Fabienne Roelants - Academia.edu (original) (raw)

Papers by Fabienne Roelants

European Journal of Anaesthesiology, Jun 1, 2011

inadequate af ter four rescue doses of oxy tocin, alternative uterotonic therapy was administered... more inadequate af ter four rescue doses of oxy tocin, alternative uterotonic therapy was administered (sulprostone). Data were entered and analysed using SPSS11.0, Student's t-test was used for parametric data; non-parametric data were analysed with a Khi-2 test. Results and Discussion: 60 patients were enrolled, all completed the study; demographic characteristics were similar among the 2 groups. There was no dif ferences in UT at any measurement time and in the number of patients who required rescue doses of oxy tocin (15 for each group). Blood loss was similar in the 2 groups (215 ml in G1 and 301ml in G2, P>0.05). Increase of heart rate 2 min af ter oxy tocin was more frequent in G2 (15 versus 8 in G1, P=0.025), there was no dif ference in other side ef fects. Conclusion: Adequate UT during CS can occur either with 2 or 5 units of oxy tocin , but the use of 2 units seems to be more safe as it cause less hemodynamic ef fects mainly tachycardia. References:

European Journal of Anaesthesiology, Jun 1, 2010

compared to a manual bolus which can be completed in 20 seconds. Catheter tip position seems to p... more compared to a manual bolus which can be completed in 20 seconds. Catheter tip position seems to play a role to influence the spread as well. Other pregnancy related factors are epidural space pressures and adjacent cavity pressures. With good explanation and communication with the parturient as well as midwives, better outcome can be expected with the bolus only regimes. PCEA Pumps with variable speed of injection needs evaluation to find out the optimum speed of bolus delivery through the epidural route. Conclusion(s): Background infusions with PCEA are successfully used to provide labour analgesia. Incidence of motor blockade is very high which raises the concern as major complications can go unnoticed. Boluses only PCEA regimes can potentially reduce the motor blockade. Reference: 1 Halpern SH. Patient-controlled epidural analgesia for labor. Anesth Analg 2009;108(3):921-8.

Anesthesiology, Sep 1, 2000

Obstetric Anesthesia Digest, Sep 1, 2009

... Patricia M. Lavand'homme, MD, PhD,; Fabienne Roelants, MD,; Hilde Waterloos, RN,; Valeri... more ... Patricia M. Lavand'homme, MD, PhD,; Fabienne Roelants, MD,; Hilde Waterloos, RN,; Valerie Collet, MSc and; Marc F. De Kock, MD, PhD. From the ... capsaicin injection.9 A dose of 150 μg is required to observe this antihyperalgesic effect, while 50 μg is ineffective.8 In a clinical trial ...

H Hé ém mo or rr ra ag gi ie es s d du u p po os st t-p pa ar rt tu um m E Ex xt tr ra ai it t d ... more H Hé ém mo or rr ra ag gi ie es s d du u p po os st t-p pa ar rt tu um m E Ex xt tr ra ai it t d de e l la a T Th hè ès se e d du u D Dr r A An nn ne e S So om mm mé é I IN NT TR RO OD DU UC CT TI IO ON N L'hémorragie du post-partum est responsable à travers le monde de 25 % des décès maternels observés [1]. En France, en 1996 et 1997, sur les 123 décès maternels dénombrés 31 étaient liés à des causes hémorragiques et parmi eux 19 à des hémorragies du post-partum et de la délivrance [2]. Les pertes sanguines normales, qui sont de 500 ml, n'entraînent que peu ou pas de modifications hémodynamiques chez les parturientes. En revanche, l'hémorragie grave définie comme un saignement de plus de 1000 ml se traduit par des manifestations cliniques plus bruyantes, est grevée d'une morbidité importante et d'une mortalité non négligeable. Dans la grande majorité des cas, les hémorragies diagnostiquées et dont la cause est identifiée répondent heureusement aux traitements de première intention, incluant utérotoniques, révision de la filière génitale et sutures en association avec une réanimation médicale adaptée. Il arrive cependant dans moins de 1 % des accouchements que ces mesures soient insuffisantes et que la poursuite des saignements associée aux altérations de l'hémostase et de l'hémodynamique imposent de recourir à d'autres modalités thérapeutiques. Ces recours ultimes sont représentés par l'hystérectomie d'hémostase, les ligatures vasculaires et l'embolisation artérielle. Ces deux dernières ont l'avantage de la conservation de l'utérus et de l'avenir obstétrical de ces patientes jeunes. Entre 1997 et 2002, 69 patientes prises en charge par notre service ont bénéficié de ces procédures. Parmi elles, 42 ont bénéficié d'une embolisation artérielle. Cette technique qui est la plus récente parmi les recours ultimes tient désormais un rôle de choix dans le traitement des phénomènes hémorragiques du post-partum ; nous nous proposons d'évaluer la place de cette technique et ses indications, ses résultats parmi les traitements de recours utilisés durant cette période en les illustrant avec les résultats de notre étude et en les comparant à ceux de la littérature. phénomènes hémorragiques. Le choix de 1000 ml comme valeur seuil pour définir l'HPPI sévère s'établit donc sur son retentissement sur l'hémodynamique et l'hémostase maternelles. Ces données corroborent la nécessité d'un diagnostic rapide de l'hémorragie et de sa quantification précise. Relations entre le degré de choc et le volume des pertes sanguines [3]. Pertes sanguines Pression artérielle Symptomatologie Degré de choc 10-15 % (/VST)

Acute pain must be treated as soon as possible to avoid the development of chronic pain which is ... more Acute pain must be treated as soon as possible to avoid the development of chronic pain which is highly prevalent worldwide and is considered as a socio-economical and health problem due to secondary disability and comorbidities such as anxiety, depression and the high rate of dependency on opioids and painkillers. Epidemic increases in opioids use highlights the need for effective adjuvant therapies that help to reduce pain and the need for drugs. In this context, music, virtual reality and hypnosis have been evaluated. Music Music and acute pain: Music intervention has shown statistically significant effects in decreasing pain (10%), emotional distress from pain, anesthetic use, opioid and non-opioid intakes and has shown an anxiolytic effect.1 2 a greater effect on pain was shown when music was delivered before surgery, when anxiety is the highest than during or after. Moreover, perioperative soft music may reduce later postoperative pain (day 7) and fatigue (days 1,7) by decreasing the surgical stress response after laparoscopic cholecystectomy.3 Music and chronic pain: Music reduced self-reported chronic pain, anxiety and depressive symptoms with a greater effect when the patient chose himself the music. This effect may be related to familiarity and the feeling of control and pleasure.4 Music in obstetrics: In comparison to a control group (no music), mothers in the music therapy group had a lower level of pain and anxiety at all stages of labor and decreased significantly their analgesics requirements in the postpartum period.5 6Music seems to decrease early postpartum depression rate.6 Music and neurophysiology: Music-induced analgesia results in the release of opioids engaging the descending pain modulation system.7Dobek investigated the neural mechanisms by applying a well-defined painful stimulus while participants listened to either their favorite music or to no music. Pain rating scores were significantly lower with music playing than without it (10% reduction of pain). Brain regions associated with enjoyable music listening include limbic, frontal, auditory regions and also dorsolateral prefrontal cortex, periaqueductal gray matter, rostral ventromedial medulla and dorsal gray matter of the spinal cord, different areas related to pain modulation.8 How to choose music?: Selecting music might be very difficult because of music’s complexity and variety. Music characteristics such as musical organization, rhythm, volume are rarely described by the authors of clinical trials and therefore, no analyses or conclusions can be done. Despite this, music without lyrics seems to be effective to alleviate pain. Duration of music intervention should not exceed 30 min per session and if administered for several days, 14–30 days appear to be effective.8 Virtual Reality (VR) VR allows a complete immersion in an artificial three-dimensional environment. the device consists of a video headset, associated with a smartphone or connected to a computer, headphones. the headset has sensors that can track the movements of the user’s head to give the illusion of movement in virtual space. a feeling of real immersion is given through visual and auditory stimuli.9 VR and acute pain The use of VR to reduce pain and anxiety has been most widely studied in the treatment of burns in both adults and children. It seems that VR would be reversible and short lived and thus that VR would not have a persistent effect in the clinical context.10 the analgesic effects of immersive VR distraction has been evaluated in volunteers receiving thermal pain stimulation and exposed to opioid administration, VR, or opioid and VR. Combined opioid and VR reduced pain reports more effectively than did opioid alone on all subjective pain measures.11 The ability of VR to reduce pain has mostly been attributed to active distraction. Indeed, attention is required for pain and exists in limited supply. If the attention is diverted, resources available for processing pain will be reduced.12 VR seems to be much more effective compared to traditional techniques because of its highly immersive nature giving a sense of presence in the virtual world.12 VR and neurophysiology: In patients using VR and exposed to a painful stimulus, fMRI studies have shown, a reduction of more than 50% in pain-related brain activity in five areas of the brain including the periqueductal grey matter, the anterior cingulate gyrus and the orbital-frontal cortex.13 VR and chronic pain: Hoffman studied the value of VR during repeated physical therapy sessions in burn victims and showed significantly lower pain scores (30–35%), when patients were immersed in virtual reality. In addition, VR maintains its efficacy over repeated sessions.14 VR technology: the technical quality of virtual reality and the degree of immersion generated are directly correlated with the quantity of analgesia provided. the use of a ‘high-tech’ video headset with a high number of pixels also contributes to…

International Journal of Obstetric Anesthesia, 2010

M any women request analgesia for childbirth. The American College of Obstetricians and Gynecolog... more M any women request analgesia for childbirth. The American College of Obstetricians and Gynecologists recommends that all women should receive pain relief on request. 1 Despite several potential risks and side effects, neuraxial labor analgesia is a very safe and effective method of providing pain relief throughout labor. Some women, however, prefer to avoid neuraxial analgesia and prefer an alternative analgesic technique. In addition, a small minority of parturients has contraindications to the use of neuraxial analgesia and therefore must select an alternate mode of pain relief. Patient-controlled intravenous analgesia (PCIA) with remifentanil has become a popular non-neuraxial, parenteral opioid option during the past 2 decades. In some institutions, it is offered routinely as a first-line strategy for labor analgesia. In other departments and services, it is reserved for the selected group of patients, such as those with contraindications to neuraxial analgesia. Most experience with remifentanil PCIA has been reported from Europe. In the current issue of the Journal, Aaronson et al 2 publish a survey on the use of remifentanil PCIA during labor in academic teaching centers in the United States. Slightly more than one-third of responding units reported the use of remifentanil PCIA in the past 12 months. The majority (87%) of institutions offered remifentanil PCIA only when a contraindication for neuraxial analgesia was present, but 13% of centers offered it as an elective alternative to epidural analgesia. Many publications on remifentanil PCIA are available in medical literature. Although the quality of analgesia was the focus of early research, maternal and perinatal safety recently has emerged as an important theme for peripartum remifentanil research. 3,4 The majority of publications are not original peer-reviewed studies but rather reviews,

International Journal of Clinical Practice, 2021

Preoperative anxiety, which can affect postoperative recovery, is often present in patients under... more Preoperative anxiety, which can affect postoperative recovery, is often present in patients undergoing surgery under loco‐regional anaesthesia (LRA). Minimising preoperative anxiety with premedication can be effective but results in drug‐related side effects. Therefore, the use of non‐pharmacological techniques should be encouraged.

Oxford Medicine Online, 2016

Persistent pain after childbirth has recently received a lot of attention as potentially many wom... more Persistent pain after childbirth has recently received a lot of attention as potentially many women could be affected. Several pain syndromes including pelvic girdle pain, low back pain, and headaches occur during the pregnancy and can persist after delivery. The prevalence of chronic pain directly related to the delivery, at 6 months and later after childbirth, is however very low (< 2%) compared to chronic pain which occurs after other types of tissue trauma as in common surgical procedures. Acute pain is a major risk factor in the development of persistent pain after surgery and trauma. After childbirth, the severity of acute pain, independent of the mode of delivery (i.e. the degree of tissue damage) only predicts an increased risk of persistent pain (a 2.5-fold increase) at 2 months but not later. An individual’s pain response seems to be the most relevant factor in the development of persistent pain. In retrospective studies, patient-specific risk factors, such as a pre-exi...

The Breast, 2018

Background: In oncology, hypnosis has been used for pain relief in metastatic patients but rarely... more Background: In oncology, hypnosis has been used for pain relief in metastatic patients but rarely for induction of anesthesia. Material and method: Between January 2010 and October 2015, 300 patients from our Breast Clinic (Cliniques universitaires Saint-Luc, Universit e catholique de Louvain) were included in an observational, non-randomized study approved by our local ethics committee (ClinicalTrials.gov e NCT03003611). The hypothesis of our study was that hypnosis intervention could decrease side effects of breast surgery. 150 consecutive patients underwent breast surgery while on general anesthesia (group I), and 150 consecutive patients underwent the same surgical procedures while on hypnosis sedation (group II). After surgery, in each group, 32 patients received chemotherapy, radiotherapy was administered to 123 patients, and 115 patients received endocrine therapy. Results: Duration of hospitalization was statistically significantly reduced in group II versus group I: 3 versus 4.1 days (p ¼ 0.0000057) for all surgical procedures. The number of post-mastectomy lymph punctures was reduced in group II (1e3, median value n ¼ 1.5) versus group I (2e5, median value n ¼ 3.1) (p ¼ 0.01), as was the quantity of lymph removed (103 ml versus 462.7 ml) (p ¼ 0.0297) in the group of mastectomies. Anxiety scale was also statistically reduced in the postoperative period among the group of patients undergoing surgery while on hypnosis sedation (p ¼ 0.0000000000000002). The incidence of asthenia during chemotherapy was statistically decreased (p ¼ 0.01) in group II. In this group, there was a statistically non-significant trend towards a decrease in the incidence of nausea/ vomiting (p ¼ 0.1), and the frequency of radiodermitis (p ¼ 0.002) and post-radiotherapy asthenia (p ¼ 0.000000881) was also reduced. Finally, the incidence of hot flashes (p ¼ 0.0000000000021), joint and muscle pain (p ¼ 0.0000000000021) and asthenia while on endocrine therapy (p ¼ 0.000000022) were statistically significantly decreased in group II. Discussion: Hypnosis sedation exerts beneficial effects on nearly all modalities of breast cancer treatment. Conclusion: Benefits of hypnosis sedation on breast cancer treatment are very encouraging and further promote the concept of integrative oncology.

The incidence of breast cancer worldwide is increasing as is the survival rate after breast cance... more The incidence of breast cancer worldwide is increasing as is the survival rate after breast cancer. This is essentially due to therapeutic progress. However, anticancer treatment is associated with nonnegligible side effects related to the different treatment modalities. One of the greatest challenges for the coming years will be to promote the participation of patients in their therapeutic plan and to encourage them to not give up their adjuvant treatment for alternative, inefficient and dangerous therapies. In this context, the use of hypnosis is a very good option among highly motivated patients. Hypnosis is able to decrease side effects induced by surgery, general anesthesia and anticancer treatments and generates an important feeling of satisfaction among patients. Herein, we report the case of a breast cancer patient undergoing a modified radical mastectomy and sentinel lymph node biopsy for an extensive intraductal carcinoma, while under hypnosis analgesia and interpectoral b...

La gynécologie-andrologie vous présente quelques innovations marquantes développées en 2015. Les ... more La gynécologie-andrologie vous présente quelques innovations marquantes développées en 2015. Les nouveautés de la spécialité concernent tant la progression thérapeutique avec l'application de la technique du ganglion sentinelle en chirurgie oncologique pelvienne, que l'aspect qualité de vie des patients durant les soins, en particulier au travers de l'utilisation de l'hypnose lors des traitements des pathologies mammaires bénignes et malignes ou en procréation médicalement assistée.[Innovations] The gynecology-andrology department presents several major innovations developed in 2015. Advances have been achieved in the fields of both treatment strategies, as illustrated by the implementation of the sentinel node technique for pelvic cancers, and of quality of life during patient care, especially via using hypnosis while treating benign and malignant breast diseases or in reproductive medicine

Case Reports in Perinatal Medicine, 2015

Malformation affecting the genital tract is a rare condition. Enlargement of the mass and specifi... more Malformation affecting the genital tract is a rare condition. Enlargement of the mass and specific complications may occur following hemodynamic changes associated with pregnancy. A 25-year-old pregnant primigravida affected by an extended vulvar and thigh venous malformation with localised intravascular consumptive coagulopathy was referred to our hospital. Her antenatal care was uneventful until term. She underwent an elective caesarean section because the venous malformation location precluded vaginal birth. At 3 days postpartum, she suffered life-threatening bleeding in the abdominal cavity with disseminated intravascular coagulation requiring multiple blood and platelets transfusions as well as transarterial embolisation. The patient recovered and was discharged after 20 days. Specific counselling and management of pregnant patients with large vascular malformations is essential as it is associated with increased complications rate such as peripartal thrombosis and haemorrhages...

Acta anaesthesiologica Belgica, 2009

Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epid... more Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epidural or combined spinal-epidural technique) is the most effective way to relieve that pain but it is contraindicated or impossible to perform for some parturients. We designed a survey of the current use of analgesic alternatives to epidural analgesia (EA) for labor pain, specifically the use of opioid patient-controlled intravenous analgesia (PCIA), in the French part of Belgium (Wallonia and Brussels). A questionnaire was mailed to the departmental chair of the hospitals with an obstetric unit, both in university and non-university centers (total of 53 centers). The questionnaire evaluated the availability of EA, the alternatives used when EA was contraindicated, the use of opioid-based PCIA for labor analgesia as well as opioid preference and doses, and finally the reasons for not using opioid PCIA. The response rate was 67.5% (36 centers). Among the responding hospitals, EA was avail...

International Journal of Obstetric Anesthesia, 2010

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apol... more This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Regional Anesthesia and Pain Medicine, 2003

Regional Anesthesia and Pain Medicine, 2003

European Journal of Anaesthesiology, 2007

The incidence of hypotension is less in L5 group although the need of ERA is higher. Hypotension ... more The incidence of hypotension is less in L5 group although the need of ERA is higher. Hypotension is strongly correlated to lower umbilical cord blood gases. EVE is not adequate for CS with these low doses. References:

European Journal of Anaesthesiology, Jun 1, 2011

inadequate af ter four rescue doses of oxy tocin, alternative uterotonic therapy was administered... more inadequate af ter four rescue doses of oxy tocin, alternative uterotonic therapy was administered (sulprostone). Data were entered and analysed using SPSS11.0, Student's t-test was used for parametric data; non-parametric data were analysed with a Khi-2 test. Results and Discussion: 60 patients were enrolled, all completed the study; demographic characteristics were similar among the 2 groups. There was no dif ferences in UT at any measurement time and in the number of patients who required rescue doses of oxy tocin (15 for each group). Blood loss was similar in the 2 groups (215 ml in G1 and 301ml in G2, P>0.05). Increase of heart rate 2 min af ter oxy tocin was more frequent in G2 (15 versus 8 in G1, P=0.025), there was no dif ference in other side ef fects. Conclusion: Adequate UT during CS can occur either with 2 or 5 units of oxy tocin , but the use of 2 units seems to be more safe as it cause less hemodynamic ef fects mainly tachycardia. References:

European Journal of Anaesthesiology, Jun 1, 2010

compared to a manual bolus which can be completed in 20 seconds. Catheter tip position seems to p... more compared to a manual bolus which can be completed in 20 seconds. Catheter tip position seems to play a role to influence the spread as well. Other pregnancy related factors are epidural space pressures and adjacent cavity pressures. With good explanation and communication with the parturient as well as midwives, better outcome can be expected with the bolus only regimes. PCEA Pumps with variable speed of injection needs evaluation to find out the optimum speed of bolus delivery through the epidural route. Conclusion(s): Background infusions with PCEA are successfully used to provide labour analgesia. Incidence of motor blockade is very high which raises the concern as major complications can go unnoticed. Boluses only PCEA regimes can potentially reduce the motor blockade. Reference: 1 Halpern SH. Patient-controlled epidural analgesia for labor. Anesth Analg 2009;108(3):921-8.

Anesthesiology, Sep 1, 2000

Obstetric Anesthesia Digest, Sep 1, 2009

... Patricia M. Lavand'homme, MD, PhD,; Fabienne Roelants, MD,; Hilde Waterloos, RN,; Valeri... more ... Patricia M. Lavand'homme, MD, PhD,; Fabienne Roelants, MD,; Hilde Waterloos, RN,; Valerie Collet, MSc and; Marc F. De Kock, MD, PhD. From the ... capsaicin injection.9 A dose of 150 μg is required to observe this antihyperalgesic effect, while 50 μg is ineffective.8 In a clinical trial ...

H Hé ém mo or rr ra ag gi ie es s d du u p po os st t-p pa ar rt tu um m E Ex xt tr ra ai it t d ... more H Hé ém mo or rr ra ag gi ie es s d du u p po os st t-p pa ar rt tu um m E Ex xt tr ra ai it t d de e l la a T Th hè ès se e d du u D Dr r A An nn ne e S So om mm mé é I IN NT TR RO OD DU UC CT TI IO ON N L'hémorragie du post-partum est responsable à travers le monde de 25 % des décès maternels observés [1]. En France, en 1996 et 1997, sur les 123 décès maternels dénombrés 31 étaient liés à des causes hémorragiques et parmi eux 19 à des hémorragies du post-partum et de la délivrance [2]. Les pertes sanguines normales, qui sont de 500 ml, n'entraînent que peu ou pas de modifications hémodynamiques chez les parturientes. En revanche, l'hémorragie grave définie comme un saignement de plus de 1000 ml se traduit par des manifestations cliniques plus bruyantes, est grevée d'une morbidité importante et d'une mortalité non négligeable. Dans la grande majorité des cas, les hémorragies diagnostiquées et dont la cause est identifiée répondent heureusement aux traitements de première intention, incluant utérotoniques, révision de la filière génitale et sutures en association avec une réanimation médicale adaptée. Il arrive cependant dans moins de 1 % des accouchements que ces mesures soient insuffisantes et que la poursuite des saignements associée aux altérations de l'hémostase et de l'hémodynamique imposent de recourir à d'autres modalités thérapeutiques. Ces recours ultimes sont représentés par l'hystérectomie d'hémostase, les ligatures vasculaires et l'embolisation artérielle. Ces deux dernières ont l'avantage de la conservation de l'utérus et de l'avenir obstétrical de ces patientes jeunes. Entre 1997 et 2002, 69 patientes prises en charge par notre service ont bénéficié de ces procédures. Parmi elles, 42 ont bénéficié d'une embolisation artérielle. Cette technique qui est la plus récente parmi les recours ultimes tient désormais un rôle de choix dans le traitement des phénomènes hémorragiques du post-partum ; nous nous proposons d'évaluer la place de cette technique et ses indications, ses résultats parmi les traitements de recours utilisés durant cette période en les illustrant avec les résultats de notre étude et en les comparant à ceux de la littérature. phénomènes hémorragiques. Le choix de 1000 ml comme valeur seuil pour définir l'HPPI sévère s'établit donc sur son retentissement sur l'hémodynamique et l'hémostase maternelles. Ces données corroborent la nécessité d'un diagnostic rapide de l'hémorragie et de sa quantification précise. Relations entre le degré de choc et le volume des pertes sanguines [3]. Pertes sanguines Pression artérielle Symptomatologie Degré de choc 10-15 % (/VST)

Acute pain must be treated as soon as possible to avoid the development of chronic pain which is ... more Acute pain must be treated as soon as possible to avoid the development of chronic pain which is highly prevalent worldwide and is considered as a socio-economical and health problem due to secondary disability and comorbidities such as anxiety, depression and the high rate of dependency on opioids and painkillers. Epidemic increases in opioids use highlights the need for effective adjuvant therapies that help to reduce pain and the need for drugs. In this context, music, virtual reality and hypnosis have been evaluated. Music Music and acute pain: Music intervention has shown statistically significant effects in decreasing pain (10%), emotional distress from pain, anesthetic use, opioid and non-opioid intakes and has shown an anxiolytic effect.1 2 a greater effect on pain was shown when music was delivered before surgery, when anxiety is the highest than during or after. Moreover, perioperative soft music may reduce later postoperative pain (day 7) and fatigue (days 1,7) by decreasing the surgical stress response after laparoscopic cholecystectomy.3 Music and chronic pain: Music reduced self-reported chronic pain, anxiety and depressive symptoms with a greater effect when the patient chose himself the music. This effect may be related to familiarity and the feeling of control and pleasure.4 Music in obstetrics: In comparison to a control group (no music), mothers in the music therapy group had a lower level of pain and anxiety at all stages of labor and decreased significantly their analgesics requirements in the postpartum period.5 6Music seems to decrease early postpartum depression rate.6 Music and neurophysiology: Music-induced analgesia results in the release of opioids engaging the descending pain modulation system.7Dobek investigated the neural mechanisms by applying a well-defined painful stimulus while participants listened to either their favorite music or to no music. Pain rating scores were significantly lower with music playing than without it (10% reduction of pain). Brain regions associated with enjoyable music listening include limbic, frontal, auditory regions and also dorsolateral prefrontal cortex, periaqueductal gray matter, rostral ventromedial medulla and dorsal gray matter of the spinal cord, different areas related to pain modulation.8 How to choose music?: Selecting music might be very difficult because of music’s complexity and variety. Music characteristics such as musical organization, rhythm, volume are rarely described by the authors of clinical trials and therefore, no analyses or conclusions can be done. Despite this, music without lyrics seems to be effective to alleviate pain. Duration of music intervention should not exceed 30 min per session and if administered for several days, 14–30 days appear to be effective.8 Virtual Reality (VR) VR allows a complete immersion in an artificial three-dimensional environment. the device consists of a video headset, associated with a smartphone or connected to a computer, headphones. the headset has sensors that can track the movements of the user’s head to give the illusion of movement in virtual space. a feeling of real immersion is given through visual and auditory stimuli.9 VR and acute pain The use of VR to reduce pain and anxiety has been most widely studied in the treatment of burns in both adults and children. It seems that VR would be reversible and short lived and thus that VR would not have a persistent effect in the clinical context.10 the analgesic effects of immersive VR distraction has been evaluated in volunteers receiving thermal pain stimulation and exposed to opioid administration, VR, or opioid and VR. Combined opioid and VR reduced pain reports more effectively than did opioid alone on all subjective pain measures.11 The ability of VR to reduce pain has mostly been attributed to active distraction. Indeed, attention is required for pain and exists in limited supply. If the attention is diverted, resources available for processing pain will be reduced.12 VR seems to be much more effective compared to traditional techniques because of its highly immersive nature giving a sense of presence in the virtual world.12 VR and neurophysiology: In patients using VR and exposed to a painful stimulus, fMRI studies have shown, a reduction of more than 50% in pain-related brain activity in five areas of the brain including the periqueductal grey matter, the anterior cingulate gyrus and the orbital-frontal cortex.13 VR and chronic pain: Hoffman studied the value of VR during repeated physical therapy sessions in burn victims and showed significantly lower pain scores (30–35%), when patients were immersed in virtual reality. In addition, VR maintains its efficacy over repeated sessions.14 VR technology: the technical quality of virtual reality and the degree of immersion generated are directly correlated with the quantity of analgesia provided. the use of a ‘high-tech’ video headset with a high number of pixels also contributes to…

International Journal of Obstetric Anesthesia, 2010

M any women request analgesia for childbirth. The American College of Obstetricians and Gynecolog... more M any women request analgesia for childbirth. The American College of Obstetricians and Gynecologists recommends that all women should receive pain relief on request. 1 Despite several potential risks and side effects, neuraxial labor analgesia is a very safe and effective method of providing pain relief throughout labor. Some women, however, prefer to avoid neuraxial analgesia and prefer an alternative analgesic technique. In addition, a small minority of parturients has contraindications to the use of neuraxial analgesia and therefore must select an alternate mode of pain relief. Patient-controlled intravenous analgesia (PCIA) with remifentanil has become a popular non-neuraxial, parenteral opioid option during the past 2 decades. In some institutions, it is offered routinely as a first-line strategy for labor analgesia. In other departments and services, it is reserved for the selected group of patients, such as those with contraindications to neuraxial analgesia. Most experience with remifentanil PCIA has been reported from Europe. In the current issue of the Journal, Aaronson et al 2 publish a survey on the use of remifentanil PCIA during labor in academic teaching centers in the United States. Slightly more than one-third of responding units reported the use of remifentanil PCIA in the past 12 months. The majority (87%) of institutions offered remifentanil PCIA only when a contraindication for neuraxial analgesia was present, but 13% of centers offered it as an elective alternative to epidural analgesia. Many publications on remifentanil PCIA are available in medical literature. Although the quality of analgesia was the focus of early research, maternal and perinatal safety recently has emerged as an important theme for peripartum remifentanil research. 3,4 The majority of publications are not original peer-reviewed studies but rather reviews,

International Journal of Clinical Practice, 2021

Preoperative anxiety, which can affect postoperative recovery, is often present in patients under... more Preoperative anxiety, which can affect postoperative recovery, is often present in patients undergoing surgery under loco‐regional anaesthesia (LRA). Minimising preoperative anxiety with premedication can be effective but results in drug‐related side effects. Therefore, the use of non‐pharmacological techniques should be encouraged.

Oxford Medicine Online, 2016

Persistent pain after childbirth has recently received a lot of attention as potentially many wom... more Persistent pain after childbirth has recently received a lot of attention as potentially many women could be affected. Several pain syndromes including pelvic girdle pain, low back pain, and headaches occur during the pregnancy and can persist after delivery. The prevalence of chronic pain directly related to the delivery, at 6 months and later after childbirth, is however very low (< 2%) compared to chronic pain which occurs after other types of tissue trauma as in common surgical procedures. Acute pain is a major risk factor in the development of persistent pain after surgery and trauma. After childbirth, the severity of acute pain, independent of the mode of delivery (i.e. the degree of tissue damage) only predicts an increased risk of persistent pain (a 2.5-fold increase) at 2 months but not later. An individual’s pain response seems to be the most relevant factor in the development of persistent pain. In retrospective studies, patient-specific risk factors, such as a pre-exi...

The Breast, 2018

Background: In oncology, hypnosis has been used for pain relief in metastatic patients but rarely... more Background: In oncology, hypnosis has been used for pain relief in metastatic patients but rarely for induction of anesthesia. Material and method: Between January 2010 and October 2015, 300 patients from our Breast Clinic (Cliniques universitaires Saint-Luc, Universit e catholique de Louvain) were included in an observational, non-randomized study approved by our local ethics committee (ClinicalTrials.gov e NCT03003611). The hypothesis of our study was that hypnosis intervention could decrease side effects of breast surgery. 150 consecutive patients underwent breast surgery while on general anesthesia (group I), and 150 consecutive patients underwent the same surgical procedures while on hypnosis sedation (group II). After surgery, in each group, 32 patients received chemotherapy, radiotherapy was administered to 123 patients, and 115 patients received endocrine therapy. Results: Duration of hospitalization was statistically significantly reduced in group II versus group I: 3 versus 4.1 days (p ¼ 0.0000057) for all surgical procedures. The number of post-mastectomy lymph punctures was reduced in group II (1e3, median value n ¼ 1.5) versus group I (2e5, median value n ¼ 3.1) (p ¼ 0.01), as was the quantity of lymph removed (103 ml versus 462.7 ml) (p ¼ 0.0297) in the group of mastectomies. Anxiety scale was also statistically reduced in the postoperative period among the group of patients undergoing surgery while on hypnosis sedation (p ¼ 0.0000000000000002). The incidence of asthenia during chemotherapy was statistically decreased (p ¼ 0.01) in group II. In this group, there was a statistically non-significant trend towards a decrease in the incidence of nausea/ vomiting (p ¼ 0.1), and the frequency of radiodermitis (p ¼ 0.002) and post-radiotherapy asthenia (p ¼ 0.000000881) was also reduced. Finally, the incidence of hot flashes (p ¼ 0.0000000000021), joint and muscle pain (p ¼ 0.0000000000021) and asthenia while on endocrine therapy (p ¼ 0.000000022) were statistically significantly decreased in group II. Discussion: Hypnosis sedation exerts beneficial effects on nearly all modalities of breast cancer treatment. Conclusion: Benefits of hypnosis sedation on breast cancer treatment are very encouraging and further promote the concept of integrative oncology.

The incidence of breast cancer worldwide is increasing as is the survival rate after breast cance... more The incidence of breast cancer worldwide is increasing as is the survival rate after breast cancer. This is essentially due to therapeutic progress. However, anticancer treatment is associated with nonnegligible side effects related to the different treatment modalities. One of the greatest challenges for the coming years will be to promote the participation of patients in their therapeutic plan and to encourage them to not give up their adjuvant treatment for alternative, inefficient and dangerous therapies. In this context, the use of hypnosis is a very good option among highly motivated patients. Hypnosis is able to decrease side effects induced by surgery, general anesthesia and anticancer treatments and generates an important feeling of satisfaction among patients. Herein, we report the case of a breast cancer patient undergoing a modified radical mastectomy and sentinel lymph node biopsy for an extensive intraductal carcinoma, while under hypnosis analgesia and interpectoral b...

La gynécologie-andrologie vous présente quelques innovations marquantes développées en 2015. Les ... more La gynécologie-andrologie vous présente quelques innovations marquantes développées en 2015. Les nouveautés de la spécialité concernent tant la progression thérapeutique avec l'application de la technique du ganglion sentinelle en chirurgie oncologique pelvienne, que l'aspect qualité de vie des patients durant les soins, en particulier au travers de l'utilisation de l'hypnose lors des traitements des pathologies mammaires bénignes et malignes ou en procréation médicalement assistée.[Innovations] The gynecology-andrology department presents several major innovations developed in 2015. Advances have been achieved in the fields of both treatment strategies, as illustrated by the implementation of the sentinel node technique for pelvic cancers, and of quality of life during patient care, especially via using hypnosis while treating benign and malignant breast diseases or in reproductive medicine

Case Reports in Perinatal Medicine, 2015

Malformation affecting the genital tract is a rare condition. Enlargement of the mass and specifi... more Malformation affecting the genital tract is a rare condition. Enlargement of the mass and specific complications may occur following hemodynamic changes associated with pregnancy. A 25-year-old pregnant primigravida affected by an extended vulvar and thigh venous malformation with localised intravascular consumptive coagulopathy was referred to our hospital. Her antenatal care was uneventful until term. She underwent an elective caesarean section because the venous malformation location precluded vaginal birth. At 3 days postpartum, she suffered life-threatening bleeding in the abdominal cavity with disseminated intravascular coagulation requiring multiple blood and platelets transfusions as well as transarterial embolisation. The patient recovered and was discharged after 20 days. Specific counselling and management of pregnant patients with large vascular malformations is essential as it is associated with increased complications rate such as peripartal thrombosis and haemorrhages...

Acta anaesthesiologica Belgica, 2009

Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epid... more Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epidural or combined spinal-epidural technique) is the most effective way to relieve that pain but it is contraindicated or impossible to perform for some parturients. We designed a survey of the current use of analgesic alternatives to epidural analgesia (EA) for labor pain, specifically the use of opioid patient-controlled intravenous analgesia (PCIA), in the French part of Belgium (Wallonia and Brussels). A questionnaire was mailed to the departmental chair of the hospitals with an obstetric unit, both in university and non-university centers (total of 53 centers). The questionnaire evaluated the availability of EA, the alternatives used when EA was contraindicated, the use of opioid-based PCIA for labor analgesia as well as opioid preference and doses, and finally the reasons for not using opioid PCIA. The response rate was 67.5% (36 centers). Among the responding hospitals, EA was avail...

International Journal of Obstetric Anesthesia, 2010

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apol... more This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Regional Anesthesia and Pain Medicine, 2003

Regional Anesthesia and Pain Medicine, 2003

European Journal of Anaesthesiology, 2007

The incidence of hypotension is less in L5 group although the need of ERA is higher. Hypotension ... more The incidence of hypotension is less in L5 group although the need of ERA is higher. Hypotension is strongly correlated to lower umbilical cord blood gases. EVE is not adequate for CS with these low doses. References: