Therapeutic Suggestion in Postoperative Pain Control: A Randomized Controlled Trial.

OBJECTIVES: There is conflicting research on the effect of therapeutic suggestion in the perioperative period. This study systematically compared subjective and objective measures of postoperative pain, nausea and vomiting, urinary and bowel function, and global perception of symptomatic improvement between participants receiving perioperative therapeutic suggestion versus routine perioperative care during minimally invasive pelvic reconstructive surgery. METHODS: This was a single-blinded, randomized controlled trial of participants undergoing vaginal hysterectomy with minimally invasive sacrocolpopexy and concomitant prolapse repairs. The intervention group received perioperative therapeutic suggestion, whereas the control group did not. Primary outcomes included postoperative pain scores and analgesic use. Secondary outcomes included a postoperative nausea and vomiting scale, the Pelvic Floor Distress Inventory Questionnaire-Short Form 20, the Patient Global Impression of Improvement scale, and time to return of bowel and bladder function. RESULTS: Sixteen participants were randomized to each group. Final analysis included 15 intervention and 14 control participants. Overall measures of postoperative pain and analgesic use were low across all participants without a significant difference between intervention and control groups (opioid: 52.5; interquartile range [IQR], 25.5-58.9 vs 66 IQR, 7.3-125.8; morphine milligram equivalents; P = 0.64; acetaminophen: 2225 mg; IQR, 500-2600 mg vs 2800 mg; IQR, 650-4775 mg; P = 0.38). There were no statistically significant differences in secondary outcomes of urinary symptoms, bowel function, and subjective improvement of prolapse symptoms. CONCLUSIONS: No differences in postoperative pain, analgesic use, return of bowel and bladder function, or pelvic organ prolapse symptoms were noted in participants receiving perioperative therapeutic suggestion versus routine perioperative care.

A Pilot Study on Resident and Pediatrician Knowledge and Confidence in the Diagnosis of Slipped Capital Femoral Epiphysis.

Introduction. The purpose of this study was to identify deficiencies in pediatric residents' and pediatricians' knowledge and confidence in diagnosing slipped capital femoral epiphysis (SCFE). Methods. Pediatricians and residents at our institution answered an anonymous 12-question survey on knowledge and confidence in SCFE diagnosis. Results. Twenty pediatricians and 30 pediatric residents participated in the survey. Of 30 residents, 22 (77%) reported low confidence ordering radiographs evaluating for SCFE in patients with hip pain. Four of 20 pediatricians (20%) reported low confidence ordering radiographs for patients with hip pain. Forty percent (8/20) of pediatricians did not feel comfortable diagnosing a SCFE based on radiographs, which was significantly different from 80% (24/30) of residents who did not feel comfortable diagnosing a SCFE based on radiographs (P = .004). There was a significant difference between residents and pediatricians in comfort ordering and diagnosing radiographs (P < .01). There was no significance between pediatrician and resident scores for knowledge-based questions (P = .50). Discussion. Despite scoring well on knowledge-based questions, more than half of pediatricians and pediatric residents felt uncomfortable ordering radiographs to evaluate for SCFE in patients with hip or knee pain. This may be one factor contributing to the continued delay in SCFE diagnosis.