Effect of panniculus elevation device on postoperative pain after cesarean delivery: a randomized controlled trial.

BACKGROUND: Suboptimal treatment of postpartum pain is associated with persistent pain and postpartum depression. Multimodal analgesia can achieve superior pain relief and decreased opioid consumption after surgery. There is limited and conflicting data on abdominal support devices to reduce postoperative pain and opioid use after cesarean delivery. OBJECTIVE: This study aimed to examine whether the use of a panniculus elevation device decreases opioid use and improves postoperative pain after cesarean delivery. STUDY DESIGN: This was an unblinded prospective trial in which eligible, consenting patients aged ≥18 years were randomized to the panniculus elevation device group or no device group within 36 hours after cesarean delivery. The device studied adheres to the abdomen and lifts the panniculus. Moreover, it can be repositioned during use. Patients with a vertical skin incision or chronic opioid use disorder were excluded. Participants were surveyed 10 and 14 days after delivery about opioid use and pain satisfaction. The primary outcome was total morphine milligram equivalents used after delivery. The secondary outcomes were inpatient and outpatient opioid use, subjective pain scores, and Patient-Reported Outcomes Measurement Information System pain interference scores. An a priori subgroup analysis was performed on participants with obesity who may uniquely benefit from panniculus elevation. RESULTS: Of 538 patients screened for inclusion from April 2021 to July 2022, 484 were eligible, and 278 were consented and randomized. Moreover, 56 participants (20%) were lost to follow-up, leaving 222 (118 in the device group vs 104 in the control group) for analysis. Follow-up frequency was similar between groups (P=.09). Demographic and clinical characteristics were similar between groups. There was no statistically significant difference in total opioid use, other opioid use measures, or pain satisfaction outcomes. Median device use was 5 days (interquartile range, 3-9), and 64% of participants randomized to device use stated that they would use it again. Here, similar trends were observed among participants with obesity (n=152). CONCLUSION: The use of a panniculus elevation device did not significantly reduce total opioid use after cesarean delivery in patients.

Attention to bone health in follow-up of gynaecological cancers in tertiary care.

OBJECTIVE: Women with gynaecological cancers are at an increased risk of cancer treatment-induced bone loss, which impacts on their quality of life and overall survival. Clinical cancer follow-up reviews focus on cancer status and fail to attend to important health and quality-of-life issues. We questioned whether there was a care-gap between tertiary clinicians and primary care physicians in the management of bone health in this cohort. Significant care-gaps in relation to bone health have been demonstrated in other oncologic settings. The objective of this study was to determine the level of attention to bone health in the care of women living with and beyond gynaecological cancer at a tertiary referral centre for gynaecological oncology. METHODS: Retrospective, observational cohort study of attention to bone health in the management and follow-up of gynaecological cancers. RESULTS: This study shows that there has been suboptimal attention from the carers at a cancer centre to bone health during the oncological follow up of women undergoing treatment for gynaecological cancer. In those at particular risk of cancer treatment-induced bone loss (iatrogenic menopause and/or external beam pelvic radiotherapy), 52% of women had no reference to bone health in their notes, and 57% had no assessment of bone mineral density. CONCLUSION: Tertiary cancer carers may underestimate the importance of bone health or believe that it falls outside the remit of their gynaecologic oncology service. Further research is needed to explore whether these findings are indicative of a true care gap and to gain insight into possible corrective measures.

From physical to virtual: How the COVID-19 pandemic changed a tertiary gynaecologic oncology surveillance program in Ireland.

•Virtual follow up is acceptable to gynecological oncology patients.•Some patients may be reluctant to sit in waiting rooms post pandemic.•Lack of physical examination did not affect most patients' appointments.