To Every Nerve There Is a Needle—The Threat of a Pygmalion Effect

Mossad, Emad B.

doi:10.1053/j.jvca.2020.08.054

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Specific clinical advantages/disadvantages of each technique are beyond the scope of this manuscript yet have been recently summarized. [17][18][19][20][21][22][23][24][25] Advancements in ultrasoundguided techniques have led to an increased use of fascial plane blocks. Major unresolved issues regarding these techniques involve simplicity (easily performed in a busy clinical environment), reliability of postoperative analgesia, time period of analgesia produced (single shot vs. and side effect profile/safety.…”

Section: Intrathecal Morphine In Robotic Cardiac Surgerymentioning

confidence: 99%

Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

et al. 2021

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Background Intrathecal morphine decreases postoperative pain in standard cardiac surgery. Its safety and effectiveness have not been adequately evaluated in minimally invasive cardiac surgery. The authors hypothesized that intrathecal morphine would decrease postoperative morphine consumption after minimally invasive cardiac surgery. Methods In this randomized, placebo-controlled, double-blinded clinical trial, patients undergoing robotic totally endoscopic coronary artery bypass received either intrathecal morphine (5 mcg/kg) or intrathecal saline before surgery. The primary outcome was postoperative morphine equivalent consumption in the first 24 h after surgery; secondary outcomes included pain scores, side effects, and patient satisfaction. Pain was assessed via visual analog scale at 1, 2, 6, 12, 24, and 48 h after intensive care unit arrival. Opioid-related side effects (nausea/vomiting, pruritus, urinary retention, respiratory depression) were assessed daily. Patient satisfaction was evaluated with the Revised American Pain Society Outcome Questionnaire. Results Seventy-nine patients were randomized to receive intrathecal morphine (n = 37) or intrathecal placebo (n = 42), with 70 analyzed (morphine 33, placebo 37). Intrathecal morphine patients required significantly less median (25th to 75th percentile) morphine equivalents compared to placebo during first postoperative 24 h (28 [16 to 46] mg vs. 59 [41 to 79] mg; difference, –28 [95% CI, –40 to –18]; P < 0.001) and second postoperative 24 h (0 [0 to 2] mg vs. 5 [0 to 6] mg; difference, –3.3 [95% CI, –5 to 0]; P < 0.001), exhibited significantly lower visual analog scale pain scores at rest and cough at all postoperative timepoints (overall treatment effect, –4.1 [95% CI, –4.9 to –3.3] and –4.7 [95% CI, –5.5 to –3.9], respectively; P < 0.001), and percent time in severe pain (10 [0 to 40] vs. 40 [20 to 70]; P = 0.003) during the postoperative period. Mild nausea was more common in the intrathecal morphine group (36% vs. 8%; P = 0.004). Conclusions When given before induction of anesthesia for totally endoscopic coronary artery bypass, intrathecal morphine decreases use of postoperative opioids and produces significant postoperative analgesia for 48 h. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Intrathecal Morphine In Robotic Cardiac Surgerymentioning

confidence: 99%

Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

et al. 2021

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“…1 The administration of intraoperative fentanyl at the subjective discretion of this non-blinded anesthesiologist also promotes the likelihood of a Pygmalion effect in the small sample size study. [1][2][3] The use of depth of sedation monitoring with bispectral index or sedation score targets as the basis of intraoperative management may have provided more objective results. 4 Furthermore, reliance on pain-induced hemodynamic responses is compounded by the underlying cardiac disease pathophysiology in patients with multiple co-morbidities.…”

mentioning

confidence: 99%

Probing Analgesic Potential With Prudence!

Magoon

Makhija

Kaushal

2022

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Randomized controlled trials and alternative study designs in surgical oncology

Ceelen¹,

Søreide²

2023

European Journal of Surgical Oncology

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To Every Nerve There Is a Needle—The Threat of a Pygmalion Effect

Cited by 4 publications

References 18 publications

Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

Probing Analgesic Potential With Prudence!

Randomized controlled trials and alternative study designs in surgical oncology

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