Topical Analgesia with Lidocaine Plus Diclofenac Decreases Pain in Benign Anorectal Surgery: Randomized, Double-blind, and Controlled Clinical Trial.

OBJECTIVE: The aim of this study is to evaluate the efficacy and safety of a topical formulation containing lidocaine plus diclofenac (CLIFE1) compared to lidocaine (CLIFE2), to decrease pain in benign anorectal surgery (BARS) to date not evaluated. More than 50% of patients undergoing BARS, especially hemorrhoidectomy, suffer from moderate and severe postoperative pain. This remains an unresolved problem that could be addressed with the new CLIFE1 topical treatment. METHODS: A multicenter, randomized double-blind, active-controlled parallel-group superiority trial, was conducted in two Spanish hospitals. Patients undergoing BARS (hemorrhoids, anal fistula and anal fissure) were randomized at the end of surgery at a 1:1 ratio to receive first dose either CLIFE1 (n = 60) or CLIFE2 (n = 60) anorectal topical treatment, and after every 12 h for the first three postoperative days and once a day from the fourth to sixth. The primary outcome was average of pain decrease after topical treatment, measured with visual analogue scale (VAS) by the patients themselves, the evening in the surgery day and four times daily for the first three postoperative days. RESULTS: The results of 120 patients included out of 150 selected undergoing BARS show a decrease in pain after CLIFE1 topical treatment (7.47 ± 13.09) greater than with CLIFE2 (4.38 ± 6.75), difference -3.21 95% CI (-5.75; -0.68), p = 0.008, decreasing significantly postoperative pain ( ≥ 9 mm, VAS) in 35% of patients undergoing benign anorectal surgery, compared to 18.33 % treated with lidocaine. CONCLUSIONS: The CLIFE1 topical treatment shows better analgesic efficacy than CLIFE2 in BARS.

Evolución de la CMA en una Unidad de Ginecología (1991-2004) / No disponible

Introducción: Las técnicas quirúrgicas ginecológicas, realizadas en programas de CMA, han ido cambiando a lo largo del tiempo, tanto por motivos de organización como por la incorporación de nuevas tecnologías. Objetivo: Analizar y valorar los cambios a lo largo del tiempo del tipo de procedimientos quirúrgicos realizados en CMA en ginecología. Material y método: Se realiza un estudio retrospectivo de todas las intervenciones de CMA, entre 1993 y 2004. Se comparan dos periodos de tiempo iguales: de 1993 a 1998 con 900 procedimientos y de 1999 a 2004 con 875 procedimientos. Resultados: El número de procedimientos que se realizan por año ha permanecido estable en nuestra unidad, entre los 140 y 160. Sin embargo ha habido un cambio sustancial en el tipo de procedimientos realizados. Ha aumentado la práctica de las laparoscopias quirúrgicas que han pasado de una media de 2,33/año en el primer periodo a una de 8,83/año en el segundo. El cambio más relevante ha sido el experimentado por la histeroscopia quirúrgica que ha pasado de una media de 5/año en el primer periodo a 68,83/año, en el segundo. Conclusiones: El principal procedimiento realizado mediante CMA en ginecología, actualmente, es la histerocopia quirúrgica, básicamente por pólipo endometrial. La laparoscopia quirúrgica por quiste de ovario se realiza con éxito en CMA, en casos seleccionados. Creemos factible introducir en CMA nuevas técnicas quirúrgicas, con buenos resultados, como la colocación de mallas suburetrales para la corrección de la incontinencia urinaria de esfuerzo (AU)

Introduction: Surgical procedures carried out in gynaecology as ambulatory surgery have been changing since they were introduced. Changes have happened due to both: new techniques have been introduced and changes in the organization. Objective: To analyze and value the changes in gynaecology surgical procedures carried out as ambulatory surgery over the time. Material and method: A prospective study is carried out about all procedures made in the Outpatients’ Surgical Unit by the Gynaecolgy Service between 1993 and 2004. We compare two equal periods of time: The first one since 1993 to 1998 containing 900 procedures and the second one since 1999 to 2004 with 875 procedures. Results: The number of procedures wich we practice per year is almost the same, between 140 and 160, although there has been an essential change in the type of procedures. We performed more surgical laparoscopies in the second period than in the first one (medium rates 8.83 and 1.75/year, respectively), but the most important change has been the one made by the surgical hysteroscopy wich has increased from 5/year in the first period to 68.83/year in the second one. Conclusions: The main procedure performed in ambulatory gynaecological surgery nowadays is the surgical hysteroscopy, basically for endometrial polyp. The surgical laparoscopy for ovarian cyst is successfully performed in ambulatory surgery in selected patients (AU)

[Predictive factors of hospital admission in ambulatory surgery at a regional hospital]. / Factores predictores del ingreso hospitalario en la cirugía ambulatoria de un hospital comarcal.

BACKGROUND: Hospital admission following ambulatory surgery is a valid measure of morbidity and a quality indicator. To improve the efficiency of an ambulatory surgery unit it is essential to study the factors associated with unexpected hospital admission. Our goal was to analyze the association of age, ASA, type of surgical and anesthetic procedures, surgical duration, pain, vomiting and surgical and anesthetic complications with unexpected hospital admission. PATIENTS AND METHODS: Retrospective case-control study. The cases were all patients who underwent ambulatory surgery in the Viladecans Hospital (Barcelona, Spain) from October 1990 till May 1996 (n = 6,071), cases (n1 = 93), controls (n0 = 552). Logistic regression models with a predictive variable and multiple logistic regression were obtained. OR and 95% CI were calculated. RESULTS: Age was not significant for admission. ASA greater than status 1 (OR: 3.4 [1.4-9]); p = 0.01), the procto-perineo-sacrococcygeal procedures have significant risk (OR: 35 [4-304]; p < 0.00001), and other types of surgery were not significant. General, spinal anaesthesia and non-spinal locoregional ones with sedation were not significant (p > 0.2), but spinal anesthesia with deep sedation carried a significant risk (OR: 20 [3-122]; p < 0.00001). Surgical duration higher than 40 min (OR: 22 [5-94]; p < 0.00001), pain (OR: 12 [3-55]; p < 0.00001) and vomiting (OR: 8.5 [1.2-59]; p = 0.03) were significant factors in predicting hospital admission. CONCLUSIONS: The factors related with unexpected hospital admission following ambulatory surgery were: surgical and anesthetic complications, pain, procto-perineal and sacrococcigeal procedures, spinal anesthesia with profound sedation and a surgical duration time higher than 40 min.

[Aseptic meningitis after intradural anesthesia]. / Meningitis aséptica tras anestesia intradural.

We report a case of aseptic meningitis after intradural anesthesia in a 70-year-old male. Clinical features developed 4 hours after surgery, and they consisted of high fever, severe headache, drowsiness and temporospatial disorientation, without signs of meningeal irritation. The analysis of cerebrospinal fluid (CSF) showed pleocytosis, normal biochemical findings, and absence of microorganisms both in Gram stain and in culture. The outcome was favorable, and the clinical features disappeared within 48 hours without antibiotic therapy.