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Postoperative pain relief for patients undergoing open radical prostatectomy (surgical removal of the prostate gland via a lower abdominal surgical incision) is provided by either strong painkillers such as intravenous morphine (delivered into the peripheral vein of the patient), or by the infusion of a local anaesthetic solution via an epidural catheter, which is inserted by an anesthetists into the epidural space that surrounds the spinal cord. The local anaesthetic solution acts by numbing the nerves around the spinal cord thereby providing pain relief from the surgical wound. One alternative method of administering the local anaesthetic solution for its beneficial effects without the inherent risks of epidural insertion is to administer the local anaesthetic solution directly into the patient’s circulation via a peripheral vein. Many well-designed studies investigating patients undergoing major abdominal surgery have shown that this method of administering the local anaesthetic solution provides excellent pain relief with minimal side effects. This technique also has beneficial effects on early postoperative return on bowel function. The administration of local anaesthetic solutions via this route is inexpensive, easy to administer, and safe. There is only one published clinical trial investigating this technique in patients undergoing radical prostatectomy. The main end point of this study was return of bowel function. However, it is not known if the addition of a systemic local anaesthetic solution with morphine accelerates postoperative recovery and shortens the duration of hospital stay. This research study will investigate this precise question. The purpose of the study is to compare whether the use of a lignocaine infusion together with intravenous morphine reduces time to readiness for discharge compared to using intravenous morphine alone. Adult patients undergoing elective open radical prostatectomy will be invited to participate. Patients will be approached and consented for surgery in the Urology or Anaesthetic Outpatient Clinics. All patients will have general anaesthesia and surgery performed accordance to the standard practice of their caring surgeons and anaesthetists. All patients will receive intravenous morphine together with simple pain relief adjuvants such as paracetamol and non-steroidal anti-inflammatory tablets. This is standard practice at Austin Hospital for all patients undergoing this operation. Consenting patients will be randomised into 2 groups. One group will receive an infusion of a local anaesthetic solution (ligonacaine); the other group will receive a placebo solution of normal saline. Neither the patient nor anaesthetist (or any member of the surgical or nursing team) will know which group the patient has been randomised to. This study is therefore a prospective double-blinded, randomised, placebo-controlled trial. This is the gold standard experimental research design. The main study aim will be to collect data from the patient’s postoperative records and assess when the patient is ready for hospital discharge. Other secondary end points collected will include pain and sedation scores, return of bowel function, cumulative morphine use, need for rescue pain medication and side effects of morphine and the local anaesthetic solution. Standard and specialised statistical tests will be used to analyse differences between the two groups of patients. All patients will be managed by the Austin Hospital acute pain service guidelines, in accordance with standard practices and infusion protocols.

It is not known from published data how to best provide postoperative pain relief for patients who undergo major liver surgery. Many institutions that specialise in hepatobiliary surgery like Austin Health use intravenous morphine in addition to regional techniques such as an epidural or an interpleural catheter to provide postoperative analgesia. Research however shows that after patients undergo major liver surgery, there are significant disturbances in the clotting system of the body. This may increase the risk of bleeding complications. For this reason many institutions now consider epidural catheters to be unsafe in this setting because of the increased risk of epidural haematoma with the devastating neurological complication of spinal cord compression and paraplegia. At Austin Health, the standard accepted practice in providing postoperative analgesia after liver surgery is intravenous morphine, either alone or in combination with an interpleural catheter. An interpleural catheter is a small tube that is placed between the linings layers of the lungs by the anaesthetist at the end of the operation. A solution of local anaesthetic is infused continuously into the interpleural space, which then numbs the nerves that supply the skin over the surgical wound, reducing postoperative pain. Interpleural catheters have been shown to be effective in the management of pain following thoracic and upper abdominal surgery with minimal risks. However, no study has investigated whether the routine use of interpleural catheters after liver surgery is advantageous over morphine alone. The theoretical advantages of using an interpleural catheter is that it may result in less morphine being used, thereby reducing morphine related complications such as respiratory depression, sedation, nausea, vomiting and itch. However an interpleural catheter may not improve pain at all, therefore its use may be an unnecessary intervention that can be associated with uncommon complications such as infection, local anaesthetic toxicity and rarely a punctured lung. These questions have never been investigated in any scientific way before; therefore this study will help answer these questions and make a valuable contribution to caring for patients undergoing liver surgery. The purpose of this study is to compare whether the use of an interpleural catheter together with morphine provides better postoperative pain relief than just morphine alone. The provision of postoperative analgesia and the management of the patient in the postoperative period will not be changed or modified in any way as per the current postoperative guidelines and practices for analgesia after liver surgery. Patients undergoing suitable liver surgery will be invited to participate in the study. They will be approached after consenting for surgery in the hepatobiliary or anaesthetic outpatient clinics. All patients will have a general anaesthetic and surgery performed according to the usual practice of their caring clinicians. All patients will receive intravenous morphine together with simple analgesic adjuvants such as paracetamol. This is standard practice at Austin for all patients undergoing liver resection. Consenting patients will then be randomised into 2 groups. One group will receive an interpleural catheter with an infusion of local anaesthetic solution, the other group will not. Both techniques are considered standard practice at many centers that specialise in hepatobiliary surgery, including Austin Health. The main study aim will be to collect data from the patient’s postoperative records and assess there level of pain and how much morphine each group uses. These are standard parameters and observations routinely recorded in the patients records. We will use standard statistical tests to analyse the differences between the two groups of patients. The primary end-point will be pain on movement during the first 24 postoperative hours. Other end points will be cumulative 24 hour morphine consumption, with sufficient subjects being enrolled to find a 25% difference in morphine use between the two groups. Other end-points to be measured at 6, 12, 24 and 48 hours and will include patient rated scores for pain, nausea and itchiness, nurse-rated sedation score, and cumulative morphine doses. These are standard parameters and observations recorded for all patients. Subjects will be asked to rate their satisfaction with their postoperative analgesia on a qualitative scale at the completion of the trial. All patients will be managed by the Austin Health acute pain service guidelines, in accordance with standard practices for morphine and interpleural catheter based regimes.

This project has been designed to investigate the efficacy of rotation to methadone for pain control in people with cancer whose pain is uncontrolled despite substantial increases in the dose of their prescribed narcotic. By uncontrolled we mean that the person has rated their pain as being equal to or above 4 on an 11 point pain rating scale that ranges from 0 (equivalent to no pain at all), to 10 (equivalent to unbearable pain). To be eligible for this study, a person’s pain must have been clinically assessed to have two different components. One component relates to the type of pain that results when injured body tissues cause pain receptors to fire (known as nociceptive pain) and the other component relates to the type of pain that results when nervous tissues is damaged (known as neuropathic pain). People who meet these conditions will be rotated to a dose of methadone that is equivalent to their previous narcotic does in terms of analgesic potential. They will be required to maintain a daily diary about their pain levels, possible narcotic side effects (such as constipation), quality of life and mood. Diary entries before rotation to methadone will be compared statistically to diary entries after rotation to methadone. If people are improved with rotation to methadone then they can keep taking it.

To improve the proportion of elderly patients with moderate to severe vitamin D deficiency reaching target levels above 75nmol/L with the implementation of loading dose vitamin D. The aim is to test the hypotheses: Loading dose cholecalciferol 5000units daily will bring higher proportion of patients with moderate to severe deficiency up to target levels(>75nmol/L) compared to 1000units daily.

This study is a multi-center, prospective, open label, safety/efficacy study enrolling up to 30 patients. Safety and efficacy are the primary objectives based on analysis of reported and observed adverse events and the WOMAC validated OA questionnaire(pain component). A series of validated subject-completed questionnaires, a visual analogue scale for pain and formal orthopaedic examination, will be performed over the course of the 60 months at the following intervals: baseline, 6 weeks, 3 months, 6, 12, 24, 36, 48 and 60 months. X-ray and/or MRI data will be collected pre-operatively and the following post operative intervals 6 months, 12, 24, 36, 48, and 60 months.

Baseline mucociliary and cough clearance is very abnormal in asthmatics with excessive secretions and presenting symptoms of chronic cough and sputum production. Inhaled mannitol markedly improves mucociliary clearance and this effect is dose dependent in the large airways. Repetitive voluntary coughing following inhalation of mannitol enhances clearance of mucus. Asthmatics with mucociliary dysfunction, after careful assessement and appropriate premedication may benefit from inhaling mannitol to clear excessive secretions and prevent mucus plug formation in the small airways

Intracytoplasmic sperm injection is commonly used to aid fertilisation rates in men with low sperm counts , poor sperm mobility and high levels of sperm DNA fragmentation. The sperm used to inject into the egg is hand picked by the scientist, based on sperm appearance. However, a scientist is unable to detect poor DNA based on sperm appearance. The PICSI dish contains a substance called hyaluronan that normally exists around an egg. It is proposed that sperm with lower levels of DNA damage are more likely to bind to this hyaluronan. This allows the scientists to be more selective in the handpicking process. By handpicking only that sperm that has bound to the substance, they may be selecting the better sperm for injection into the egg.

Observational studies, mostly from Europe and North America, suggest that people with low vitamin D status may have increased risks of some chronic diseases and death. Given that sunlight is essential for vitamin D synthesis this has prompted calls from some to relax sun protection messages or so increased population-wide vitamin D supplementation through expanded mandatory food fortification. However there is no strong evidence from clinical trials to support these measures and the International Agency for Research on Cancer has specifically called for randomised trials of high dose vitamin D supplementation for prevention of cancer and lowering of total mortality. We propose here to assess the feasibility of such a trial in the four eastern states of Australia. Participants randomly selected from the electoral roll will be invited to participate, and randomly assigned to a monthly intake of one of two vitamin D doses (60,000 IU/month or 30,000 IU/month) or placebo for 12 months. Baseline and post-intervention serum vitamin D levels will be measured. Outcomes will be recruitment rate, representativeness of the general population, change in vitamin D levels according to population subgroup and economics.

The objectives of this study are to assess the bone ingrowth after total hip arthroplasty using the "Short Mini Stem".

It is well known that the chance of live birth in assisted reproduction treatment decreases with increasing female age, and drops markedly after 40 years of age, however, some woman younger than this is an ‘unexpected poor responder’ during their IVF cycle. Tesarik reported in 2005 that the ability of human oocytes to form normal embryos is related to the concentration of different hormones in follicular fluid (Mendoza et al., 1999, 2002). Among the hormones studied, growth hormone (GH) showed the most consistent relationship with different parameters of embryo quality, and higher concentrations of GH in follicular fluid were associated with rapid embryo cell division, good embryo morphology and a high embryo implantation potential (Mendoza et al., 1999, 2002).He also reports a decrease in follicular fluid GH concentration in women aged 40 years as compared with young women. Studies evaluating the benefits of co-treatment with recombinant human Growth Hormone (r-hGH) during controlled ovarian stimulation for human assisted reproduction treatment have reported controversial findings. A Cochrane review (Harper et al. 2008) and updated as part of a review of the management of poor responders (Kyrou et al. 2008), suggest that there exists some evidence for the use of GH in the management of IVF cycles of poor responders. The aim of this study is to determine the influence of GH treatment as an adjunct to stimulation with the maximal dose of Follicle Stimulating Hormone(FSH) stimulation in the unexpected poor responding IVF patient, ie patients requiring maximal dose of stimulation despite being under 41 years of age.