Research is an essential part of healthcare development. The Anaesthetics Research Unit collaborates with local and global organisations to ensure patients receive the most appropriate care and have the best possible outcomes before, during and after surgery.
Our Unit is well regarded in leading and participating in clinical trials of new techniques, medicines and technologies to address some of the most common complications of surgery, from nausea and vomiting to chronic pain and cognitive dysfunction.
The Unit recruits patients into a number of ANZCA Clinical Trials Network multicentre public-good trials, helping seek definitive answers in the fields of anaesthesia, perioperative medicine and pain that are relevant to patients, practitioners and policymakers. Visit the ANZCA website for descriptions of trials and links to publications.
Research Areas
The Prospective study Of Physical aCtivity, sleep and nutrition for post-OpeRative cogNitive decline (POPCORN) study is a Barwon Health-led prospective study run by Dr Melissa Formica. The study looks at whether lifestyle factors including exercise, diet and sleep are associated with an increased risk for developing post-operative cognitive decline, seven days after surgery.
If such factors are found to contribute to an increased risk, standard pre-surgery care can be modified to address these factors more specifically to reduce risk, especially for older patients where risk is naturally higher.
The Point of Care Diagnostics for Iron Deficiency (POCID study) is a collaborative study between Barwon Health and the CSIRO to determine whether saliva ferritin levels can be used to detect iron deficiency and/or overload just as accurately as serum ferritin.
If saliva levels are just as accurate, this may lead to an increased willingness from patients, particularly older adults, children and those with a needle phobia, to have their iron levels checked. This may in turn, lead to better outcomes for patients post-surgery as iron deficiency can be treated prior.
In collaboration with Deakin University, we are leading a clinical trial that tests a medication that may be able to prevent Post-Operative Cognitive Dysfunction, or POCD.
POCD is a condition where a person who has undergone surgery can sometimes experiences changes to their memory, mood, and other cognitive areas. While often short in duration, POCD can sometimes remain for years.
This is an entirely new approach to the prevention of POCD and will have high impact on patient outcomes if found to be beneficial. We are recruiting patients having major non-cardiac surgery at the University Hospital Geelong who are over the age of 60 years of age.
To find out more or to participate, call 0411 399 025.
We are proud participants in the ROCKet Trial, an NHMRC-funded, international, large-scale trial in which approximately 5000 patients who are undergoing major surgery will be recruited to test whether ketamine given prior to and following surgery reduces the incidence of chronic post-surgical pain.
Chronic pain after surgery is a widespread problem, especially after breast cancer, abdominal and thoracic surgeries and knee and hip operations. A large Australasian study recently found 12 per cent of patients still suffered pain 12 months following major surgery, with a third rating their pain as severe.
To find out more or to participate, call 0411 399 025.
Reference:
Schug, S. A., & Peyton, P. (2017). Does perioperative ketamine have a role in the prevention of chronic postsurgical pain: the ROCKet trial. British Journal of Pain, 11(4), 166–168. https://doi.org/10.1177/2049463717736076
The NATO study has been designed to see if early or non-anaemic iron deficiency slows down recovery after surgery for colorectal cancer, or if non-anaemic iron deficiency increases complications after surgery, such as infection. If it is found that it does, then it raises possibilities for treating the low iron levels before surgery, potentially preventing complications, and allowing for earlier return to normal function after an operation. If the hypothesis of NATO is proven, it will identify a new group of patients who are at risk of poor recovery following colorectal surgery, opens an exciting new frontier in preparing patients for these procedures, and improving survival and reducing complications from the operation.
Wound infections after surgery are serious and can be life-threatening. They delay hospital discharge by days or weeks and add substantial costs to the healthcare system. The TRIGS trial investigates tranexamic acid, a drug known to reduce bleeding in cardiac surgery. There is evidence that tranexamic acid (TXA) has immune-protective effects that could prevent infections in all types of surgery.
The five-year TRIGS Trial (Tranexamic acid to reduce infection after gastrointestinal surgery) will enrol 3,300 people having major abdominal surgery and look at outcomes including postoperative infections, the need for blood transfusion, and speed of recovery after surgery.
Women undergoing breast surgery and cancer treatment are a high-risk group for development of chronic postsurgical pain (CPSP), where it is estimated that nearly half of breast cancer surgery patients may develop this outcome. Preliminary evidence from meta-analyses and systematic literature reviews suggests that lidocaine infusions may be beneficial in reducing CPSP. Further, the team has published the results of the LOLIPOP pilot trial. This trial enrolled 150 patients and examined feasibility and safety outcomes in addition to pharmacokinetic data, in preparation for the large international multicentre trial.
In our recent survey of ANZCA Fellows, 52% of respondents reported the incorporation of perioperative lidocaine into their practice, with the principal aim to reduce acute surgical pain and opioid use. These findings, in addition to the results of the meta-analysis, confirm that there is equipoise regarding lidocaine as a perioperative intervention. This trial will inform clinical practise globally.
Funded by a Medical Research Future Fund grant, the five year LOLIPOP trial is a large (n=4300) superiority trial evaluating the effect of lidocaine infusions in the intra- and postoperative periods on the incidence of moderate or severe chronic post-surgical pain (CPSP) at one year in patients undergoing unilateral elective breast cancer surgery. Secondary outcomes will include analgesic efficacy (pain scores), psychological and quality of life outcomes, the influence of pharmacogenomic profile on efficacy, and cost-effectiveness.
Collaborating Organisations
Melbourne Health | Austin Health | Alfred Health |
CSIRO | University of Melbourne | Deakin University |
Research Team
Research Staff
- Dr Andrew Marriott, Group Leader
- Dr Claire Furyk, Group Leader
- Dr Cameron Osborne, Group Leader
- Dr Nathan Fifer, Group Leader
- Dr Melissa Formica, Research Fellow
- Ms Rachel Fiddes, Research Nurse
- Ms Madeleine Newell, Research Nurse
- Ms Sara Aldred, Research Nurse
- Ms Kayla Edridge, Research Scientist
Featured Publications
Effects of a multi-component, resistance-based exercise program combined with additional lean red meat on health-related quality of life in older adults: Secondary analysis of a 6-month randomized controlled trial. Formica, Gianoudis J, Nowson CA, O’Connell SL, Milte C, Ellis KA, Daly RM. J Nutr Health Aging. 2023 doi: 10.1007/s12603-023-1915-1 |
Effect of lean red meat combined with a multicomponent exercise program on muscle and cognitive function in older adults: A 6-month randomized controlled trial. Formica M, Gianoudis J, Nowson CA, O’Connell SL, Milte C, Ellis KA, Daly RM. Am J Clin Nutr. 2020;112(1): 113-128. |
Greater circulating copper concentrations and copper/zinc ratios are associated with lower psychological distress, but not cognitive performance, in a sample of Australian older adults. Mravunac M, Szymlek-Gay E, Daly RM, Roberts BR, Formica M, Gianoudis J, O’Connell SL, Nowson CA, Cardoso BR. Nutrients. 2019;11: 2503. |
Selenium status is not associated with cognitive performance: A cross-sectional study in 154 older Australian adults. Cardoso B, Szymlek-Gay E, Roberts B, Formica M, Gianoudis J, O’Connell S, Nowson C, Daly R. Nutrients. 2018;10: 1847. |
Post-operative cognitive dysfunction: An exploration of the inflammatory hypothesis and novel therapies. [NOTE – Abstract only; Barwon Health staff can request full text from Library]. Skvarc DR, Berk M, Byrne LK, Dean OM, Dodd S, Lewis M, Marriott A, Moore EM, Morris G, Page RS, et al. Neuroscience & Biobehavioral Reviews. 2018;84: 116-133. |
Does lean red meat enhance the effects of exercise on muscle health and function in the elderly? Daly RM, Formica M, Gianoudis J, Ellis K, O’Connell S, Nowson C. Innovation in Aging. 2017;1: 1052-1053. |
Brain functional alterations in type 2 diabetes – A systematic review of fMRI studies. [NOTE – Full text for Barwon Health staff; public can view abstract]. Macpherson H, Formica M, Harris E, Daly RM. Front Neuroendocrinol. 2017;47: 34-46. |
The effect of N-acetylcysteine (NAC) on human cognition – A systematic review. [NOTE – Abstract only; Barwon Health staff can request full text from Library]. Skvarc DR, Dean OM, Byrne LK, Gray L, Lane S, Lewis M, Fernandes BS, Berk M, Marriott A. Neuroscience & Biobehavioral Reviews. 2017;78: 44-56. |
The post-anaesthesia N-acetylcysteine cognitive evaluation (PANACEA) trial: Study protocol for a randomised controlled trial. Skvarc DR, Dean OM, Byrne LK, Gray LJ, Ives K, Lane SE, Lewis M, Osborne C, Page R, Stupart D, et al. Trials. 2016;17 |
(NOTE – a number of these publications stem from M Formica’s previous affiliation with IMPACT) |
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To find out about Clinical Trials currently underway at Barwon Health, click here.
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Clinical trials require ongoing investment and there are several ways to support this amazing work.
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To donate now or for more information and further discuss your support, please contact the Barwon Health Foundation.
Page last updated: December 19, 2024