Category Archives: anesthesiology

Study Finds Women Who Had Epidural Had Lower Risk of Severe Maternal Complications

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PainRelief.com Interview with
Prof. Rachel Kearns
Consultant Anaesthetist, Glasgow Royal Infirmary
Honorary Professor, University of Glasgow
Senior NRS Fellow

PainRelief.com: What is the background for this study? What are the main findings?

Response: This was an observational study which looked at health data from over half a million mothers giving birth in Scotland. We compared women who had received an epidural in labour with those who had not and found that women who had an epidural had a lower risk of severe maternal morbidity (severe health complications during childbirth or the 6 weeks following birth).  

We found that women with a higher underlying risk for having complications, for example women delivering a baby pre-term or women with pre-existing health conditions, had an even greater reduction in risk.

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Empathetic Care By Physicians Provides Better Pain Relief Than Most Other Modalities

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PainRelief.com Interview with:
John C. Licciardone, DO, MS, MBA, FACPM
Regents Professor and Richards-Cohen Distinguished Chair in Clinical Research
Department of Family Medicine, MET-568
University of North Texas Health Science Center
Fort Worth, TX 76107

PainRelief.com: What is the background for this study?

Response: The Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation focuses on the patient-physician relationship and its association with chronic pain treatment and outcomes.

Previous studies involving physician empathy often have been limited to pain clinics and involved short-term follow-up. Our study aimed to study the impact of physician empathy on outcomes among patients with chronic low back pain in community settings throughout the United States over 12 months of follow-up.

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Socially Disadvantaged Women Received Fewer Epidurals for Pain Relief During Childbirth

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MedicalResearch.com Interview with:
Dr Lucy Halliday
School of Medicine, Dentistry and Nursing
University of Glasgow
Glasgow, UK

pregnancy-woman-belly-hands-46207 (1)

MedicalResearch.com: What is the background for this study?

Response: Socioeconomic deprivation is associated with adverse maternal and childhood outcomes. Epidural analgesia is the gold standard for labour analgesia, and is associated with improved maternal pain scores and satisfaction, reduced rates of post-traumatic stress disorder and postnatal depression and may reduce severe maternal morbidity. Scotland is a country with a fully publicly funded national health service that aims to provide equitable treatment that is free at the point of care. We wanted to look at the association between socioeconomic deprivation and utilisation of labour epidural analgesia.

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Racial Differences in Chronic Pain Among Football Players

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PainRelief.com Interview with:
Robert R Edwards, Ph.D.
Associate Professor of Anaesthesia
Pain Management Center
Brigham and Women’s Hospital

PainRelief.com: What is the background for this study?

Response: Chronic pain affects over 100 million American adults, and is a leading cause of reduced quality of life. However, in the US, the of burden of pain falls most heavily on members of racial and ethnic minority groups who frequently report more pervasive and severe pain compared with those in the majority.

In this study we evaluated race differences in pain among nearly 4,000 former professional American-style football players who self-identified as either Black or white.

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Nitrous Oxide “Cracking” Can Reduce Greenhouse Gas From Pain Killer Used During Childbirth

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PainRelief.com Interview with:
Dr Clifford L Shelton
Consultant Anaesthetist, Wythenshawe Hospital
Senior Clinical Lecturer, Lancaster Medical School (Director of Simulation and Skills)
Executive Editor, Anaesthesia Reports
Deputy Chair of PCPIE, National Institute of Academic Anaesthesia Health Services Research Centre

Dr. Annie Pinder
North West School of Anaesthesia,
Health Education England North West, Manchester, UK

PainRelief.com: What is the background for this study?

Response: Inhaled nitrous oxide is the most commonly-used pain relief for labour in the UK – used by an estimated 77% of women in labour. However, it has a high ‘carbon footprint’ and depletes the ozone layer so healthcare organisations must take steps to reduce its release. Previous works have also noted high levels of nitrous oxide in the work environment of midwives working on labour ward, which can have health implications.

In Scandinavia, nitrous oxide ‘cracking’ technology has been used for several years to address these concerns and this has recently become available in the UK – however, there is little available effectiveness of the technology in the clinical workplace. We previously conducted a bench experiment to assess the ability of cracking technology to reduce ambient nitrous oxide concentrations under ideal circumstances and found a substantial improvement when the technology was in place. However, controlled experimental situations are not representative of real-life.

In this study we therefore aimed to assess whether ambient nitrous oxide levels would be reduced when the technology was implemented on the low-risk birth centre of a typical UK maternity hospital.

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Use of Nitrous Oxide for Pain Relief During Labor and Delivery Reevaluated in Light of Greenhouse Gas Emissions Concerns

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PainRelief.com Interview with:
Prof. Bernd Froessler MD, PhD, FANZCA
Department of Anaesthesia
Lyell McEwin Hospital
Clinical Professor
Discipline of Acute Care Medicine
University of Adelaide

Prof. Bernd Froessler

PainRelief.com: What is the background for this study?

Response: Nitrous oxide (N2O) is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID-19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. This 19-day sudden disruption period at our hospital provided a ‘natural experiment’ and opportunity to re-evaluate the role and need for N2O, with the aim to determine the impact of withdrawing N2O on labour analgesia use and maternal and neonatal outcomes.

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Racial and Ethnic Disparities in Use of Epidural Blood Patch for Pain Relief in Obstetric Patients

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PainRelief.com Interview with:
Allison Lee, MD, MS  [she/her/hers]
Associate Professor of Anesthesiology
Division of Obstetric Anesthesia
Officer of Diversity, Equity and Inclusion, Department of Anesthesiology
Medical Director of the Margaret Wood Center for Simulation and Education
Columbia University Medical Center
New York, NY 10032

Dr. Lee

PainRelief.com:  What is the background for this study? 

Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:

  • Lower labor epidural rates, despite it being the most effective modality for pain relief.
  • Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
  • Worse management of pain after cesarean delivery

Given the importance of effective management of postdural puncture headache and in light of growing evidence of  complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.

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Conditioned Open-Label Placebos Provide Pain Relief in Some Post-Surgical Patients

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PainRelief.com Interview with:
Kristin Schreiber, MD, PhD
Neuroscientist and Clinical Regional Anesthesiologist
Brigham and Women’s Hospital
Assistant Professor of Anesthesia
Harvard Medical School

PainRelief.com:  What is the background for this study?

Response: Traditionally, the placebo effect has involved deceiving patients, where they think they may be taking a real medication. “Open-label placebos” are when placebos are given to patients, and patient are told that they are in fact a placebo. Recent research has suggested that these open-label placebos may actually reduce a number of symptoms in patients, including chronic low back pain. We were interested whether this strategy could be used to help reduce pain and opioid use around the time of surgery. We decided to combine the use of OLP with a conditioning approach, so that anytime a patient took an opioid analgesic, they would take the open-label placebo, so that the OLP pills would be associated with pain relief. That way when patients took them on their own, it would serve to trigger an expectation of pain relief, which is thought to at least partially explain the placebo effect.  

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Recorded Music plus Text During Anesthesia Reduced Need for Pain Medication

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PainRelief.com Interview with:
Prof. Dr. Ernil Hansen
Department of Anesthesiology
University Hospital Regensburg
Regensburg, Germany

Prof. Dr. Hansen

PainRelief.com: What is the background for this study? What are the main findings?

Response: It is becoming more and more clear that besides drugs and surgery it is communication that makes therapy effective. A meta-analysis we had conducted recently, suggested some beneficial effects of taped words played during surgery in older studies.

Our current study on 385 patients showed evidence that a text based on hypnotherapeutic principles an reduce postoperative pain and use of opioids. Pain within the first 24h after surgery decreased by 25%, opioid requirement by 34%. Six patients needed to be treated to save one patient from opioid exposure at all. High demand for analgesics was reduced by 41%. 

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New Model Helps Clinicians Predict Which Patients Require Highest Doses of Opioids for Pain Relief

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PainRelief.com Interview with:
Dr. Mieke Soens, MD
Anesthesiology Specialist 
Brigham and Women’s Hospital

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Opioid use worldwide has doubled in the last two decades and several countries, including the US, are struggling with a real opioid epidemic. Higher opioid doses after surgery are associated with prolonged opioid use and misuse. For example, in a study of more than 30,000 patients undergoing minor surgery such as appendectomy or gallbladder surgery, the risk to become a chronic opioid user was around 6% compared to 0.4% in the non-surgical population.

Many of our colleagues have previously identified predictors associated with more severe pain and opioid use after surgery, however, to assess those predictors, they had to use lengthy questionnaires. This approach is very time-consuming and impractical for use in daily clinical practice. The machine learning models that we have developed can work quickly and in real-time prior to surgery to mine data from patient’s electronic medical records and without the need for cumbersome questionnaires, in order to selectively identify those patients who will need high doses of opioids after surgery.

This can help reduce postoperative opioid use, by allowing the care team to maximize non-opioid analgesic strategies in these patients. Examples of non-opioid strategies include nerve blocks and epidurals and different types of non-opioid medications. We know that these alternatives can be very costly and sometimes risky. Therefore, being able to target the right treatment to the right patient is important to not only to reduce opioid use, but also to ensure that patients receive the treatment that is right for them.

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