous antiseptic efficacy of 2% alcoholic chlorhexidine and povidone-iodine-alcohol for preventing the bacterial colonisation of PNCs in orthopaedic surgery. Methods: We performed a randomised, controlled trial, comparing two cutaneous antisepsis strategies, one based on 2% alcoholic chlorhexidine and the other on povidone-iodine-5% alcohol, for placed PNCs before orthopaedic surgery. The primary endpoint was the incidence of catheter bacterial colonisation (threshold > 1000 colony-forming units/ml). The secondary endpoints were the incidence of catheter-related infections and the adverse effects of the antiseptic solutions. Results: From November 2016 to May 2018, we included 113 patients in this study. The use of alcoholic chlorhexidine was associated with a lower incidence of catheter colonisation (15.5% (n = 9) versus 32.7% (n = 18); OR: 0.28 [0.09-0.77], p = 0.01). No catheter-related infections or adverse effects of antiseptic solutions were observed in either group. The risk factors associated with colonisation were a duration of catheter use ≥ 3 days (p = 0.04) and obesity (p = 0.005). The most frequently identified bacterium was Staphylococcus epidermidis. Conclusion: Skin disinfection with 2% alcoholic chlorhexidine decreases bacterial colonisation rates for placed perineural catheters