Research priorities in regional anaesthesia: an international Delphi study

Background: Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. Methods: We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as ‘definitely’ include in any round, it was accepted. Indicative questions rated as ‘definitely’ or ‘probably’ by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. Results: There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven ‘highest priority’ research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. Conclusions: We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas

Design and Development of A Web-Based Chronic Pain Registry System

Introduction: Chronic pain is a significant clinical problem in the world. No treatment is quite effective for chronic pain due to its complex nature. However timely retrieval of accurate and comprehensive information through organized clinical and epidemiological studies is an essential prerequisite for providing high-quality clinical care and more accurate health care planning. This can be achieved by the creation of an electronic registry system as a strong source of information. The purpose of this study was to develop and evaluate a chronic pain registry for patients with chronic pain syndromes. Material and Methods: In the current study, Onion architecture with the MVC design pattern was selected in design phase. Using onion architecture leads to more flexible and reusable codes and results in easier development and maintenance. In the development phase, MYSQL DBMS and the PHP programming language, which are suitable for developing the web-based system, were used. Results: The minimum data set was determined in the previous study. This dataset covered six areas: demographic information, initial pain assessment, medical history, mental health and well-being, diagnostic measures, and diagnosis and treatment plan. A web-based pain registry system was developed based on the minimum data set. Conclusion: There are many studies for development of web- based pain registries in the world but there is a few information about technical architecture and structure in design phase. In current study, we focused on the technical architecture design of system. Using onion architecture leads to more flexible and reusable codes and results in easier development and maintenance. In the current study, it was chosen to use MYSQL and the PHP programming language, which is suitable for developing the web-based system. Finally, a web-based registry system was developed to store and report on the information of patients suffering from chronic pain. It can manage and control chronic pain and facilitate future research

Comparing the effect of ketamine and benzydamine gargling with placebo on post-operative sore throat: A randomized controlled trial

Background: Air way intubation for general anesthesia usually leads to sore throat after surgery. Ketamine plays an important role to block a number of receptors related to pain. Benzydamine hydrochloride is a non-steroidal anti-inflammatory drug that has been used to improve oropharyngeal disorders. In this study, it was intended to compare the effect of gargling different solutions before the surgery on post-operative sore throat (POST) in patients who underwent general anesthesia for hysterectomy. Materials and Methods: A total of 60 patients who underwent the elective hysterectomy were entered to the randomized controlled trial regarding to the eligibility criteria. Patients were simply randomly allocated to three groups and received one code. Every code was representative for a specific drug: 20 cc normal saline (control group) or 1.5 mg benzydamine in 20 cc solution or 20 mg ketamine in 20 cc solutions. All the research teams were blinded to the received solutions. POST was evaluated with numerical rating scale. The data were entered to SPSS software and analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance test, were performed. Results: The mean ages of ketamine, benzydamine, and normal saline recipients were not significantly different. The trend of the severity of sore throat during the first 24 h after the operation in ketamine recipients was significantly lower than the other two groups (P < 0.001). Conclusion: The pain scale after surgery was reduced by using both ketamine and benzydamine, but the ketamine effect was more noticeable

Which one is more efficient on propofol 2% injection pain? Magnesium sulfate or ondansetron: A randomized clinical trial

Background: Painful sensation has been reported after propofol injection in most of the patients but no definite mechanism for this painful sensation has been proposed yet. The present randomized clinical trial compares analgesic effect of ondansetron, magnesium sulphate (MS) and placebo on patients after propofol 2% injection. Materials and Methods: The present randomized clinical trial with parallel design was performed on 90 patients American Society of Anesthesiologists I-II undergoing general anesthesia within vitrectomy operation with propofol induction. Subjects were randomly allocated into three groups with 30 patients each: (1) MS group (2) ondansetron group and (3) normal saline (NS) group as placebo group. Anesthesia induction and maintenance were the same between groups. Pain intensity of propofol injection in subjects was assessed by a four-point scale (none 0, mild 1, moderate 2 and severe 3) at four time intervals (5, 10, 20 and 25 s) after injection. Results: MS and ondansetron had significant impacts on pain reduction after propofol 2% injection in comparison with NS as placebo. Comparing two trial groups did not have any significant priority for analgesic impact. Conclusion: Using ondansetron or MS had no priority on each other on declining propofol injection induced pain