OAA Large Project Grant

The successful applicants for the OAA Large Project Grant were:

Principal Applicant
Dr Nicola Beale
Consultant Anaesthetist, John Radcliffe Hospital, Oxford

Oxford Persisting Post-Operative Pain Study (OxPPOPS): the incidence and predictive factors of persisting pain one year after caesarean section


Scientific Abstract
Chronic pain is a worldwide problem affecting 20% of the adult population, costing 200 billion Euros per annum. It has a major impact on quality of life, as many of the drugs used in its treatment are ineffective. Post-operative pain persisting for many months after surgery is an increasingly recognised source of chronic pain. Nearly a quarter of women give birth by caesarean section (CS), which is now one of the most frequently performed operations in the UK. It has been estimated that at least 15% of women experience pain for at least one year after caesarean section and, given the large number of women undergoing surgery, this represents a significant problem. This longitudinal prospective study aims to identify the incidence of persistent pain one year after elective caesarean section. Several mechanisms for the development of chronic pain have been identified including patient psychological factors, anaesthetic techniques, the surgical procedure and
post-operative analgesic management. By collecting data on all aspects of the patient and their treatment, we aim to identify the predictive factors involved in the transition to chronic pain. Knowledge of these factors will enable us to develop interventions that will ultimately reduce the incidence of persistent post-operative pain.
 First year report from Dr N Beale.pdf (99 KB)

Principal Applicant
Dr Catherine Ralph
Blood Conservation Lead, Royal Cornwall Hospital

Is cell salvage of vaginal blood loss suitable for re-infusion?


Scientific Abstract
Establishing routine intra-operative cell salvage (ICS) can contribute to the conservation of allogeneic blood transfusion to the obstetric population 1. A significant proportion of women who have a massive obstetric haemorrhage will bleed vaginally and are denied the opportunity to have an autologous blood re-infusion.

Blood lost vaginally will be collected into an adapted adhesive drape with a reservoir, from which it will be immediately aspirated into a Haemonetics Cell Saver®; 5 + system; If adequate volumes are collected, it will be processed. Pre-wash samples from the collection reservoir and post wash samples will be taken and tested for alpha-feta-protein (AFP), heparin levels, fetal red blood cells, plasma free haemoglobin (Hb), Hb, haematocrit (Hct), potassium and microalbumin. In addition the sample will be sent to microbiology to test for contamination.

The results from analysis of 50 cases-2 samples per case, will be recorded and compared to the quality of samples from ICS blood.

ICS is currently restricted to women who bleed in theatre. This project aims to assess the suitability of re-infusing salvaged vaginal blood.

1. Ralph CJ, Sullivan I, Faulds J. Intra-operative cell salvaged blood as part of a blood conservation strategy in Caesarean section: is fetal red cell contamination important? Br J Anaesth 2011;107: 404-408

 First year report from Dr C Ralph.pdf (90 KB)
 Final report from Dr C Ralph (95 KB)

Principal Applicant
Professor Michael Wee
Consultant and Lead Obstetric Anaesthetist, Poole Hospital NHS Foundation Trust

Quantification of the pressures generated during insertion of an epidural needle and subsequent imaging of the epidural space in labouring women of varying body mass indices.


Scientific Abstract
Epidural simulators create a safe environment for anaesthetists to learn epidural techniques. Early models were crude and lack of realism reduced any benefit. There still exists the need for high-fidelity simulators to improve training and reduce morbidity from epidurals. The current obesity epidemic combined with a reduction in working hours of trainees exacerbates this problem. Moreover, increasing litigation amongst the obstetric population creates a significant cost burden. This study involves parturients of increasing body mass indices (BMI). It is not known whether the anatomical make-up of ligaments in pregnant women varies with increasing obesity and the reality is that anaesthetists are faced with performing epidurals on women with increasing BMI and body morphology. The key element is the measurement of resultant pressure exerted on an epidural needle as it is advanced through the lumbar spinal ligaments of parturients. A pressure transducer, linked to the needle via a sterile threeway tap and saline line will enable pressure measurements to be determined and recorded wirelessly to a remote receiver. Integration of the measured epidural pressures with imaging from ultrasound and MRI of the lumbar spine of parturients will assist in creating a unique training simulator whereby exact patient characteristics can be inputted and a realistic experience achieved. No such simulator exists at present.

 Final Report from Prof M Wee.pdf (372 KB)