Anaesthetics

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.