Episode #171 A Literature Review and Patient Safety at Anesthesiology 2023

Hello and welcome back to the Anesthesia Patient Safety Podcast.  My name is Alli Bechtel, and I am your host. Thank you for joining us for another show and this is a special preview episode! The American Society of Anesthesiologists Annual Meeting, Anesthesiology 2023 kicks off this week in San Francisco, CA. The conference runs from October 13-17^th. Are you going to the conference? You might be on your way there now! We want to make sure that you know all about the patient safety sessions and educational offerings and ways to contribute!

Before we talk about the APSF talks at Anesthesiology 2023, let’s do a quick dive into the literature. Thank you to Jayashree Sood for completing the summary of the article, “Non-opioid analgesics for the prevention of chronic postsurgical pain: a systemic review and network meta-analysis” by Doleman and colleagues published in the British Journal of Anesthesia in April 2023. To follow along with us, head over to APSF.org and click on the Patient Safety Resources Heading, 5^th one down is In the Literature and then scroll down until you get to our featured article today. I will include a link in the show notes as well.

Have you heard about this article. It addresses a big threat to anesthesia patient safety that may impact patients after surgery or even discharge from the hospital, Chronic post-surgical pain. Did you know that 20-30% of patients who have surgery may continue to experience pain post-operatively? This study is a meta-analysis that looked at the impact of non-opioid analgesic medications on immediate pain control and on the prevention of chronic post-surgical pain. The analysis included 134 trials with over 23,000 patients with a focus on randomized controlled trials of adults who had different surgical procedures. The interventions included the following non-opioid analgesics which are effective for treating acute postoperative pain and were administered via routes other than neuraxial.

• Paracetamol
• Non-steroidal anti-inflammatory drugs
• COX-2 inhibitors
• Ketamine
• Gabapentinoids (pregabalin and gabapentin)
• Alpha-2 agonists (clonidine and dexmedetomidine)
• Nefopam
• Intravenous lidocaine

At this time, we do not know what causes chronic post-surgical pain, but it may be due to a combination of the intensity of acute pain, sustained peripheral inflammation, central sensitization, and heightened pain sensitivity.

Chronic post-surgical pain is defined as pain persisting for 3 months or more.

This study focused on the occurrence of chronic post-surgical pain within the first 6 months after surgery. Secondary outcomes included utilization of opioids in the first 6 months and beyond and the severity of opioid usage in these time frames and the occurrence of serious adverse events.

The study revealed that IV lidocaine was the most effective for reducing the incidence of CPSP 6 months after surgery. This was followed by Ketamine, gabapentinoids, and dexmedetomidine.

For more information, we hope that you will check out the original article. Check out the citation in the show notes. Plus, for more In the Literature reviews, head over to APSF to a summary of recent noteworthy patient safety articles.

Now, let’s talk about the big upcoming meeting. Patient safety at Anesthesiology 2023 kicks off with three featured APSF Events.

The APSF Panel is on Saturday, October 14^th from 1:15-2:15 in the afternoon. It is called, “Emerging Medical Technologies – A Patient Safety Perspective on Wearables, Big Data, and Remote Care.” The moderator is Jeffrey Feldman, and the panelists include Ashish Khanna (Ash-sheesh), Jonathan Tan, and Michael Scott. If you attended the 2023 APSF Stoelting Conference last month or tuned into the livestream, then you will have a sneak peek at this topic. This panel is a powerhouse of speakers and topics that you do not want to miss!!

Next up is the ASA/APSF Ellison C. Pierce Jr MD Patient Safety Memorial Lecture which will be given by John Eichhorn (Ache-corn) on Saturday, October 14, 2023, from 3:45 p.m. – 4:45 p.m. The title of this talk is “Integrating Behavior and Technology for Anesthesia Patient Safety.” We hope to see you there.

We have another exciting patient safety event. It is the “Late Breaking APSF Consensus Recommendations on Perioperative Hemodynamic Instability.” We hope that you can check it out on Sunday, October 15 from 10:15-11:15am. This panel is moderated by the APSF President, Dan Cole and then speakers on the panel include Michael Scott, Louise Sun, Vilma Joseph, and Richard Dutton. Make sure that you are in the audience for the latest in perioperative patient safety.

When you are at these sessions, we want to hear from you! Please share your thoughts and takeaways and highlights from the featured APSF events on twitter and tag us at @APSForg and use the hashtag #ANES23 and if you are listening to the podcast, let us know by using the hash tag #APSFpodcast.

In between these sessions, we hope you will visit the APSF at the ASA Resource Center in the Exhibit Hall and stop by our booth.

We invite you to join the #ASPFCrowd. With your signature, Fresenius Kabi will donate money to APSF. Fresenius Kabi is proud to support the Anesthesia Patient Safety Foundation in important initiatives to support the APSF vision that “no one shall be harmed by anesthesia care.” Your signature on the APSF signing wall boosts global support and provides a crowdfunding contribution to APSF. Your action and a donation made on your behalf helps to provide for the following enduring programs, the APSF website with over 1 million visitors each year, safety research and education, the APSF Newsletter translations, and the APSF Consensus Conferences. Your signature can have a big impact!

Are you in the Giving Mood? Then, we invite you to try out the Dip Jar at the APSF booth. You can donate to the APSF by dipping your credit card in the jar. The donation amount will be displayed on the Dip Jar, and you can support our vision that no one shall be harmed by anesthesia care.”  We can’t wait to meet you at the APSF booth at the ASA Annual Meeting in San Francisco!

You might be getting packed up for the conference now, so we are going to wrap up for today. If you have any questions, please email us at [email protected] and check out the show notes for links to everything we discussed today.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2023, The Anesthesia Patient Safety Foundation