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Dr. Matthew Chong, PGY3, coauthors CAS Practice Guidelines and new Meta-analysis

Dr. Matthew ChongTo say that 2017 has been an eventful year for Dr. Matt Chong, PGY3, would be an understatement. Matt started the year with a prestigious authorship on the 2017 edition of the Canadian Anesthesiologists’ Society’s (CAS) “Guidelines to the Practice of Anesthesia” (Can J Anaesth. 2017 Jan;64(1):65-9).

Dr. Chong [pictured] then co-authored a systematic review and meta-analysis, “Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks: A Systematic Review and Meta-Analysis,” which is scheduled to appear in the March issue of Regional Anesthesia and Pain Medicine.

Matt is no stranger to having his residency research make headlines. In 2016 at the Midwestern Anesthesia Residency Competition (MARC), he presented two posters, both of which won in final competitions:

On behalf of the entire department, we would like to congratulate Matt on his success. We look forward to seeing more of his exciting work in the future.




Guidelines to the Practice of Anesthesia - Revised Edition 2017.

Dobson G, Chong M, Chow L, Flexman A, Kurrek M, Laflamme C, Lagacée A, Stacey S, Thiessen B.

Can J Anaesth. 2017 Jan;64(1):65-91.

Abstract

The Guidelines to the Practice of Anesthesia Revised Edition 2017 (the guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2017 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.

Read more on the CAS Website



Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks: A Systematic Review and Meta-Analysis.

Chong MA, Berbenetz NM, Lin C, Singh S.

Reg Anesth Pain Med. 2017 Mar 1.[Epub ahead of print]

Abstract

Dexamethasone is a useful adjuvant in regional anesthesia that is used to prolong the duration of analgesia for peripheral nerve blocks. Recent randomized controlled trials (RCTs) have demonstrated conflicting results as to whether perineural versus intravenous (IV) administration is superior in this regard, and the perineural use of dexamethasone remains off-label. Therefore, we sought to perform a systematic review and meta-analysis of RCTs.

METHODS:

In accordance with PRISMA guidelines, we performed a random-effects meta-analysis of RCTs comparing perineural versus IV dexamethasone with duration of analgesia as the primary outcome.

RESULTS:

Eleven RCTs met the inclusion criteria with a total of 1076 subjects. Perineural dexamethasone prolonged the duration of analgesia by 3.77 hours (95% confidence interval [CI], 1.87-5.68 hours; P < 0.001) compared to IV dexamethasone, with high statistical heterogeneity. For secondary outcomes, perineural dexamethasone prolonged the duration of both motor (3.47 hours [95% CI, 1.49-5.45]; P < 0.001) and sensory (2.28 hours [95% CI, 0.38-4.17]; P = 0.019) block compared to IV administration. Furthermore, perineural dexamethasone patients consumed slightly less oral opioids at 24 hours than IV dexamethasone patients (7.1 mg of oral morphine equivalents [95% CI, 0.74-13.5 mg]; P = 0.029), and there were no statistically significant differences in the other secondary outcomes. Notably, no increase in adverse events was detected.

CONCLUSIONS:

Perineural dexamethasone prolongs the duration of analgesia across the RCTs included in our meta-analysis. The magnitude of effect of 3.77 hours raises the question as to whether perineural dexamethasone should be administered routinely over its IV counterpart-or reserved for selected patients where such prolongation would be clinically important.

Read More on Pubmed