Christopher Liu

• BSc, MBBS(Hons), MMED(Anesthesiology)
• Senior Consultant at Alleviate Pain Clinic

Please confirm that an ethics committee approval has been applied for or granted Not relevant Background and Aims Critical limb ischemia is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical interv...

Background and Aims The Erector Spinae Plane block (ESPB) is an increasingly used to provide analgesia for surgeries involving the chest wall, rib fractures and even cancer pain. Although several meta-analyses that demonstrated the effectiveness of this block, its mechanism of action is still unclear. Anatomical studies on this ESPB injectate sprea...

Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We describe the successful use of a continuous local anesthetic infusion via an infraclavicular nerve...

Purpose This umbrella review was conducted to summarize the evidence between association between HLA*1502 allele with various antiepileptic induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Methods Pubmed, Scopus and EMBASE were searched for eligible reviews in May 2023. Study was registered in PROSPERO. Two authors indep...

Objective: To review the best evidence on the long-term efficacy of neurostimulation for chronic pain. Materials and Methods: We systematically reviewed PubMed, CENTRAL, and WikiStim for studies published between the inception of the databases and 21 July 2022. Randomized-controlled trials (RCTs) with a minimum of one-year follow-up that were of...

Background The pericapsular nerve group block (PENG) is a novel technique that blocks the articular branches of the hip joint. This study aimed to compare its effectiveness to a sham block in elderly patients with hip fractures. Method A randomized double-blind controlled trial was conducted in elderly patients with intertrochanteric and neck of f...

Pain management in the geriatric population is challenging. The high stakes involved with pain in older adults can be daunting with significant disability due to reduced mobility, falls and anxiety. Chronic pain is widespread and affects up to 25% of the older adult population. This chapter explores chronic pain in older person and how it differs...

Post-dural puncture headache (PDPH) is a well-recognised complication of neuraxial procedures. Although it is generally considered to be self-limiting, there is mounting evidence suggesting an association between PDPH and chronic headaches. In this review, chronic headache after dural puncture was defined as the reporting of persistent headaches mo...

Background and aims: Lower extremity amputation (LEA) is a commonly performed surgery and is associated with significant mortality and morbidity. This review compares the impact of anaesthetic technique on 30-day mortality and other perioperative outcomes in patients undergoing LEA. Methods: A systematic search of databases including PubMed, Emb...

Background Hip fracture is a common reason for elderly admission to hospital and majority of patients will require a hip fixation surgery. Pain originating from a hip fracture is usually severe and the need to improve comfort is paramount, especially before the hip fixation surgery because severe pain results in unnecessary stress response such as...

Background: Perineural dexamethasone has been regarded as a promising adjunct for prolonging the duration of nerve blocks. However, it is uncertain whether its effects are due to local effects on the nerves or from systemic absorption. This systematic review aimed to compare the duration of postoperative analgesia associated with perineural versus...

Objectives Intensive care audits point to family refusal as a major barrier to organ donation. In this study, we sought to understand refusal by accounting for the decision-maker’s mindset. This focused on: (1) how decisions compare when made on behalf of a relative (vs the self); and (2) confidence in decisions made for family members. Design Cro...

Objectives Intensive care audits point to family refusal as a major barrier to organ donation. In this study, we sought to understand refusal by accounting for the decision-maker’s mindset. This focused on: (1) how decisions compare when made on behalf of a relative (versus the self); and (2) confidence in decisions made for family members. Design...

PurposeChronic post-surgical pain (CPSP) is a highly prevalent complication following thoracic surgery. This is a prospective cohort study that aims to describe the pain trajectories of patients undergoing thoracic surgery beginning preoperatively and up to 1 year after surgery Methods Two hundred and seventy nine patients undergoing elective thora...

UNSTRUCTURED • Background The COVID-19 pandemic unmasked how quickly healthcare systems could be overwhelmed. One of the most pressing issues was the lack of hospital and intensive care beds. Attempts to mitigate these addresses both ends of the equation: admissions and bed creation. While it is relatively straightforward to utilize resources in ge...

Since the coronavirus disease 2019 (COVID-19) was deemed a pandemic on 11 March 2020, we have seen exponential increases in the number of cases and deaths worldwide. The rapidly evolving COVID-19 situation requires revisions to clinical practice to defer non-essential clinical services to allocate scarce medical resources to the care of the COVID-1...

Singapore is one of the most densely populated small island-states in the world. During the coronavirus disease 2019 (COVID-19) pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community by housing low-risk COVID-19 patients from April to August 2020. The...

The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta-analysis was undertaken to determine if the erector spinae plane block is effective at reducing pain scores and opioid consumption after breast surgery. This study also evaluated the outcomes o...

Background: Historically, brain death legislation was adopted in Asia at a much later stage than it was in the West, with heated public debates surrounding these laws. In this study, we investigated whether the poor acceptance of brain death continues to the present day, focusing on the following: (1) what the Asian public understands brain death...

Background Tenesmus is the unpleasant sensation of incomplete emptying of the rectum and it may be a distressing symptom for patients who suffer from rectal masses. Unlike nociceptive pain or visceral pain, little is understood about the pathway for this pain phenotype. There are also few studies examining the palliative treatment of this symptom....

Background: The recreational and medical use of cannabinoids has been increasing. While most studies and reviews have focused on the role of cannabinoids in the management of acute pain, no study has examined the postoperative outcomes of surgical candidates who are on cannabinoids preoperatively. This retrospective cohort study examined the impac...

Malignant mesothelioma is a rare tumour arising from mesothelial lining that mostly occurs in the pleura with survival of around 12 months.¹ Extrapleural pneumonectomy, which is the mainstay of treatment for locally advanced malignant pleural mesothelioma, presents a great challenge to anaesthesiologists as it can be associated with high perioperat...

The perineural administration of alcohol or phenol results in protein denaturation and, consequently, neurolysis. This can produce long-lasting analgesia, with a duration of 3-6 months. Although neurolytic blocks for the brachial plexus have been described in multiple review articles and textbooks, they are rarely performed. As such, little is know...

Introduction Frail patients have decreased physiological reserves and consequently, they are unable to recover as quickly from surgery. Frailty, as an entity, is a risk factor of increased morbidity and mortality. It is also associated with a longer time to discharge. This trial is undertaken to determine if a novel prehabilitation protocol (10-day...

Purpose of review: Though numerous treatment options are available to address cancer pain, inadequate management continues to be an ongoing problem worldwide. Recent findings: A systematic review of the recent scientific literature was conducted with attention to new therapies along with reports of general consensus that were analyzed. Pain rese...

We report a patient with an inferior alveolar neuropraxia following the use of an LMA Proseal TM device. Inferior alveolar neuropraxia is a rare complication following use of a supraglottic airway device. Although it is often self‐limiting, it may cause considerable distress to the patient. We discuss previous reports of inferior alveolar neuroprax...

Till recently, the mainstay of graduate medical training was by didactic teaching, rote learning and apprenticeship. While these teaching methods are good for imparting knowledge, they are unfortunately insufficient for training technical skills, teamwork and complex decision making. In this review article, we explore the challenges currently faced...

We investigated whether the type of anaesthesia affects mortality and length of stay after non-traumatic major lower extremity amputations. A total of 1365 eligible patients who were operated on between 2002 and 2010 were included in the final analysis. Propensity score matching was used to produce 475 matched pairs of patients undergoing operation...

Introduction: The Framingham Risk Score (FRS) is a well-validated epidemiologic tool used to assess the risk for a first cardiac event. Because young patients presenting with a first myocardial infarction (MI) tend to have less significant risk profiles compared with older patients, we hypothesized that FRS may underestimate cardiac risk in these p...

The Framingham Risk Score (FRS) is a well-validated epidemiologic tool used to assess the risk for a fi rst cardiac event. Because young patients presenting with a fi rst myocardial infarction (MI) tend to have less significant risk profiles compared with older patients, we hypothesized that FRS may underestimate cardiac risk in these patients. We...