M Carr

East Coast Community Healthcare CIC, Beccles, England, United Kingdom

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Publications (4)9.33 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The effectiveness of surgically placed wound catheters (SPWC) and local anaesthetic infusion in the management of post-operative pain following breast surgery is controversial. This meta-analysis was performed to assess efficacy SPWC compared to other techniques of pain management. The meta-analysis included randomised control trials that compared SPWC with other forms of pain control. Post-operative opioid requirements and pain measured in visual analogue scale (VAS) were analysed using Comprehensive Meta-analysis Software version 2. Literature was reviewed for the safety of the SPWC and local anaesthetic infusion. Four randomised controlled trials evaluating 147 women were included in the final analysis. The overall standard difference in means was 0.094 and 0.033 for post-operative opioid requirement and pain respectively favouring the SPWC and local anaesthetic infusion group. It is a safe technique with no major adverse events as a result. Surgically placed wound catheters and local anaesthetic infusion is clinically safe in a wide range of surgical procedures on the breast and there appears to be a trend towards improved post operative pain relief. The studies analyzed in this review have several important drawbacks such as inadequate power to detect significant differences (none of them included more than 50 patients). A well designed RCT of patients undergoing breast surgery with an adequate number is of patients required to emphatically demonstrate if the operative site infusion with local anaesthetic solution postoperatively is safe and efficacious compared to opioid based regimens alone for post operative pain relief.
    Breast disease 09/2011; 33(1):1-8.
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    ABSTRACT: Sentinel lymph node biopsy (SLNB) is an important method of staging early breast cancer because of the inherent benefits it confers on patients in terms of arm function and quality of life. Its success depends on a high level of accuracy in detecting the sentinel node. This is achieved by a dual mapping technique that employs a radio-labelled nanocolloid and a vital blue dye. The vital dyes however carry the risk of anaphylaxis, and as more surgeons employ SLNB in their daily practice, a proportionate rise in the number of anaphylactic reactions can be expected. A comprehensive review of risks and benefits associated with using vital blues dyes has not been published and therefore a retrospective review was undertaken of the different levels of anaphylaxis associated with vital dyes as well as their benefits in SLNB. An OVID MEDLINE search was performed of the English published literature using appropriate search terms to find published trial data and case series that focused on adverse reactions to vital blue dyes. The risk of severe anaphylaxis (grade 3) can be as low as 0.06%, and up to 0.4% for patients undergoing SLNB when data is analysed from large trials. Furthermore, adverse reactions associated with blue dyes are reversible with appropriate management. Surgeons should continue to use vital dyes to ensure that SLNB remains a highly sensitive procedure.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 02/2011; 37(2):101-8. · 2.56 Impact Factor
  • International Journal of Surgery (London, England) 01/2011; 9(7):536. · 1.44 Impact Factor
  • Source
    Breast Cancer Research 01/2009; 11:1-1. · 5.33 Impact Factor

Publication Stats

12 Citations
9.33 Total Impact Points

Institutions

  • 2011
    • East Coast Community Healthcare CIC
      Beccles, England, United Kingdom
  • 2009
    • Northumbria Healthcare NHS Foundation Trust
      North Shields, England, United Kingdom