Objective The aim of this study is to analyze post‐cesarean morphine consumption using continuous ropivacaine subfascial wound infusion. Methods After standardized spinal anesthesia (0.5% hyperbaric bupivacaine 8–10 mg combined with sufentanil 2–2.5 μg), women undergoing cesarean section (n = 69) were randomly allocated to receive either ropivacaine 0.2% (n = 35) or NaCl 0.9% (n = 34) infused through a subfascial wound catheter during 48 h in a multimodal analgesic approach. As primary outcome, opioid use by intravenous patient‐controlled analgesia was analyzed. Secondary outcomes were intensity of pain on visual analog scale at rest and at mobilization, postoperative nausea/vomiting, pruritus and time of first ambulation. Independent t test or Mann–Whitney U test, and Pearson's χ2 test or Fisher's exact test were used as appropriate. Results Morphine consumption was significantly lower in the ropivacaine group (21.52 ± 21.56 mg) compared with the placebo group (29.57 ± 22.38 mg; 95% confidence interval −18.8 to 2.76; p = 0.047). No significant differences were observed in pain evaluated by visual analog scale, except for pain at mobilization 6 h after surgery (ropivacaine versus placebo: 3.90 ± 2.66 versus 5.36 ± 2.55; p = 0.030). No significant differences were observed in the incidence of postoperative nausea/vomiting, pruritus, and time of first ambulation. Conclusion Continuous ropivacaine subfascial wound infusion results in less post‐cesarean morphine consumption. EudraCT trail registration number: 2017‐004797‐33. EudraCT link: https://www.clinicaltrialsregister.eu/ctr-search/trial/2017-004797-33/BE#A

Purpose Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. Methods This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. Results Median pain score at 24 h at rest was 3 [2–4] for Oxy group vs 2 [1.75–3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3–6] vs 3 [2–5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). Conclusions In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. Trial registration Clinical Trials: NCT04448457; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3

BackgroundObjectives To evaluate and compare the efficacy of 14-day dosing with celecoxib 200 mg BID and naproxen 500 mg BID in patients with acute shoulder pain. Methods Patients with pain onset within the previous 14 days and pain intensity of > = 40 mm on a 100-mm VAS were randomly assigned to enter one of two parallel groups of a doubleblind controlled, multicenter study. The primary assessment was pain at rest. Results The primary ITT analysis was conducted in 202 randomised and treated patients, 99 in the celecoxib group and 103 in the naproxen group. Baseline characteristics were similar (47 ± 12 years of age; mean duration of acute episode, 5.6 ± 5.1 days). At 14 days, the mean (± SE) decrease in pain at rest was not statistically significantly different between the two groups. According to the limits of 95% CI of the difference between groups, celecoxib seemed to be at least as effective as naproxen. Fewer patients experienced epigastric pain with celecoxib (7 patients vs 14 with naproxen). This adverse event led to treatment discontinuation in 2 patients receiving celecoxib and 5 receiving naproxen. One patient with a history of ulcer had duodenitis (Hp positive) in the celecoxib group.

<p> The probabilistic assessment of risk due to landslides for Disaster Risk Reduction (DRR) purposes in terms of absolute and quantitative metrics (e.g., number of expected fatalities, economic damage) is still quite challenging. If, on the one side, landslide susceptibility models based on the combined statistical analysis of observed events and geomorphological predisposing factors can be efficiently implemented, they must be integrated by further hypothesis and information to capture the complexity of landslides hazard and be efficiently used for the assessment of risk. For instance, most susceptibility models are static and do not formally account for main triggering conditions (e.g., rainfall or seismic activity). Furthermore, they do not include any probabilistic information on the frequency/magnitude relationships of the related events, hence conveying relative and partial information. In this contribution, a simplified framework for probabilistic landslides risk assessment is presented and its application for multi-hazard risk assessment in Burundi is discussed. The proposed approach is based on the integration of multi-temporal susceptibility models accounting for monthly average precipitation patterns into a heterogeneous Poisson point process model. The occurrence process model is used to generate a large portfolio of events, each associated with a feature representing its magnitude whose distribution is modelled by a simple power law. These events can be combined with exposure and fragility/vulnerability information to obtain a probabilistic assessment of risk of different adverse consequences on people, assets and infrastructure.</p><p>The proposed approach has been exemplified in the context of a multi-hazard risk assessment at national scale for Burundi and has proved successful in providing spatialised absolute and relative risk estimates that could be compared and combined with risk assessments related to other hazards (e.g., earthquakes and floods) with different characteristics and return periods.</p><p> The practical implementation was based on the available data for the targeted region, which is limited, and relies on several assumptions and hypothesis that are accompanied by a significant level of uncertainty. The results have been preliminarily assessed using the data provided by the IOM Emergency Tracking Tool (ETT) from the period 2018-2021. The results indicate that the framework is flexible and can be used to obtain actionable information on risk due to landslides at different temporal and spatial scales. Our findings further highlight the importance of addressing landslide risk from a larger, interdisciplinary perspective, fostering the systematic collection of risk-oriented data (e.g., event inventories including information on damage and loss) and the synergies among different actors involved in DRR and Climate Change Adaptation. The potential and limitations of the proposed approach for regional landslide risk and for multi-hazard risk assessment will be discussed. The described research activities have been carried out within the framework of an international project funded by the European Union, implemented by the International Organization of Migration (IOM) and coordinated by IDOM (Spain).</p>

Objectives Analyze the efficacy in pain management of continuous ropivacaine subfascial wound infusion after caesarean delivery. Design Prospective, randomized controlled, double-blind study. Participants 69 caesarean section patients. Intervention After standardised spinal anesthesia (8-10 mg of 0.5 % hyperbaric bupivacaine combined with 2-2.5 μg of sufentanil) patients were randomly allocated: ropivacaine 0.2 % infused through a subfascial wound catheter (n = 35) or NaCl 0.9 % (n = 34), for 48 hours combined with recommended multimodal analgesia approach. Outcomes The primary outcome was the total amount of IV opioid use by patient-controlled analgesia in the first 48 hours after caesarean delivery. Secondary outcomes, assessed at regular intervals, were intensity of pain evaluated by VAS (0-10) at rest and at mobilisation, the incidence of post-operative nausea/vomiting and pruritus and time of first ambulation. Results Morphine consumption was significantly lower (mean ± standard deviation), in the ropivacaine group (21.52 mg ± 21.56) compared to the placebo group (29.57 mg ± 22.38; P value = 0.047). No significant differences were observed in pain evaluated by VAS (mean ± standard deviation), except for pain at mobilisation 6 hours after surgery (ropivacaine vs. placebo: 3.90 ± 2.66 vs. 5.36 ± 2.55; P value = 0.03). No significant differences were observed in the incidence of post-operative nausea/vomiting and pruritus and time of first ambulation. Conclusion Continuous ropivacaine subfascial wound infusion can be considered as an effective analgesic method in addition to multimodal analgesia after caesarean delivery, resulting in less morphine consumption. Trail registration EudraCT 2017-004797-33 Funding none