Anaesthesia Latest Evidence Newsletter

May 2016

Outreach Your Outreach Librarian can help facilitate evidence-based practise for

all Anaesthesia staff, as well as assisting with academic study and research. We can help with literature searching, obtaining journal

articles and books, and setting up individual current awareness alerts.

Literature Searching We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some

time with one of the librarians for a 1 to 1 session where we can guide you through the process of creating a well-focused literature research and introduce you to the health databases access via NHS Evidence.

Critical Appraisal Training We also offer one-to-one or small group training in literature

searching, accessing electronic journals, and critical appraisal/Statistics. These are essential courses that teach how to

interpret clinical papers.

For more information, email: katie.barnard@uhbristol.nhs.uk

Books Books can be searched for using SWIMS our online catalogue at

www.swims.nhs.uk. Books and journals that are not available on site or electronically may be requested from other locations. Please email

requests to: library@uhbristol.nhs.uk

mailto:katie.barnard@uhbristol.nhs.ukhttp://www.swims.nhs.uk/mailto:library@uhbristol.nhs.uk

Contents 1: Current Awareness database articles 2: Tables of Contents from May’s Anaesthesia

journals 3: New NICE Guidance 4: Latest relevant Systematic Reviews from the

Cochrane Library 5: Quick exercise

Upcoming Lunchtime Drop-in Sessions

June (12pm)

Weds 8th Understanding articles

Thurs 16th Statistics

Fri 24th Information resources

May (1pm)

Weds 4th Understanding articles

Thurs 12th Statistics

Fri 20th Information resources

Tues 31st Literature Searching

The Library and Information Service provides free specialist information skills training for

all UHBristol staff and students. To book a place, email: library@uhbristol.nhs.uk

If you’re unable to attend we also provide one-to-one or small group sessions. Contact

library@uhbristol.nhs.uk or katie.barnard@uhbristol.nhs.uk to arrange a session.

Current Awareness Database Articles

If you require full articles please email: library@uhbristol.nhs.uk

Title: Similar mortality with general or regional anesthesia in elderly hip fracture patients. Citation: Acta orthopaedica, Apr 2016, vol. 87, no. 2, p. 152-157, 1745-3682 (April 2016) Author(s): Brox, W Timothy, Chan, Priscilla H, Cafri, Guy, Inacio, Maria C S Abstract: Background and purpose - There is continuing confusion among practitioners with regard to the optimal choice of anesthetic type for repair of hip fractures. We investigated whether type of anesthetic was associated with short-term mortality after hip fracture surgery. Patients and methods - We conducted a retrospective cohort study of patients with surgically treated hip fractures, performed between January 1, 2009 and December 31, 2012. Exposure of interest was anesthesia type (general, spinal/neuroaxial, and mixed). Endpoints were 30-, 90-, and 365-day post-surgery mortality. Multivariable conditional logistic regression models were used and odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results - Of the 7,585 participants, 5,412 (71%) were women and the median age was 80 (IQR: 72-85) years old. Of the total cohort, 4,257 (56%) received general anesthesia, 3,059 (40%) received spinal/neuroaxial, and 269 (4%) received mixed anesthesia. Overall, the incidence of 30-, 90-, and 365-day mortality was 4% (n = 307), 8% (n = 583), and 15% (n = 1,126), respectively. When compared with general anesthesia, the 365-day odds of mortality was marginally lower in patients with spinal/neuroaxial anesthesia (OR = 0.84, CI: 0.70-1.0), but it was similar in patients with mixed anesthesia (OR = 1.3, CI: 0.70-2.3). No other statistically significant differences were observed. Interpretation - Regarding mortality, this study does not support specific recommendations regarding the type of anesthetic in surgery of fractured hips.

Title: Radiation safety for anaesthesia providers in the orthopaedic operating room. Citation: Anaesthesia, Apr 2016, vol. 71, no. 4, p. 455-461, 1365-2044 (April 2016) Author(s): Rhea, E B, Rogers, T H, Riehl, J T Abstract: In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

Title: Does Ondansetron Modify Sympathectomy Due to Subarachnoid Anesthesia?: Meta-analysis, Meta-regression, and Trial Sequential Analysis. Citation: Anesthesiology, Apr 2016, vol. 124, no. 4, p. 846-869, 1528-1175 (April 2016) Author(s): Terkawi, Abdullah S, Mavridis, Dimitris, Flood, Pamela, Wetterslev, Jørn, Terkawi, Rayan S, Bin Abdulhak, Aref A, Nunemaker, Megan S, Tiouririne, Mohamed Abstract: Disagreement among many underpowered studies has led to an equivocal understanding of the efficacy of the 5-HT3 antagonist ondansetron in preventing the consequences of

mailto:library@uhbristol.nhs.uk

sympathectomy after subarachnoid anesthesia. The authors assessed the efficacy of ondansetron with respect to the overall quality and statistical power of the meta-analyses. The authors used a standard and a newer method of meta-analysis, trial sequential analysis (TSA), to estimate adjusted CIs based on how much information has been accrued. They also used random-effects meta-analyses techniques, small trial bias assessment, selection models, sensitivity analyses, and the Grading of Recommendations on Assessment, Development, and Evaluation system. These results from the aforementioned techniques were compared, and importance of consideration of these factors was discussed. Fourteen randomized placebo-controlled trials (1,045 subjects) were identified and analyzed. By using conventional meta-analyses, the authors determined that ondansetron was associated with reduction in the incidence of hypotension (relative risk = 0.62 [95% CI, 0.46 to 0.83], P = 0.001; TSA-adjusted CI, 0.34 to 1.12; I = 60%, P = 0.002) and bradycardia (relative risk = 0.44 [95% CI, 0.26 to 0.73], P = 0.001; TSA-adjusted CI, 0.05 to 3.85; I = 0%, P = 0.84). However, the authors found indications of bias among these trials. TSAs demonstrated that the meta-analysis lacked adequate information size and did not achieve statistical significance when adjusted for sparse data and repetitive testing. The Grading of Recommendations on Assessment, Development, and Evaluation system showed that the results had low to very low quality of evidence. The analyses fail to confirm evidence that ondansetron reduces the incidence of hypotension and bradycardia after subarachnoid anesthesia due to the risk of bias and information sizes less than the required. As results from meta-analysis are given significant weight, it is important to carefully evaluate the quality of the evidence that is input. Full Text: Available from Ovid in Anesthesiology

Title: Double-dorsal versus single-volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial. Citation: Emergency medicine Australasia : EMA, Apr 2016, vol. 28, no. 2, p. 193-198, 1742-6723 (April 2016) Author(s): Martin, Shane P, Chu, Kevin H, Mahmoud, Ibrahim, Greenslade, Jaimi H, Brown, Anthony Ft Abstract: The objective of this present study is to compare pain associated with the double-dorsal versus a single-volar subcutaneous injection in the provision of digital anaesthesia for finger injuries presenting to the ED. A randomised controlled trial from November 2012 to January 2014 at a single adult tertiary-referral hospital. ED patients with finger injuries requiring digital anaesthesia was randomised to either the double-dorsal or a single-volar subcutaneous injection technique. The primary outcome was patient reported injection pain measured on a 100 mm visual analogue scale with the assessor blinded to the injection technique. The secondary outcome was success of anaesthesia defined as ability to perform the assessment and treatment without further anaesthetic supplementation after 5 min. Eighty-six patients were enrolled. Median (IQR) age was 34 (24-47) years and 79% were men. The majority (66.3%) had distal phalanx injuries. Forty patients were randomised to the double-dorsal and 46 to a single-volar subcutaneous injection technique. The mean (standard deviation) pain score of the double-dorsal injection was 39.1 (24.2) and a single-volar injection was 37.3 (24.5) with a difference of 1.8 (95% CI -8.8 to 12.3). Digital anaesthesia was successful in 64.9% of the double-dorsal and 71.7% of the single-volar subcutaneous injections, a difference of 6.8% (95% CI -12.7 to 26.3). In ED patients with finger injuries requiring digital anaesthesia, both the double-dorsal or single-volar subcutaneous injection techniques have similar pain of injection and success rates of anaesthesia. Single-volar injection appears suitable alternative to the commonly performed double-dorsal injection in the ED. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

http://link.worldcat.org/?rft.institution_id=130073&spage=846&pkgName=journalsAthens&issn=0003-3022&linkclass=to_article&jKey=00000542-000000000-00000&issue=4&provider=Ovid&date=2016-04&aulast=Terkawi%2C+Abdullah+S&atitle=Does+Ondansetron+Modify+Sympathectomy+Due+to+Subarachnoid+Anesthesia%3F%3A+Meta-analysis%2C+Meta-regression%2C+and+Trial+Sequential+Analysis.&title=Anesthesiology&rft.content=fulltext%2Cprint&eissn=1528-1175&linkScheme=ovid.athens&jHome=http%3A%2F%2Fovidsp.ovid.com%2Fathens%2Fovidweb.cgi%3FT%3DJS%26NEWS%3Dn%26CSC%3DY%26PAGE%3Dtoc%26D%3Dovft%26AN%3D00000542-000000000-00000&volume=124&dbKey=OVFT&rft.order_by=preference&linktype=best

Title: Risks Associated With Anesthesia Services During Colonoscopy. Citation: Gastroenterology, Apr 2016, vol. 150, no. 4, p. 888-894, 1528-0012 (April 2016) Author(s): Wernli, Karen J, Brenner, Alison T, Rutter, Carolyn M, Inadomi, John M Abstract: We aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services. We conducted a prospective cohort study and analyzed administrative claims data from Truven Health Analytics MarketScan Research Databases from 2008 through 2011. We identified 3,168,228 colonoscopy procedures in men and women, aged 40-64 years old. Colonoscopy complications were measured within 30 days, including colonic (ie, perforation, hemorrhage, abdominal pain), anesthesia-associated (ie, pneumonia, infection, complications secondary to anesthesia), and cardiopulmonary outcomes (ie, hypotension, myocardial infarction, stroke), adjusted for age, sex, polypectomy status, Charlson comorbidity score, region, and calendar year. Nationwide, 34.4% of colonoscopies were conducted with anesthesia services. Rates of use varied significantly by region (53% in the Northeast vs 8% in the West; P < .0001). Use of anesthesia service was associated with a 13% increase in the risk of any complication within 30 days (95% confidence interval [CI], 1.12-1.14), and was associated specifically with an increased risk of perforation (odds ratio [OR], 1.07; 95% CI, 1.00-1.15), hemorrhage (OR, 1.28; 95% CI, 1.27-1.30), abdominal pain (OR, 1.07; 95% CI, 1.05-1.08), complications secondary to anesthesia (OR, 1.15; 95% CI, 1.05-1.28), and stroke (OR, 1.04; 95% CI, 1.00-1.08). For most outcomes, there were no differences in risk with anesthesia services by polypectomy status. However, the risk of perforation associated with anesthesia services was increased only in patients with a polypectomy (OR, 1.26; 95% CI, 1.09-1.52). In the Northeast, use of anesthesia services was associated with a 12% increase in risk of any complication; among colonoscopies performed in the West, use of anesthesia services was associated with a 60% increase in risk. The overall risk of complications after colonoscopy increases when individuals receive anesthesia services. The widespread adoption of anesthesia services with colonoscopy should be considered within the context of all potential risks. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Title: Exploring the Impact of Intraoperative Interventions for Pain and Anxiety Management During Local Anesthetic Surgery-A Systematic Review and Meta-Analysis. Citation: Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses / American Society of PeriAnesthesia Nurses, Apr 2016, vol. 31, no. 2, p. 118-133, 1532-8473 (April 2016) Author(s): Hudson, Briony F, Ogden, Jane Abstract: To compare the effectiveness of audiovisual and relaxation-based intraoperative interventions for their impact on intraoperative pain and anxiety. Systematic review and meta-analysis. The following databases were searched for articles published between 1990 and January 2014: MEDLINE, PsychINFO, CINAHL, and Web of Science. Twenty randomized trials meeting the following inclusion criteria were included; adult participants undergoing elective outpatient surgery under local anesthetic using a form of distraction-based intraoperative intervention for the management of anxiety and pain. Thirty percent of studies reviewed found that intraoperative interventions improved patient experience in comparison to treatment as usual, 20% of studies were inconclusive, and 50% of studies found that interventions during surgery provided no benefit. Both relaxation-based and audiovisual interventions were found to be efficacious for pain and anxiety management during surgery under local anesthetic. This review indicates that relaxation-based interventions could be more effective than audiovisual interventions for managing intraoperative anxiety.

Title: Dorsal Penile Nerve Block With Ropivacaine-Reduced Postoperative Catheter-Related Bladder Discomfort in Male Patients After Emergence of General Anesthesia: A Prospective, Randomized, Controlled Study. Citation: Medicine, Apr 2016, vol. 95, no. 15, p. e3409., 1536-5964 (April 2016) Author(s): Li, Jing-Yi, Yi, Ming-Liang, Liao, Ren Abstract: Catheter-related bladder discomfort (CRBD) is a distressing symptom complex after surgery, especially in male patients who have had urinary catheterization under general anesthesia. In this prospective, randomized, controlled trial, we compared dorsal penile nerve block (DPNB) with 0.33% ropivacaine with intravenous tramadol 1.5 mg kg in prevention of CRBD, as well as the incidences of postoperative side effects.Fifty-eight male patients aged 18 to 50 years, undergoing elective liver surgery and limb surgery with urinary catheterization, were enrolled and divided randomly into 2 groups. In the DPNB group, patients were given dorsal penile nerve block with 15 mL of 0.33% ropivacaine, and in the tramadol intravenous administration (TRAM) group, patients were given 1.5 mg kg tramadol after the completion of surgery before extubation. The primary outcome was the incidence of CRBD, and the secondary outcomes included the severity of CRBD, postoperative side effects, postoperative pain, and the acceptance of urinary catheterization. Patients were evaluated upon arrival to postanesthetic care unit (PACU), at 0.5, 1, 2, 4, and 6 hours after patients' arrival in the PACU for outcomes.The incidence of CRBD was significantly lower in the DPNB group than in the TRAM group, either upon arrival to PACU (10.3% vs 37.9%, P = 0.015), or at 0.5 hours (3.4% vs 34.5%, P = 0.003), 1 hours (3.4% vs 37.9%, P = 0.001), 2 hours (6.9% vs 34.5%, P = 0.010), and 4 hours (6.9% vs 27.6%, P = 0.039) after patients' arrival in PACU. Compared with the TRAM group, the severity of postoperative CRBD upon arrival to PACU (P = 0.011) and at 0.5 hours (P = 0.005), 1 hours (P = 0.002), 2 hours (P = 0.005), 4 hours (P = 0.017), and 6 hours (P = 0.047) after patients' arrival in PACU were all significantly reduced in the DPNB group. The incidences of postoperative nausea, vomiting, dizziness, and sedation were decreased significantly in the DPNB group compared with the TRAM group (P < 0.05). The acceptance of urinary catheterization was 93.1% (27/29 patients) in the DPNB group and 58.6% (17/29 patients) in the TRAM group, respectively (P < 0.001).DPNB with ropivacaine has a better effect for CRBD reduction and less side effects than intravenous tramadol administration.The trial has been registered at www.clinicaltrials.gov (NCT01721031).

Title: Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort Study. Citation: Medicine, Apr 2016, vol. 95, no. 16, p. e3468., 1536-5964 (April 2016) Author(s): Chia, Yuan-Yi, Lo, Yuan, Chen, Yan-Bo, Liu, Chun-Peng, Huang, Wei-Chun, Wen, Chun-Hsien Abstract: To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA).LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP.From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was

used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013.Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34).CD with EA might increase the risk of subsequent chronic LBP.

Title: Alkalinized lidocaine versus lidocaine gel as local anesthesia prior to intra-vesical botulinum toxin (BoNTA) injections: A prospective, single center, randomized, double-blind, parallel group trial of efficacy and morbidity. Citation: Neurourology and urodynamics, Apr 2016, vol. 35, no. 4, p. 522-527, 1520-6777 (April 2016) Author(s): Nambiar, Arjun K, Younis, Ayman, Khan, Zainab A, Hildrup, Iona, Emery, Simon J, Lucas, Malcolm G Abstract: To assess the efficacy and morbidity of alkalinized lidocaine solution compared to lidocaine gel for intra-vesical anesthesia during botulinum toxin (BoNTA) injections in a statistically powered, prospective, parallel group, double-blind randomized controlled trial. Fifty-four patients of either sex were randomized to receive either alkalinized lidocaine (AL) solution (10 ml 8.4% sodium bicarbonate + 20 ml 2% lidocaine solution + 22 ml sterile Aquagel®) or lidocaine gel (LG) (22 ml standard 2% lidocaine gel Instillagel® + 30 ml 0.9% normal saline solution). Primary outcome was average pain (assessed by 100 mm visual analog score) felt during intra-vesical BoNTA injections performed at least 20 min after instillation. Secondary outcome was the rate of adverse events. Of 60 randomized patients 54 received the allocated intervention and were analyzed. Mean pain score in the AL group was 17.11 mm (95%CI 8.65-25.57 mm) and in the LG group was 19.53 mm (95%CI 13.03-26.03mm) with no significant difference between the groups. Cost of interventional medication in the AL group was almost double that of the LG group. No adverse events were attributable to local anesthetic instillation in either group. Alkalinized lidocaine solution is not superior to lidocaine gel for anesthesia during intra-vesical BoNTA injections, and the higher cost precludes its use over lidocaine gel at our centre. We have used the results of this study to adapt our local protocol for BoNTA injections and continue to use lidocaine gel as the local anesthetic of choice. Neurourol. Urodynam. 35:522-527, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Title: Occupational exposure to volatile anaesthetics: a systematic review. Citation: Occupational medicine (Oxford, England), Apr 2016, vol. 66, no. 3, p. 202-207, 1471-8405 (April 2016) Author(s): Molina Aragonés, J M, Ayora, A Ayora, Ribalta, A Barbara, Aparici, A Gascó, Lavela, J A Medina, Vidiella, J Sol, López, M Herreros Abstract: The effects of long-term occupational exposure to small concentrations of volatile anaesthetics on health professionals are still uncertain despite the research literature available on this subject. To analyse the existing literature on the health effects of volatile anaesthetics on exposed health professionals. We performed a systematic review from March 2013 to January 2014. The literature was searched in the Medline and Cochrane libraries using the following keywords: 'Anaesthetics AND occupational health', 'Volatile anaesthetics AND occupational health',

'Sevoflurane AND occupational health' and 'Occupational surveillance AND anaesthetics', with no time limit. We used the Scottish Intercollegiate Guidelines Network to evaluate the quality of studies and to grade the recommendations. From 1429 articles retrieved from the databases and an additional 20 obtained from secondary sources, we excluded 1391 (95.9%). After excluding duplicate publications, we finally included 17 articles in the review. Evidence for adverse effects of volatile anaesthetics on exposed personnel is scarce and inconsistent, but there is no evidence of adverse effects when environmental levels are kept within legal threshold values. Further studies are needed to improve our knowledge of the effects of occupational exposure to volatile anaesthetics. New surveillance methods that include systematic data collection, clinical signs and biomarkers of exposure are required to formulate consistent and reproducible surveillance criteria for exposed personnel.

Title: A Prospective, Randomized, Controlled Trial of Paravertebral Block versus General Anesthesia Alone for Prosthetic Breast Reconstruction. Citation: Plastic and reconstructive surgery, Apr 2016, vol. 137, no. 4, p. 660e, 1529-4242 (April 2016) Author(s): Wolf, Omer, Clemens, Mark W, Purugganan, Ronaldo V, Crosby, Melissa A, Kowalski, Alicia M, Kee, Spencer S, Liu, Jun, Goravanchi, Farzin Abstract: Paravertebral blocks have gained popularity because of ease of implementation and a shift toward ambulatory breast surgery procedures. Previous retrospective studies have reported potential benefits of paravertebral blocks, including decreased narcotic and antiemetic use. The authors conducted a prospective controlled trial of patients undergoing breast reconstruction over a 3-year period. The patients were randomized to either a study group of paravertebral blocks with general anesthesia or a control group of general anesthesia alone. Demographic and procedural data, in addition to data regarding pain and nausea patient-reported numeric scores and consumption of opioid and antiemetic medications, were recorded. A total of 74 patients were enrolled to either the paravertebral block (n = 35) or the control group (n = 39). There were no significant differences in age, body mass index, procedure type, or cancer diagnosis between the two groups. Patients who received a paravertebral block required less opioid intraoperatively and postoperatively combined compared with patients who did not receive paravertebral blocks (109 versus 246 fentanyl equivalent units; p < 0.001), and reported significantly lower pain scores at 0 to 1 (3.0 versus 4.6; p = 0.02), 1 to 3 (2.0 versus 3.2; p = 0.01), and 3 to 6 (1.9 versus 2.7; p = 0.04) hours postoperatively. The study group also consumed less antiemetic medication (0.7 versus 2.1; p = 0.05). Incorporating paravertebral blocks carries considerable potential for improving pathways for breast cancer patients undergoing breast reconstruction-with minimal procedure-related morbidity. This is the first prospective study designed to assess paravertebral blocks in the setting of prosthetic breast reconstruction. Therapeutic, II.

Title: A randomized placebo-controlled trial to evaluate a novel noninjectable anesthetic gel with thermosetting agent during scaling and root planing in chronic periodontitis patients. Citation: Saudi journal of anaesthesia, Apr 2016, vol. 10, no. 2, p. 192-197, 1658-354X (2016 Apr-Jun) Author(s): Dayakar, M M, Akbar, S M Abstract: To study the efficacy of a noninjectable anesthetic gel with a thermosetting agent in the reduction of pain during scaling and root planing (SRP) in untreated chronic periodontitis patients. This study is a randomized, double-masked, split-mouth, placebo-controlled trial. Thirty patients were enrolled who underwent SRP in a split-mouth (right side/left side) manner. Before commencement of SRP, both quadrants on each side were isolated and had a randomized gel (either

placebo or test gel) placed in the periodontal pockets for 30 s. The pain was measured using numerical rating scale (NRS) and verbal rating scale (VRS). The median NRS pain score for the patients treated with the anesthetic test gel was 1 (range: 0-4) as opposed to 5 (range: 3-7) in the placebo treated patients. The mean rank of pain score using NRS in test gel was 16.18 as compared to 44.82 in placebo treated sites. Hence, significant reduction in pain was found in test gel as compared to placebo using NRS (P < 0.001). The VRS showed that the majority of patients reported no pain or mild pain with a median of 1 as compared to placebo treated sites with a median of 2 suggestive of moderate pain. The NRS and VRS pain scores showed that the side treated with anesthetic gel was statistically more effective than the placebo in reducing pain during SRP. Full Text: Available from ProQuest in Saudi Journal of Anaesthesia Available from National Library of Medicine in Saudi Journal of Anaesthesia

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http://link.worldcat.org/?rft.institution_id=130073&spage=192&pkgName=nhshospital&PQUEST.WAYFlessID=48304&issn=1658-354X&linkclass=to_article&jKey=226459&issue=2&provider=PQUEST&date=2016-04&aulast=Dayakar%2C+M+M&atitle=A+randomized+placebo-controlled+trial+to+evaluate+a+novel+noninjectable+anesthetic+gel+with+thermosetting+agent+during+scaling+and+root+planing+in+chronic+periodontitis+patients.&title=Saudi+Journal+of+Anaesthesia&rft.content=fulltext%2Cprint&linkScheme=pquest.athens&jHome=http%3A%2F%2Fsearch.proquest.com%2Fpublication%2F226459%2Fshibboleth%3Faccountid%3D48304&volume=10&rft.order_by=preference&linktype=besthttp://link.worldcat.org/?rft.institution_id=130073&spage=192&pkgName=UKPMCFT&issn=1658-354X&linkclass=to_article&jKey=1285&issue=2&provider=NLM&date=2016-04&aulast=Dayakar%2C+M+M&atitle=A+randomized+placebo-controlled+trial+to+evaluate+a+novel+noninjectable+anesthetic+gel+with+thermosetting+agent+during+scaling+and+root+planing+in+chronic+periodontitis+patients.&title=Saudi+Journal+of+Anaesthesia&rft.content=fulltext%2Cprint&eissn=0975-3125&linkScheme=epmc&jHome=http%3A%2F%2Feuropepmc.org%2Fjournals%2F1285%2F&volume=10&rft.order_by=preference&linktype=bestmailto:library@uhbristol.nhs.uk

Tables of Contents from May’s Anaesthesia journals

If you require full articles please email: library@uhbristol.nhs.uk

Anesthesia June 2016, Volume 71, Issue 6

Anesthesia & Analgesia May 2016, Volume 122, Issue 5

Anesthesiology May 2016, Volume 124, Issue 5

British Journal of Anaesthesia May 2016, Volume 116, Issue 5

Current Opinion in Anaesthesiology June 2016, Volume 29, Issue 3

New Guidance

NG46 Controlled drugs: safe use and management

NG45 Routine preoperative tests for elective surgery

mailto:library@uhbristol.nhs.ukhttp://onlinelibrary.wiley.com/doi/10.1111/anae.2016.71.issue-6/issuetochttp://onlinelibrary.wiley.com/doi/10.1111/anae.2016.71.issue-6/issuetochttp://journals.lww.com/anesthesia-analgesia/pages/currenttoc.aspxhttp://journals.lww.com/anesthesia-analgesia/pages/currenttoc.aspxhttp://anesthesiology.pubs.asahq.org/issue.aspxhttp://anesthesiology.pubs.asahq.org/issue.aspxhttp://bja.oxfordjournals.org/content/currenthttp://bja.oxfordjournals.org/content/currenthttp://journals.lww.com/co-anesthesiology/pages/currenttoc.aspxhttp://journals.lww.com/co-anesthesiology/pages/currenttoc.aspxhttps://www.nice.org.uk/guidance/ng46https://www.nice.org.uk/guidance/ng45

Latest relevant Systematic Reviews from the Cochrane Library

Vapocoolants (cold spray) for pain treatment during intravenous cannulation

Topical NSAIDs for chronic musculoskeletal pain in adults

Oral morphine for cancer pain

Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults

Single dose dipyrone (metamizole) for acute postoperative pain in adults

Quick exercise

Heterogeneity Heterogeneity is the extent to which studies brought together in a systematic review demonstrate variation across a range of key variables.

Match the different types of heterogeneity:

1. Statistical heterogeneity (conventionally just known as ‘heterogeneity’) 2. Methodological heterogeneity 3. Clinical heterogeneity

A. Variability in the participants, interventions and outcomes studied B. Variability in study design and risk of bias C. Variability in the intervention effects being evaluated in the different studies

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009484.pub2/fullhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007400.pub3/fullhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003868.pub4/fullhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009016.pub2/fullhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009016.pub2/fullhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011421.pub2/full

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Contact the Anaesthesia Outreach librarian:

katie.barnard@uhbristol.nhs.uk

www.uhbristol.nhs.uk/for-clinicians/

library-and-information-service