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  1. Article ; Online: Use of pudendal nerve blocks in rubber band ligation of haemorrhoids: an Australia-wide cross-sectional analysis.

    Watson, Eleanor G R / Ong, Hwa Ian / Proud, David M / Mohan, Helen M / Korda, Rosemary J

    ANZ journal of surgery

    2024  

    Abstract: Background: Surgeons vary in their approach to preventing pain post rubber band ligation (RBL) of haemorrhoids, with pudendal nerve blocks (PNB) being one analgesic strategy. No data exists on how commonly PNBs are used in RBL in Australia, and whether ... ...

    Abstract Background: Surgeons vary in their approach to preventing pain post rubber band ligation (RBL) of haemorrhoids, with pudendal nerve blocks (PNB) being one analgesic strategy. No data exists on how commonly PNBs are used in RBL in Australia, and whether use varies by year and patient and hospital characteristics.
    Methods: Aggregate data from the National Hospital Morbidity Database was obtained for all admissions for RBL in Australia from 2012 to 2021, with and without a PNB, overall and in relation to sex, age group, hospital remoteness, hospital sector, and year of procedure. Adjusted relative risks (adj. RR) of PNB were estimated using Poisson regression, mutually adjusting for all variables.
    Results: Of the 346 542 admissions for RBL, 14013 (4.04%) involved a PNB. The proportion of patients receiving a PNB increased between 2012-2013 and 2020-2021, from 1.62% to 6.63% (adj. RR 3.99, CI 3.64-4.36). Patients most likely to receive a PNB were female (adj. RR 1.10; CI 1.07-1.14) aged 25-34 years (adj. RR 1.13; CI 1.01-1.26); in major-city (adj. RR 1.25 CI 1.20-1.30) and private hospitals (adj. RR 3.28 CI 3.13-3.45).
    Conclusion: This is the first published analysis of the use of PNB in RBL. Pudendal nerve block use has increased over time, with substantial variation in practice. Blocks were more than three times as likely to be used in private compared to public hospitals. If evidence supporting PNB use is established, equitable access to the procedure should be pursued.
    Language English
    Publishing date 2024-01-04
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.18849
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 180: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Analgesic effect of local anaesthetic in haemorrhoid banding: systematic review and meta-analysis.

    Watson, Eleanor G R / Ong, Hwa Ian / Shearer, Nicholas J W / Smart, Philip J / Burgess, Adele N / Proud, David M / Mohan, Helen M

    International journal of colorectal disease

    2024  Volume 39, Issue 1, Page(s) 34

    Abstract: Purpose: Rubber band ligation of haemorrhoids can be,painful and there is no consensus regarding the optimal analgesic strategy. This study aims to determine whether there is a difference in post-procedural pain in adults undergoing haemorrhoid banding ... ...

    Abstract Purpose: Rubber band ligation of haemorrhoids can be,painful and there is no consensus regarding the optimal analgesic strategy. This study aims to determine whether there is a difference in post-procedural pain in adults undergoing haemorrhoid banding who have received local anaesthetic, a pudendal nerve block or no regional or local analgesia.
    Methods: MEDLINE, Embase, Google Scholar and clinical trial registries were searched for randomised trials of local anaesthetic or pudendal nerve block use in banding. Primary outcomes were patient-reported pain scores. The quality of the evidence was assessed using the GRADE approach.
    Results: Seven studies were included in the final review. No articles were identified that studied pudendal nerve blocks. The difference in numerical pain scores between treatment groups favoured the local anaesthetic group at all timepoints. The mean difference in scores on a 10-point scale was at 1 h,-1.43 (95% CI-2.30 to-0.56, p < 0.01, n = 342 (175 in treatment group)); 6 h,-0.52 (95% CI-1.04 to 0.01, p = 0.05, n = 250 (130 in treatment group)); and 24 h,-0.31 (95% CI-0.82 to 0.19, p = 0.86, n = 247 (127 in treatment group)). Of reported safety outcomes, vasovagal symptoms proceeded to meta-analysis, with a risk ratio of 1.01 (95% CI 0.64-1.60). The quality of the evidence was rated down to 'low' due to inconsistency and imprecision.
    Conclusion: This review supports the use of LA for reducing early post-procedural pain following haemorrhoid banding. The evidence was limited by small sample sizes and substantial heterogeneity across studies.
    Registration: PROSPERO (ID CRD42022322234).
    MeSH term(s) Humans ; Anesthesia, Local ; Anesthetics, Local ; Hemorrhoids/surgery ; Pain ; Pain, Procedural
    Chemical Substances Anesthetics, Local
    Language English
    Publishing date 2024-03-04
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-024-04609-8
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    Zs.A 2121: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: A pilot randomised controlled trial of patient education to improve umbilical cleanliness prior to laparoscopic surgery.

    Watson, Eleanor G R / Cobden, Elizabeth J / Vasey, Carolyn E

    ANZ journal of surgery

    2021  Volume 91, Issue 12, Page(s) 2650–2655

    Abstract: Background: Before laparoscopic abdominal surgery, surgeons frequently remove debris from patients' umbilici to prevent it from passing into the abdomen and optimise skin antisepsis. This task irritates the skin, takes time and contaminates sterile ... ...

    Abstract Background: Before laparoscopic abdominal surgery, surgeons frequently remove debris from patients' umbilici to prevent it from passing into the abdomen and optimise skin antisepsis. This task irritates the skin, takes time and contaminates sterile equipment. This pilot randomised controlled trial aimed to inform a definitive study investigating whether patient education improves umbilical cleanliness in these patients.
    Methods: To generate data on effect size and sample size, adult patients undergoing elective and emergency laparoscopic abdominal surgery were randomised to an intervention group, who received an education pack to clean their umbilicus prior to surgery, or a control group, who received no pack. Umbilical cleanliness was measured using a novel scale. To assess scale validity and reliability, all umbilici were scored by nine surgeons and surgical trainees using photographs and umbilici were swabbed to estimate bacterial load. Intervention acceptability was assessed via study consent and withdrawal rates and trial feasibility was evaluated using qualitative insights documented by investigators.
    Results: Seventy-one percent (22/31) of the intervention group had clean umbilici versus 61% (19/31) in the control group. A definitive trial would require 712 participants to show statistical significance between study groups. The umbilical cleanliness scale had excellent interrater and test-retest reliability and a moderate degree of convergent validity with respect to bacterial load. The intervention was highly acceptable to participants, and theatre nurses and surgical trainees were central to trial feasibility.
    Conclusion: A definitive trial is warranted and would contribute to an evidence-based, standardised approach to preoperative care. Trial registration no. ACTRN12620000278932.
    MeSH term(s) Humans ; Laparoscopy ; Patient Education as Topic ; Pilot Projects ; Reproducibility of Results ; Umbilicus/surgery
    Language English
    Publishing date 2021-09-01
    Publishing country Australia
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.17172
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 180: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Navigating parenthood in the surgical profession: mixed-methods study.

    Vasey, Carolyn E / Watson, Eleanor G R / Commons, Robert J / Liang, Rhea / Nestel, Debra

    The British journal of surgery

    2022  

    Abstract: Background: Significant barriers exist to surgeons being good parents and parents being good surgeons, and these barriers are heightened for women. Considering the gender balance now present in postgraduate medical schools, it is critical that these ... ...

    Abstract Background: Significant barriers exist to surgeons being good parents and parents being good surgeons, and these barriers are heightened for women. Considering the gender balance now present in postgraduate medical schools, it is critical that these barriers are overcome if surgery is to attract and retain applicants. This study aimed to investigate patterns of parenthood in surgery, explore associated attitudes and experiences, and identify barriers and solutions within an Australian and New Zealand context.
    Methods: Surgeons and trainees were invited to participate in a survey and focus groups. Quantitative results were described, and textual responses and focus group transcriptions were analysed thematically.
    Results: There were 261 survey respondents (62.8 per cent women, 37.2 per cent men) and six focus groups (34 participants). Of the survey respondents, 79.6 per cent of women and 86.5 per cent of men had children. Women were more likely to time childbirth around training or work, and most respondents without children attributed this to their career. Tensions between parenthood and surgery engendered guilt for surgeon-parents. Parenthood was often the 'elephant in the room' in training and employment discussions. Breaking the silence around parenthood and surgery made it more acceptable, normalising positive behaviour changes. The major barrier to parenthood and surgery was the lack of flexible training opportunities. Participants called for top-down establishment of mandated, stand-alone, permanent part-time training positions.
    Conclusion: Many barriers to parenthood in surgery are created by rigid workplace and professional structures that are reflective of male-dominated historical norms. A willingness to be flexible, innovative and rethink models of training and employment is central to change.
    Language English
    Publishing date 2022-11-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znac364
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.66: Show issues Location:
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  5. Article ; Online: Local anaesthetic infiltration in rubber band ligation of rectal haemorrhoids: study protocol for a three-arm, double-blind randomised controlled trial (PLATIPUS trial).

    Watson, Eleanor G R / Qin, Kirby R / Smart, Philip J / Burgess, Adele N / Mohan, Helen M / Proud, David M

    BMJ open

    2023  Volume 13, Issue 3, Page(s) e067896

    Abstract: Introduction: Rubber band ligation ('banding') is a common approach for the management of symptomatic haemorrhoids. However, up to 90% of patients experience postprocedural pain, and there is no consensus regarding the optimal analgesic strategy. In ... ...

    Abstract Introduction: Rubber band ligation ('banding') is a common approach for the management of symptomatic haemorrhoids. However, up to 90% of patients experience postprocedural pain, and there is no consensus regarding the optimal analgesic strategy. In practice, patients may receive submucosal local anaesthetic, pudendal nerve block or routine periprocedural analgesia. The aim of this study is to compare the efficacy of submucosal local anaesthetic, pudendal nerve block and routine analgesia for postprocedural pain in patients undergoing haemorrhoid banding.
    Methods and analysis: This is a multicentre, prospective, three-arm, double-blind randomised controlled trial of adults booked for haemorrhoid banding. Participants will be randomised to one of three groups in a 1:1:1 ratio: (1)submucosal bupivacaine injection; (2) pudendal nerve ropivacaine injection and (3) no local anaesthetic. The primary outcome is patient reported postprocedural pain (scored 0-10) from 30 min to 2 weeks. Secondary outcomes include postprocedural analgesia use, time to discharge, patient satisfaction, time to return to work and complications. A sample size of 120 patients is required to achieve statistical significance.
    Ethics and dissemination: This study received Human Research Ethics Approval from the Austin Health Human Research Ethics Committee (March 2022). Trial results will be submitted to a peer-reviewed journal, and presented at academic meetings. A summary of the trial results will be made available to study participants on request.
    Trial registration number: ACTRN12622000006741p.
    MeSH term(s) Adult ; Humans ; Anesthesia, Local/methods ; Anesthetics, Local ; Double-Blind Method ; Hemorrhoids/surgery ; Multicenter Studies as Topic ; Pain ; Pain, Postoperative/prevention & control ; Prospective Studies ; Randomized Controlled Trials as Topic
    Chemical Substances Anesthetics, Local
    Language English
    Publishing date 2023-03-08
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-067896
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Technique for pudendal nerve block in proctology - a video vignette.

    Watson, Eleanor G R / Shearer, Nicholas J W / Smart, Philip J / Burgess, Adele N / Proud, David M / Mohan, Helen M

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2023  Volume 25, Issue 7, Page(s) 1562–1563

    MeSH term(s) Humans ; Pudendal Nerve/surgery ; Colorectal Surgery ; Nerve Block/methods ; Anesthetics, Local
    Chemical Substances Anesthetics, Local
    Language English
    Publishing date 2023-05-31
    Publishing country England
    Document type Video-Audio Media ; Letter
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16626
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5799: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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