The American Society of Regional Anesthesia has announced it will be hosting a novel video guided session moderated by Dr Brian Harrington with presenters Eugene Viscusi MD, Edward Mariano MD, and Santhanam Suresh MD. It will feature submitted videos by ASRA members and a Panel Discussion and an Open Forum.
Pain Relief for Women Undergoing Oocyte Retrieval for Assisted Reproduction (review)
Published: January 2013
In: The Cochrane Collaboration
From: EPPI-Centre, University of London
Authors: Kwan I, Bhattacharya S, Knox F, McNeil A.
In investigating if spinal anesthesia might be the best anesthetic and analgesic approach for oocyte retrieval, I found a recent and complete review on anesthesia and oocyte retrieval. The main result of this review was that use of more than one pain relief modality improved patient comfort. My informal on-line survey of patient information provided for patients by fertility clinics suggests propofol infusion as procedural sedation/general anesthesia is likely the most common method employed for oocyte retrieval in the US.
Various methods of conscious sedation and analgesia have been used for pain relief during oocyte recovery in in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) procedures. The choice of agent has also been influenced by the quality of sedation and analgesia as well as by concerns about possible detrimental effects on reproductive outcomes.
To assess the effectiveness and safety of different methods of conscious sedation and analgesia on pain relief and pregnancy outcomes in women undergoing transvaginal oocyte retrieval.
With this update, nine new studies were identified resulting in a total of 21 trials including 2974 women undergoing oocyte retrieval. These trials compared five different categories of conscious sedation and analgesia: 1) conscious sedation and analgesia versus placebo; 2) conscious sedation and analgesia versus other active interventions such as general and acupuncture anaesthesia; 3) conscious sedation and analgesia plus paracervical block versus other active interventions such as general, spinal and acupuncture anaesthesia; 4) patient-controlled conscious sedation and analgesia versus physician-administered conscious sedation and analgesia; and 5) conscious sedation and analgesia with different agents or dosage. Evidence was generally of low quality, mainly due to poor reporting of methods, small sample sizes and inconsistency between the trials. Conflicting results were shown for women’s experience of pain. Compared to conscious sedation alone, more effective pain relief was reported when conscious sedation was combined with electro-acupuncture: intra-operative pain mean difference (MD) on 1 to 10 visual analogue scale (VAS) of 3.00 (95% CI 2.23 to 3.77); post-operative pain MD in VAS units of 2.10 (95% CI 1.40 to 2.80; N = 61, one trial, low quality evidence); or paracervical block (MD not calculable).The pooled data of four trials showed a significantly lower intra-operative pain score with conscious sedation plus paracervical block than with electro-acupuncture plus paracervical block (MD on 10-point VAS of -0.66; 95% CI -0.93 to -0.39; N = 781, 4 trials, low quality evidence) with significant statistical heterogeneity (I(2) = 76%). Patient-controlled sedation and analgesia was associated with more intra-operative pain than physician-administered sedation and analgesia (MD on 10-point VAS of 0.60; 95% CI 0.16 to 1.03; N = 379, 4 trials, low quality evidence) with high statistical heterogeneity (I(2) = 83%). Post-operative pain was reported in only nine studies. As different types and dosages of sedative and analgesic agents, as well as administrative protocols and assessment tools, were used in these trials the data should be interpreted with caution. There was no evidence of a significant difference in pregnancy rate in the 12 studies which assessed this outcome, and pooled data of four trials comparing electro-acupuncture combined with paracervical block with conscious sedation and analgesia plus paracervical block showed an odds ratio (OR) of 0.96 (95% CI 0.72 to 1.29; N = 783, 4 trials) for pregnancy. High levels of women’s satisfaction were reported for all modalities of conscious sedation and analgesia as assessed in 12 studies. Meta-analysis of all the studies was not attempted due to considerable heterogeneity.For the rest of the trials a descriptive summary of the outcomes was presented.
The evidence from this review of 21 randomised controlled trials did not support one particular method or technique over another in providing effective conscious sedation and analgesia for pain relief during and after oocyte recovery. The simultaneous use of more than one method of sedation and pain relief resulted in better pain relief than one modality alone. The various approaches and techniques reviewed appeared to be acceptable and were associated with a high degree of satisfaction in women. As women vary in their experience of pain and in coping strategies, the optimal method may be individualized depending on the preferences of both the women and the clinicians and resource availability.
Pub Med has access available to this review of Upper Extremity Regional Anesthesia, authored by Joseph M. Neal, MD, J.C. Gerancher, MD, Quinn H. Hogan, MD et al. It is wonderfully illustrated by Jennifer Gentry and provided on the web by US National Library of Medicine and the National Institutes of Health.
I refound this series of informative editorials which I believe were commissioned by B. Braun from 2004 to 2009. Contributors are quite a few experts in the field of regional anesthesia and acute pain management sharing their opinions on these topics. These are from a time when Regional Anesthesia benefited from strong advocacy and these editorials provided it!
You can get to all the articles by following the three articles which are highlighted. These are linked to all the topics below………..
- TAP: A New Standard for Abdominal Surgery?
- Is <0.2mA a reliable indicator of intraneural injection?
- 5 Top Tips for Block Reimbursement
- A Breakthrough in Nerve Stimulation
- A Two-Pronged Approach to PONV Prevention
- Get Total Knee Patients Moving With Continuous Nerve Blocks
- Nerve Blocks: The Right Choice in a Down Economy
- Nerve Blocks: A Hospital CEO’s Perspective
- Paravertebral Blocks: Benefits Beyond Expectations
- Blocks Help Hernia Patients Go Home Faster
- Intra-Articular Infusions or Nerve Blocks?
- Continuous Nerve Blocks Boost Patient Confidence
- Yes You Can Get Reimbursed for Nerve Blocks
- Peripheral Nerve Blocks: A Wise Investment
- A Surgeon’s View: Dispelling Some Common PNB Myths
- A Surgeon’s Perspective: The Power of PNBs
- Acute Pain Nurse: Key to Continuous Infusion Success
- A Breakthrough in Nerve Stimulation
- No Pain, Big Gain
- Our Insurers Pay for Peripheral Nerve Blocks
- Fortifying Our Future With PNB Training
- Stimulating Catheters for Outpatient Surgery
- When Should We Use Stimulating Catheters?
- What Is Ultrasound’s Role in Peripheral Nerve Blocks?
- There’s No Better Advertisement than a Happy Patient!
- Avoiding Post-Lithotripsy Pain
- Regional Anesthesia Took My Pain From 10 to 0
- How to Make Peripheral Nerve Blocks Even Safer
- Helping Patients Understand Regional Blocks
- Ultrasound and Nerve Stimulation: Perfect Together
- The Post-Opioid Era
- Practical Pain Control
- In Our PACU, Blocks Made Miles of Difference
- Filling the Analgesic Gap
- Is Regional Anesthesia More Cost-Efficient?
- Prime Patients Early for PNB Success
- With Nerve Blocks, Time is Safety
- Nerve Blocks Improve Patient Well-Being
- The PNBs Have It
- Continuous Peripheral Nerve Blocks: The Jury Is In
- Is Regional Anesthesia More Cost-Efficient?
- Block On!
- Regional Anesthesia: Lessons from Iraq
- Help is On the Way
- The Promise of Pediatric Peripheral Nerve Blocks
- Building a Better Regional Anesthesia Procedure Note
- Perception is Everything
- Peripheral Nerve Stimulators Improve Patient Comfort
- Regional Anesthesia Helps Elderly Patients Stay Alert and On Track
- 4 Ways to Make Continuous Infusions Run More Smoothly
- Tips for Managing Orthopedic Regional Anesthesia Patients
- How to Bill for Regional Anesthesia
- How to Ease Into Regional Blocks
- 3 Things to Know About Regional Anesthesia Programs
The upcoming 39th Annual Regional Anesthesiology and Acute Pain Medicine Meeting is being put together by program chair Sandra L. Kopp, M.D. of the Mayo clinic. The program will be held in Chicago and is now online.