Andrew Xu

Summary: Introduction: Single‐injection and continuous brachial plexus block techniques are used widely for postoperative analgesia in patients undergoing shoulder surgery. Although patient‐reported outcomes are described in individual studies, their effects have not been synthesised comprehensively using a patient‐centred framework. We sought to compare the effects of single‐injection vs. continuous brachial plexus block techniques on patient‐reported outcomes in adult patients following elective shoulder surgery. Methods: Databases were searched from inception to October 2025 and randomised controlled trials reporting patient‐reported outcomes were included. Co‐primary outcomes were postoperative patient‐reported pain intensity at rest and during movement at 12 h, 24 h and 48 h post‐surgery. Secondary outcomes included nausea and vomiting; sleep quality; patient satisfaction; opioid requests; and functional scores. Random‐effects meta‐analysis and trial sequential analysis were performed, with risk of bias and quality of patient‐reported outcome reporting assessed. Results: Twenty randomised controlled trials that included 1198 patients were analysed. Continuous brachial plexus blocks were associated with lower pain at rest at 12 h, 24 h and 48 h, with mean differences (MD) of −1.96 (95%CI −2.81 to −1.11, p < 0.001), −1.66 (95%CI −2.27 to −1.05, p < 0.001) and − 1.18 (95%CI −1.84 to −0.53, p < 0.001), respectively. Pain on movement could only be pooled at 24 h and 48 h and showed MD −2.04 (95%CI −4.26–0.19, p = 0.07) and − 1.30 (95%CI −3.67–1.07, p = 0.28) respectively. The co‐primary outcomes approached or exceeded the predefined minimal clinically important difference for pain scores after shoulder surgery, in favour of continuous techniques. Discussion: Continuous brachial plexus blocks are associated with better pain at rest and other patient‐centred outcomes following shoulder surgery, while effects on dynamic pain and long‐term functional recovery remain uncertain.

Objective: This study was undertaken to investigate the efficacy of antiseizure medications in reducing interictal epileptic discharges (IEDs) in patients with idiopathic generalized epilepsies (IGEs) and to explore the relationship between IED measures and clinical events. We hypothesize that valproate and ethosuximide are superior to levetiracetam, which in turn is superior to lamotrigine in reducing IED activity. Methods: We performed a retrospective analysis of 577 video‐electroencephalographic studies in individuals with IGEs over a median recording duration of 5 days. Clinical variables analyzed for each study included the following: antiseizure medication regimen, seizure occurrence, mean, median, and maximum IED durations, IED rate (events per hour), and IED burden (percentage of the recording containing IEDs). All IED outcomes were measured twice: for all detected IEDs and for IEDs ≥3 s. Results: Linear regression analysis of the monotherapy regimens found that carbamazepine was associated with greater IED rates (all: β = 20.0 events/h, p < .001; ≥3 s: β = 2.4 events/h, p < .001). Similarly, regression analysis of the dual therapy regimens revealed that valproate and lamotrigine were associated with reduced IED rates and burdens in the overall cohort (rate: β = −18.0 events/h, p = .028; burden: β = −.62%, p = .031). Additionally, participants with detected seizures exhibited higher IED durations, rates, and burdens than those without seizures, in both the overall and ≥3‐s cohorts (all p < .001). These findings do not conclusively support or reject the hypothesis. Significance: Carbamazepine is associated with increased interictal event rate, whereas the valproate and lamotrigine combination is associated with reduced interictal event rate and burden. Our findings also demonstrate that increased IED outcomes are associated with seizure occurrence.

Background/Objectives: Green light laser photosensitive vaporisation of the prostate (GLL-PVP) is a common procedure for bladder outlet obstruction, with a low incidence of post-operative bleeding. At Northern Health, postoperative management involved limited bladder washout with two bags of 2 L saline, spigotting, and undergoing a trial of void (TOV) the next morning. A new model of care was commenced in which patients were discharged after the two bags of washout, and the TOV occurred at home through the Hospital in the Home service. The aim of this study was to audit patient outcomes, patient satisfaction, and health service benefits of this novel program. Methods: Patients assigned to the program between March 2023 and June 2024 were analysed. Catheter removal occurred the morning after surgery, and the decision on the success of the TOV was made following an afternoon review. Results: A total of 93.3% (28/30) patients passed their TOV at home. There were no readmissions in the first 48 h postoperation, with only three emergency department (ED) presentations in this time. On a five-point rating scale, 25/25 questionnaire respondents were happy with their care, 20/25 rated the service as very good, and 5/25 rated the service as good. An extra AUD 3377.56 in revenue was generated per patient from the freed inpatient beds, which correlated to a net revenue of AUD 83,016.83 generated over the study period. Conclusions: At-home TOV after GLL-PVP is safe and feasible. There is high patient satisfaction and significant benefits to the healthcare system. This framework can additionally be adopted after other urological surgeries.