Omission of perioperative morphine reduces postoperative pain in proctological interventions: a single-center analysis.

There is an increase in outpatient procedures and this trend will continue in the future. For hemorrhoidectomy, it is the standard of treatment in many health care systems. Perioperative management including adequate pain control is of paramount importance to ensure successful ambulatory surgery. This study investigates the role and effect of morphine compared to short-acting opiates applied before, during, or after proctological interventions and with focus on hemorrhoidectomy. A retrospective analysis of a prospective database was conducted comparing two populations. The control cohort received morphine (Yes-Mô) intra- and postoperatively, while the intervention group did not receive morphine (No-Mô) between January 2018 and January 2020. Both cohorts were balanced by propensity score matching. The outcomes were postoperative pain measured by numeric ratings scale (NRS) one hour postoperatively, pain 24 h postoperatively, success rate of outpatient management, and complication rate including postoperative nausea and vomiting as well as urinary retention. The intervention population comprised 54 patients and the control group contained 79 patients. One hour after surgery, patients in No-Mô reported lower NRS (1.44 ± 1.41) compared to Yes-Mô (2.48 ± 2.30) (p = 0.029). However, there was no difference in NRS 24 h postoperatively (No-Mô: 1.61 ± 1.41 vs Yes-Mô: 1.63 ± 1.72; p = 0.738). 100% of No-Mô was managed as outpatients while only 50% of Yes-Mô was dismissed on the day of the operation (p = < 0.001). There was no difference in postoperative complications (including postoperative nausea and vomiting (PONV) and urinary retention) between the two groups (PONV No-Mô 7.4% vs Yes-Mô 5.6%, p = 1.0 and urinary retention No-Mô 3.7% vs Yes-Mô 7.4%, p = 0.679). No-Mô received an oral morphine equivalent of 227.25 ± 140.35 mg intraoperatively and 11.02 ± 18.02 mg postoperatively. Yes-Mô received 263.17 ± 153.60 mg intraoperatively and 15.97 ± 14.17 mg postoperatively. The difference in received morphine equivalent between the groups was not significant after matching for the intraoperative (p = 0.212) and postoperative (p = 0.119) received equivalent. Omission of perioperative morphine is a viable but yet not understood method for reducing postoperative pain. Omission of morphine leads to a lower use of total morphine equivalent to attain satisfactory analgesia. The reduction of the overall opiate load and using opiates with a very short half-life potentially leads to a reduction of side effects like sedation. This in turn promotes discharge of the patient on the day of surgery. Omission of morphine is safe and does not increase postoperative complications.

Manifestaciones neurológicas asociadas a infección por virus chikungunya en una población pediátrica hospitalaria

Introducción: La infección por Chikungunya se presenta fiebre y afectación cutánea. Las manifestaciones neurológicas, incluyen encefalopatías principalmente encefalitis; afectación periférica como mielitis, o una combinación de éstas. Objetivo: Describir la frecuencia y las manifestaciones neurológicas asociadas a infección por virus Chikungunya en el periodo enero-marzo 2023 en una población pediátrica. Materiales y Métodos: Estudio descriptivo retrospectivo de corte transversal de serie de casos Ingresaron menores de 18 años con manifestaciones neurológicas y resultados positivos PCR RT a virus Chikungunya que acudieron a un Hospital Público en enero-marzo del 2023. Las variables: demográficas, tiempo de evolución, síntomas, diagnósticos neurológicos, estudio de líquido cefalorraquídeo, electroencefalograma, estudios imagenológicos, tratamiento, ingreso a Unidad de Cuidados Intensivos, disfunción orgánica, mortalidad. Los datos se analizaron en SPSS utilizando estadística descriptiva. El protocolo fue aprobado por el comité de ética. Resultados: Ingresaron 24 pacientes, con edad de 10.0 ±1 meses. El 58.7% de sexo masculino. Como síntoma neurológico, el 54.1% tuvo convulsión. Los diagnósticos neurológicos, el 83.3% fue Encefalitis. Los pacientes con diagnóstico de Encefalitis, 75% fueron menores de 3 meses, 50% con líquido cefalorraquídeo patológico, 45% se realizó Electroencefalografía, 50% recibió inmunoglobulinas. El 50% ingresaron a Unidad de Cuidados Intensivos. Pediátricos. El 60% presentó disfunción orgánica. La mortalidad fue del 4.2%. Conclusión: El diagnóstico neurológico más frecuente fue la encefalitis, predominó en lactantes menores de 3 meses. Los síntomas neurológicos fueron: crisis convulsivas e irritabilidad. Más de la mitad presentaron disfunción orgánica, se registró la mortalidad de un paciente.

Introduction: Chikungunya infection present clinically with fever and skin involvement. Neurological manifestations include encephalopathies, mainly encephalitis and meningoencephalitis; peripheral involvement such as myelitis, Guillain Barré Syndrome; or a combination of these such as encephaloneuromyelopathy. Objective: To describe the frequency and neurological manifestations associated with Chikungunya virus infection during the January-March 2023 time period in a pediatric population. Materials and Methods: This was a descriptive, retrospective and cross-sectional study of a case series. Minors under 18 years of age were admitted with neurological manifestations and positive RT-PCR results for Chikungunya virus who presented to a Public Hospital in January-March 2023. The variables were: demographics, reason for hospitalization, symptoms, neurological diagnoses, cerebrospinal fluid study, electroencephalogram, imaging studies, treatment, admission to the Intensive Care Unit, organic dysfunction and mortality. Data were analyzed in SPSS using descriptive statistics. The protocol was approved by the Ethics Committee. Results: 24 patients were admitted, aged 10.0 ±16 months. 58.7% were male. As a neurological symptom, 54.1% had a seizure. Among the neurological diagnoses, 83.3% were encephalitis. Among the patients diagnosed with encephalitis, 75% were younger than 3 months, 50% had pathological cerebrospinal fluid, 45% underwent electroencephalography, and 50% received immunoglobulins. 50% were admitted to the Pediatric Intensive Care Unit. 60% presented organic dysfunction. Mortality was 4.2%. Conclusions: The most frequent neurological diagnosis was encephalitis, it predominated in infants under 3 months. The neurological symptoms were: seizures and irritability. More than half presented organic dysfunction, one patient expired.