AAGBI/Anaesthesia Research Grant
The successful applicants for the AAGBI/Anaesthesia Research Grant were:
Principal Applicant
Dr Rachel Evley
Post-Doctoral Research Fellow, University of Nottingham
Title
To determine general practitioners' views on 'good' postsurgical outcomes utilising mixed qualitative methodology
Amount
£14,613
Scientific Abstract
The White Paper, Equity and Excellence: Liberating the NHS1 sets out how the improvement of healthcare outcomes for all would be the primary purpose of the NHS. More specifically the Royal College of Surgeons of England have made clear their commitment to improved methods of ensuring high standards in surgical practice through public reporting of operation outcomes, in the document 'Measuring and using outcomes from surgery'.2 Outcomes from perioperative care are becoming more relevant to the primary care setting, not only with commissioning services but following the introduction in 2010 of the Enhanced Recovery Programme (ERP) patients are being discharged back to the primary care setting earlier.3 However, there is little evidence that currently determined postoperative outcomes take into account the problems encountered in primary care.
In this project we aim to determine what would be considered by a General Practitioner (GP) to be a 'good outcome' in the general post-surgical population. Using mixed qualitative methodology we will explore the post-surgical problems which GPs encounter, and their perception of what factors may influence these problems. Four different case scenarios of elective surgery will be presented, and a modified Delphi process will be used to synthesize opinion, the expected outcomes, and factors influencing outcomes.
First Year Report from Dr R Evley.pdf (71 KB)
Principal Applicant
Dr Daniel Harper
Research Fellow, Scarborough Hospital
Title
Pain relief after colorectal surgery: single-shot spinal combined with Painbuster®; vs. Painbuster®; alone. A double blind pilot randomised controlled trial.
Amount
£9,408
Scientific Abstract
Limiting surgical stress and managing postoperative pain are well understood to influence recovery and outcome from major surgery for colorectal cancer and both are fundamental aspects of enhanced recovery protocols.
Traditional approaches for dealing with these problems such as epidural or patient controlled intravenous opioid analgesia are associated with problems that may be detrimental to postoperative recovery and surgical outcome. As a result there is evidence in the literature of increasing interest in alternative techniques such as intrathecal anaesthesia or continuous wound infusion of local anaesthetic, however nobody has examined the effect of combining the techniques or their impact on the surgical stress response.
We intend to compare patients undergoing major resections for colorectal cancer receiving intrathecal anaesthesia in combination with a wound infusion of local anaesthetic with those receiving a continuous wound infusion alone. We will examine the surgical stress response and postoperative pain control in addition to objective measures of postoperative recovery.
We suggest that our approach will attenuate the surgical stress response and provide optimal pain control that will ultimately translate in improved recovery and outcome following surgery for colorectal cancer.
Principal Applicant
Dr James Jack
Anaesthetic SHO, Sussex County Hospital
Title
A study to determine the accuracy of zero-flux and ingestible thermometers in the perioperative setting
Amount
£2,869
Scientific Abstract
Good perioperative temperature measurement and management have been
demonstrated to improve patient outcomes. A temperature difference of 0.5°C is clinically significant so, in the perioperative period, a thermometer needs to be accurate to 0.5°C. Oesophageal and urinary bladder temperatures are accurate but unsuitable for many surgical patients. The current, clinically suitable, non-invasive thermometers are not accurate enough.
This study will investigate two methods of temperature measurement which
potentially offer significant improvements to perioperative care and research. The first is zero-flux thermometry whereby an adhesive pad on the forehead equilibrates with the patient's core temperature. The second is an ingestible capsule. This could become a powerful research tool by providing accurate readings over the whole perioperative period thereby showing us the points in the patient journey that should be targeted for prevention of heat loss or additional warming.
Aim:
To determine the accuracy during surgery of zero-flux thermometry and ingestible
capsules.
Methods:
An observational study comparing the two new methods with oesophageal
measurements. Sample size calculations show that we need a 15 patients. Temperature readings will therefore be downloaded from each device for 20 patients with a maximum
interval of 1 minute. Agreement will be determined through Bland-Altman analysis.
Principal Applicant
Dr Ben Clevenger & Dr Ramanathan Kasivisvanathan
Anaesthetic Registrars, Royal Free NHS Foundation Trust, London
Title
Short-term Outcomes with Intrathecal Opioid and Patient Controlled Analgesia versus Thoracic Epidural Analgesia for Hepatic Resection: A Randomised Controlled Trial
Amount
£18,867
Scientific Abstract
Thoracic epidural analgesia (TEA) forms the mainstay of most multimodal analgesia packages in Enhanced Recovery Programmes (ERP) for hepatic resection (HR) surgery. Postoperatively TEA has been shown to provide superior analgesia and improved respiratory function in major intra-abdominal surgery. TEA however, is accompanied by a significant failure rate. The use of TEA in HR can result in postoperative hypotension and excessive fluid administration, leading to increased "top up" blood transfusions, delayed mobilisation and increased length of stay (LOS). Due to the absence of large scale trials there is a state of clinical equipoise as to whether alternative forms of analgesia can provide better outcomes for HR.
Intrathecal morphine (ITM) and PCA has been shown to be an effective alternative to TEA in HR and may offer advantages in the context of an ERP. To date there have been no randomised controlled trials (RCT) looking at outcomes beyond pain scores between these two analgesic options.
This RCT aims to compare the outcomes of TEA with those of single shot ITM plus PCA for HR. The primary outcome is time until medically fit for discharge (tMFD). Secondary outcomes are total LOS, pain scores, fluid and blood transfusion requirements, time to mobilisation, postoperative morbidity scores (POMS), morbidity and 30 day mortality; and quality of recovery (QoR) and quality of life (QoL) scores.
First report from Dr B Clevenger & Dr R Kasivisvanathan (74 KB)
