P-P26 Post-laparotomy pain: the Rectus Sheath Pocket technique compared to other analgesic modalities

Background Wound pain is a major cause of morbidity after laparotomy, leading to reduced mobility, poor respiratory effort, and delayed discharge. In our centre, we have developed a safe and effective post-operative analgesia technique that reliably delivers a continuous, stable infusion of local anaesthetic solution into a pocket superficial to the posterior rectus sheath. Methods Sixty-eight adult patients were enrolled in the study. Group A, n = 38 received rectus sheath catheter (RSC) analgesia and Group B, n = 30 received standard post-operative analgesia. The pain score on day 1 and total opioid dosage over the first 72 hours post-operatively were recorded. All patients were recruited from Mater Dei Hospital which is the main acute hospital in Malta. The patients who were recruited consecutively for the study group underwent elective or emergency laparotomies within a pancreatic-biliary firm. For the control group, patients underwent elective or emergency laparotomies under the care of other teams within the same surgical department. Results Group A displayed significantly diminished mean pain scores (2.81±2.26 vs 4.66±2.86 p = 0.003) but no statistically significant reduction in cumulative opiate usage. On further subgroup analysis, patients over 65 years of age with RSC, displayed significantly less overall cumulative opiate usage (10.09±15.71 vs 25.79±32.97, p = 0.005). Few mild complications were recorded; catheter dislodgement (5), entrapment of catheter in wound sutures (1) and a wound hematoma (1) caused upon insertion. Conclusions Although inter-cohort demographics are consistent, case heterogeneity is acknowledged as a weakness of this endeavour. In adult patients, RSC has been demonstrated to be feasible, safe, and effective at diminishing pain scores in the postoperative period, especially so in the elderly population.

Effect of sutureless securement on hemodialysis catheter-related bloodstream infection

The use of sutureless securement devices during catheterization might reduce the risk of catheter-related bloodstream infection (CRBSI) by suppressing catheter-exit infection and catheter dislodgement. However, the effectiveness of these devices in reducing CRBSI risk when securing hemodialysis catheters has not been explored. This single-center retrospective observational study examined 211 non-tunneled hemodialysis catheters (NTHCs) from 110 hemodialysis inpatients, of which 121 were secured using conventional skin sutures (Suture group) and 90 with GRIP-LOK (GRIP-LOK group). The stabilized inverse probability of treatment (SIPT)-weighting method was used to generate a new population (SIPT-weighted model) without group differences for each of the 12 predictors of CRBSI development (i.e., age, sex, dialysis history, concomitant acute kidney injury or diabetes, concurrent use of immunosuppressant drugs or aspirin, NTHC insertion site, methicillin-resistant Staphylococcus aureus, carriage, bacteremia event within 3 months before catheterization, hemoglobin level, and serum albumin titer). The effect of GRIP-LOK compared with sutures on CRBSI in the SIPT-weighted model was evaluated using univariate SIPT-weighted Cox proportional regression analysis, which showed a significant CRBSI suppression effect of GRIP-LOK compared with sutures (hazard ratio: 0.17 [95% CI 0.04–0.78], p = 0.023). GRIP-LOK affords a lower risk of CRBSI due to indwelling NTHCs than conventional securement using sutures.

Decreasing leakage during continuous femoral nerve catheter fixation using 2-octyl cyanoacrylate glue (Dermabond®): a randomized controlled trial

Background Continuous peripheral nerve catheters (CPNCs) have been used for postoperative pain relief. A common problem encountered with CPNCs is pericatheter leakage, which can lead to dressing adhesive failure. Frequent dressing changes increase the risk of catheter dislodgement and infections. Adhesive glue is effective in securing the peripheral nerve catheter and decreasing leakage around the catheter insertion site. This study aimed to evaluate the incidence of pericatheter leakage with fixation using 2-octyl cyanoacrylate glue (Dermabond®) as compared to sterile strips. Methods Thirty patients undergoing unilateral total knee arthroplasty (TKA) with continuous femoral nerve catheter for postoperative analgesia were randomized into the catheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) group or the sterile strip group. The primary outcome was the incidence of pericatheter leakage. Secondary outcomes included the frequent of catheter displacement, the difficulty of catheter removal, pain score and patient satisfaction. Results The incidence of pericatheter leakage at 24 and 48 h was 0% versus 93 and 0% versus 100% in the Dermabond® and sterile strip groups, respectively (P < 0.001). The incidence of displacement at 24 and 48 h was 6.7% versus 93.3 and 6.7% versus 100% in the Dermabond® and sterile strip, respectively (P < 0.001). There was no difference in numeric rating scale, difficulty of catheter removal, or satisfaction scores between groups. Conclusions Catheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) decreased the incidence of pericatheter leakage, as well as catheter displacement, over 48 h as compared to sterile strip fixation. Trial registration This trial was registered on Thai clinical trial registry: TCTR20200228002, registered 24 February 2020- Retrospectively registered.

Subcutaneous tunneling technique to improve outcomes for patients undergoing chemotherapy with peripherally inserted central catheters: a randomized controlled trial

Objective To compare the value of the subcutaneous tunneling technique versus the normal technique in improving the outcomes of patients undergoing chemotherapy with peripherally inserted central catheters (PICCs). Methods One hundred thirty patients were randomly divided into an experimental group (subcutaneous tunneling technique) and control group (normal technique) according to the PICC placement technique, and clinical data were compared between the groups. Results In total, 129 PICCs were successfully inserted. Compared with the control group, the experimental group had a lower occurrence of complications after placement (especially catheter dislodgement: 3.1% vs. 15.4%, venous thrombosis: 3.1% vs. 15.4%, and wound oozing: 14.1% vs. 27.7%), lower occurrence of unscheduled PICC removal (3.1% vs. 13.8%), greater comfort during placement (14.16 ± 2.21 vs. 15.09 ± 2.49 on a scale ranging from 6 to 30 points, with higher scores indicating lower degrees of comfort), and lower costs of PICC maintenance (median (interquartile range) per-day maintenance cost: 13.90 (10.99–32.83) vs. 15.69 (10.51–57.46) Yuan). The occurrence of complications and amount of bleeding during placement were not significantly different between the two groups. Conclusions The subcutaneous tunneling technique can improve PICC placement by reducing complications and costs of maintenance with better patient comfort during placement.

Outcome following Percutaneous Trans-hepatic Biliary Drainage (PTBD) in carcinoma gallbladder: A prospective observational study

Introduction: Percutaneous Biliary drainage (PTBD) is required as palliation and optimization for surgery or chemotherapy in carcinoma gallbladder (GBC) but may be associated with complications. We aimed to study the outcomes, complications and changes in quality of life in patients with GBC undergoing PTBD. Methods: A prospective study from July 2018 to December 2019 in patients of GBC presenting with obstructive jaundice was done. Patients planned for PTBD were included in the study. The progression of disease, complications of PTBD, re-interventions, effects on initiation or completion of chemotherapy, surgical resection or intervention, overall survival was recorded. Quality of life (QoL) was assessed using SF–36 questionnaire before and after 4-6 weeks of intervention. Results: Of 160 patients assessed for inclusion, 60 (mean age: 53.7 ± 10.95 years, 27 (45 %) males) were eventually included. Eleven patients (18.3%) had metastatic disease at presentation. Of 60 patients undergoing PTBD, none had immediate procedure related complications, 41(68 %) patients had at-least one and 18 (30%) patients had more than one complication. The most common complication was peri-catheter bile leak (41.6%) followed by catheter dislodgement (30 %), blockage (23.3 %) and bleeding (10 %). Re-intervention was required in 32 (53 %) of patients. There was a significant decrease in QoL after PTBD (P<0.0001). Median survival after PTBD was 12 weeks.Conclusion: The high technical success of PTBD does not translate into the improvement of QoL, survival, and curative surgical treatment.

Decreasing the leakage of continuous femoral nerve catheter fixation using 2-octyl cyanoacrylate glue (Demabond®): A randomized controlled trial

Background: Continuous peripheral nerve catheters (CPNCs) have been used for postoperative pain relief. A common problem encountered with CPNCs is pericatheter leakage, which can lead to dressing adhesive failure. Frequent dressing changes increase the risk of catheter dislodgement and infections. Adhesive glue is effective in securing the peripheral nerve catheter and decreasing leakage around the catheter insertion site. This study aimed to evaluate the incidence of pericatheter leakage with fixation using 2-octyl cyanoacrylate glue (Dermabond®) as compared to sterile strips.Methods: Thirty patients undergoing unilateral total knee arthroplasty (TKA) with continuous femoral nerve catheter for postoperative analgesia were randomized into the catheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) group or the sterile strip group. The primary outcome was the incidence of pericatheter leakage. Secondary outcomes included the frequent of catheter displacement, the difficulty of catheter removal, pain score and patient satisfaction.Results: The incidence of pericatheter leakage at 24 and 48 hours was 0% versus 93% and 0% versus 100% in the Dermabond® and sterile strip groups, respectively (P < 0.001). The incidence of displacement at 24 and 48 hours was 6.7% versus 93.3% and 6.7% versus 100% in the Dermabond® and sterile strip, respectively (P < 0.001). There was no difference in numeric rating scale, difficulty of catheter removal, or satisfaction scores between groups.Conclusion: Catheter fixation with 2-octyl cyanoacrylate glue (Dermabond®) decreased the incidence of pericatheter leakage, as well as catheter displacement, over 48 hours as compared to sterile strip fixation.

Decreasing the leakage of continuous femoral nerve catheter fixation using 2 - octyl cyanoacrylate glue (Demabond®): A Randomized Controlled Trial study

Background: Continuous peripheral nerve catheters (CPNCs) have been used for postoperative pain relief. A common problem encountered with CPNCs is pericatheter leakage which can lead to dressing adhesive failure. Frequent dressing changes increase the risk of catheter dislodgement and infections. Adhesive glue is effective in securing peripheral nerve catheter and decreasing leakage around the catheter insertion site. This study is aimed to evaluate the incidence of pericatheter leakage by using fixation with 2-octyl cyanoacrylate glue (Demabond®) compared to sterile strip.Methods: Thirty patients undergoing unilateral total knee arthroplasty (TKA) with continuous femoral nerve catheter for postoperative analgesia were randomized to catheter fixation with 2-octyl cyanoacrylate glue (Demabond®) group or sterile strip group. The primary outcome was the incidence of pericatheter leakage. Secondary outcomes included: frequent of catheter displacement, difficulty of catheter removal, pain score and patient satisfaction.Results: The incidence of pericatheter leakage at 24 and 48 hours was 0% versus 93% and 0% versus 100% in the Demabond and sterile strip group, respectively (P < 0.001). The incidence of displacement at 24 and 48 hours was 6.7% versus 93.3% and 6.7% versus 100%, respectively (P < 0.001). There was no difference in numeric rating scale, difficulty of catheter removal as well as satisfaction scores between groups.Conclusion: Catheter fixation with 2-octyl cyanoacrylate glue (Demabond®) decreased the incidence of pericatheter leakage as well as catheter displacement over 48 hours when compared to sterile strip fixation.

Venous catheter at alternate exit site in a 2-year-old requiring long-term antibiotics for osteomyelitis: A case report

In the pediatric population, vascular access is often challenging to secure and to maintain, especially for long-term intravenous (IV) treatment. The traditional approach for patients who require long-term IV antibiotics is placement of a peripherally inserted central catheter (PICC). The challenge in the pediatric population is the high risk of dislodgement after PICC placement, as these patients tend to pull their line out accidentally or purposefully. Current bedside options to prevent catheter dislodgement include adhesive securement devices, subcutaneous securement devices, sutures, and wrapping the site in gauze. However, these modalities often fail, leading to delay in administration of IV therapies, including life-saving antibiotics. A novel approach to this very common and serious issue is to tunnel the catheter subcutaneously, thereby placing the exit site in a location difficult for the patient to reach. Tunneled catheters generally are placed in children for long-term vascular access and insertion has primarily been reserved for surgeons in the operating room or by interventional radiologists. The following case report describes a central venous access catheter placed in the internal jugular vein and tunneled to the medial dorsal thoracic region successfully at the bedside, using intracavitary electrocardiogram (ECG) navigation under moderate sedation. Although a novel exit site, the technique of tunneling and use of the jugular vein is no different than traditional tunneling techniques therefore it was not deemed necessary to seek internal review board approval.

Ultrasound-Guided Peripheral Nerve Stimulation for Knee Pain: A Mini-Review of the Neuroanatomy and the Evidence from Clinical Studies

Objectives Peri- and postoperative pain frequently develops after joint replacement for severe knee osteoarthritis. A continuous nerve block is commonly used for pain relief, but the risks of infection and catheter dislodgement should be considered. The present mini-review aimed to brief the innervation and neural sonoanatomy of the knee joint and summarize the newest evidence of peripheral nerve stimulation (PNS) use in the management of knee pain. Methods We used a systematic approach to search for relevant articles. We used the combination of “peripheral nerve stimulation” and “knee pain” as the key words for the literature search using the electronic database without language or article type restriction. The search period was from the earliest record to August 2019. Results The present review identified six studies, four of which were related to PNS for management of postoperative knee pain and two of which probed neuropathic pain. Most of the studies were either case series or case reports. Based on our search result, PNS is likely to be a feasible and safe treatment for knee pain, but its effectiveness remains uncertain. Conclusions The present review reveals that PNS is feasible for the management of knee pain, especially in the postoperative period. The procedure is safe under ultrasound guidance used for proper placement of the electrodes near the target nerves. In the future, more prospective randomized controlled trials are needed to validate the effectiveness of PNS in acute and chronic knee pain.

Use of N-acetyl cysteine to retrieve entrapped Malecot catheter in liver: an old agent for a novel application

Percutaneous catheter drainage is one way of treating large liver abscesses that are partially liquefied or have thick pus. Apart from discomfort, severe pain, inflammation or frank cellulitis at the insertion site, and sometimes catheter dislodgement, failure to retrieve a catheter is unusual. This may occur either due to fibrous tissue securing the catheter or when inspissated secretions prevent the catheter tip from straightening. N-acetyl cysteine is a mucolytic and exerts action in many parts of the body such as the mouth, throat and lungs. We report successful removal of a catheter stuck in the liver using this substance.