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1.
BMC Surg ; 21(1): 177, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794852

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. METHODS: This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. RESULTS: Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03-5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17-4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). CONCLUSIONS: PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients' outcomes.


Assuntos
Medição da Dor , Dor Pós-Operatória , Náusea e Vômito Pós-Operatórios , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hospitais Públicos , Hospitais Universitários , Humanos , Oriente Médio/epidemiologia , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Período Pós-Operatório , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
2.
Medicine (Baltimore) ; 100(5): e23724, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592830

RESUMO

BACKGROUND: In the past few decades, the number of surgery of anterior cruciate ligament reconstruction (ACLR) implemented in the outpatient centers has dramatically enhanced. There is still a lack of effective randomized controlled trials in the literature to demonstrate the effectiveness of tourniquets. As a kind of prospective clinical trial, this research protocol is conducted to compare the results of ACLR with and without the use of a tourniquet. METHODS: All the patients aged 18 or over who underwent the selective primary anterior cruciate ligament reconstruction in our hospital from November 2020 to January 2022 are eligible to take part in our experiment. Exclusion criteria are history of peripheral neuropathy, pregnancy, lumbar radiculopathy, or surgery to the injured or contralateral knee. After the written informed consent is given, the patients participating in the study are randomly assigned to the tourniquet group (group 1) and the tourniquet free group (group 2) on the day of operation, through utilizing the computer-generated random table with 10 members in each group. And the assignments were kept in an opaque and sealed envelope. Any comments on visual difficulties in the process of operative time, arthroscopy, complications, and total bleeding from suction and drainage, as well as the reduction of postoperative hemoglobin are assessed as the parameters. The software of SPSS v. 24 is applied for all the statistical analyses. RESULTS: This protocol will provide a reliable theoretical basis for the following research. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6240).


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Humanos , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Torniquetes
3.
Bone Joint J ; 103-B(2): 305-308, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517735

RESUMO

AIMS: Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. METHODS: A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. RESULTS: In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this complication. Ultrasound-guided steroid injection/physiotherapy resulted in complete resolution of symptoms in 61% of cases, partial resolution in 13%, and no benefit in 26%. Eight out of 24 patients (who initially responded to injection) subsequently underwent surgical intervention including tenotomy (n = 7) and revision of the acetabular component (n = 1). CONCLUSION: This is the largest case series to estimate the incidence of iliopsoas pathology to date. There is a higher incidence of this condition in younger patients, possibly due to the differing surgical indications. Arthoplasty for Perthes' disease or developmental dysplasia of the hip (DDH) often results in leg length and horizontal offset being increased. This, in turn, may increase tension on the iliopsoas tendon, possibly resulting in a higher risk of psoas irritation. Image-guided steroid injection is a low-risk, relatively effective treatment. In refractory cases, tendon release may be considered. Patients should be counselled of the risk of persisting groin pain when undergoing THA. Cite this article: Bone Joint J 2021;103-B(2):305-308.


Assuntos
Artroplastia de Quadril , Dor Pós-Operatória/etiologia , Músculos Psoas/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/patologia , Dor Pós-Operatória/terapia , Estudos Retrospectivos , Fatores de Risco
4.
Mymensingh Med J ; 30(1): 159-163, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397868

RESUMO

Hemorrhoidal disease is one of the commonest anorectal problems in worldwide. Stapled hemorrhoidopexy is the treatment choice due to less post-operative pain and early recovery. The aim of this study was to assess outcomes after Stapled hemorrhoidopexy (SH). This cross-sectional prospective study was performed in Shaheed Suhrawardy Medical College Hospital, Dhaka from January 2016 to December 2017. Ninety patients with symptomatic hemorrhoidal diseases were included in this study. Data collected in data collection sheet regarding demographic data, severity of symptoms, post-operative complains of patient and outcome of patients which were then analyzed. Total 90 patients were included in this study. Age ranged from 18-50 years. Male were 59(65.56%) and female were 31(34.44%). 2° hemorrhoids were 11(12.22%), 3° hemorrhoids were 63(70%), 4° hemorrhoids were 16(17.78%). Post-operative complications were mild pain 73(81.11%), moderate pain 13(14.45%), severe pain 4(4.44%), early bleeding 23(25.56%), retention of urine 16(17.78%), early urgency 15(16.67%), infection 4(4.44%), constipation 9(10%), late recurrence 4(4.44%). Outcomes of stapled hemorrhoidopexy were satisfactory in most patients. Early recovery, low complication rate, minimal post-operative pain was encountered in treatment of symptomatic hemorrhoids by stapled hemorrhoidopexy.


Assuntos
Hemorroidas , Grampeamento Cirúrgico , Adolescente , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Feminino , Hemorroidas/epidemiologia , Hemorroidas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
5.
Lancet Neurol ; 20(2): 98-106, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33357512

RESUMO

BACKGROUND: Degenerative cervical myelopathy represents the most common form of non-traumatic spinal cord injury. This trial investigated whether riluzole enhances outcomes in patients undergoing decompression surgery for degenerative cervical myelopathy. METHODS: This multicentre, double-blind, placebo-controlled, randomised, phase 3 trial was done at 16 university-affiliated centres in Canada and the USA. Patients with moderate-to-severe degenerative cervical myelopathy aged 18-80 years, who had a modified Japanese Orthopaedic Association (mJOA) score of 8-14, were eligible. Patients were randomly assigned (1:1) to receive either oral riluzole (50 mg twice a day for 14 days before surgery and then for 28 days after surgery) or placebo. Randomisation was done using permuted blocks stratified by study site. Patients, physicians, and outcome assessors remained masked to treatment group allocation. The primary endpoint was change in mJOA score from baseline to 6 months in the intention-to-treat (ITT) population, defined as all individuals who underwent randomisation and surgical decompression. Adverse events were analysed in the modified intention-to-treat (mITT) population, defined as all patients who underwent randomisation, including those who did not ultimately undergo surgical decompression. This study is registered with ClinicalTrials.gov, NCT01257828. FINDINGS: From Jan 31, 2012, to May 16, 2017, 408 patients were screened. Of those screened, 300 were eligible (mITT population); 290 patients underwent decompression surgery (ITT population) and received either riluzole (n=141) or placebo (n=149). There was no difference between the riluzole and placebo groups in the primary endpoint of change in mJOA score at 6-month follow-up: 2·45 points (95% CI 2·08 to 2·82 points) versus 2·83 points (2·47 to 3·19), difference -0·38 points (-0·90 to 0·13; p=0·14). The most common adverse events were neck or arm or shoulder pain, arm paraesthesia, dysphagia, and worsening of myelopathy. There were 43 serious adverse events in 33 (22%) of 147 patients in the riluzole group and 34 serious adverse events in 29 (19%) of 153 patients in the placebo group. The most frequent severe adverse events were osteoarthrosis of non-spinal joints, worsening of myelopathy, and wound complications. INTERPRETATION: In this trial, adjuvant treatment for 6 weeks perioperatively with riluzole did not improve functional recovery beyond decompressive surgery in patients with moderate-to-severe degenerative cervical myelopathy. Whether riluzole has other benefits in this patient population merits further study. FUNDING: AOSpine North America.


Assuntos
Vértebras Cervicais/cirurgia , Craniectomia Descompressiva/métodos , Degeneração do Disco Intervertebral/tratamento farmacológico , Degeneração do Disco Intervertebral/cirurgia , Fármacos Neuroprotetores/uso terapêutico , Procedimentos Neurocirúrgicos/métodos , Riluzol/uso terapêutico , Compressão da Medula Espinal/tratamento farmacológico , Compressão da Medula Espinal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Método Duplo-Cego , Determinação de Ponto Final , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/efeitos adversos , Dor Pós-Operatória/epidemiologia , Riluzol/efeitos adversos , Resultado do Tratamento
6.
Anaesthesia ; 76(1): 45-53, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33253427

RESUMO

Sleep apnoea is associated with negative outcomes following general anaesthesia. Current recommendations suggest using short-acting anaesthetic agents in preference to standard agents to reduce this risk, but there is currently no evidence to support this. This randomised controlled triple-blind trial tested the hypothesis that a combination of short-acting agents (desflurane-remifentanil) would reduce the postoperative impact of general anaesthesia on sleep apnoea severity compared with standard agents (sevoflurane-fentanyl). Sixty patients undergoing hip arthroplasty under general anaesthesia were randomised to anaesthesia with desflurane-remifentanil or sevoflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnoea-hypopnoea index on the first postoperative night. Secondary outcomes were the supine apnoea-hypopnoea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3. Pre-operative sleep study data were similar between groups. Mean (95%CI) values for the supine apnoea-hypopnoea index on the first postoperative night were 18.9 (12.7-25.0) and 21.4 (14.2-28.7) events.h-1 , respectively, in the short-acting and standard anaesthesia groups (p = 0.64). Corresponding values on the third postoperative night were 28.1 (15.8-40.3) and 38.0 (18.3-57.6) events.h-1 (p = 0.34). Secondary sleep- and pain-related outcomes were generally similar in the two groups. In conclusion, short-acting anaesthetic agents did not reduce the impact of general anaesthesia on sleep apnoea severity compared with standard agents. These data should prompt an update of current recommendations.


Assuntos
Anestesia Geral/métodos , Apneia Obstrutiva do Sono/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Inalatórios , Anestésicos Intravenosos , Artroplastia de Quadril , Desflurano , Método Duplo-Cego , Feminino , Fentanila , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Remifentanil , Sevoflurano , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Decúbito Dorsal , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(45): e23065, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157964

RESUMO

Dental general anesthesia (DGA) is a safe and high-quality restorative and preventive treatment option for children with severe early childhood caries (S-ECC), who require extensive dental treatment and exhibit anxiety and emotional or cognitive immaturity or are medically compromised. However, several postoperative complications have been reported in children under DGA. This study aimed to evaluate and analyze the prevalence of the relevant factors of postoperative complications in healthy Chinese children following DGA to provide a foundation for pre-, intra-, and postoperative overall health management for healthy and disabled children after DGA.A total of 369 systematically healthy Chinese children (36-71 months old) undergoing a DGA were studied. Data were collected on patients' histories, characteristics, anesthesia, and dental procedures. Parents or caregivers were interviewed before and 72 hours after the procedure. Data were analyzed using logistic regression.Approximately 94.86% of the enrolled children reported one or more complications. The most prevalent complication was postoperative pain (62.70%), followed by weariness, agitation, masticatory problems, drowsiness, oral bleeding, coughing, fever, sore throat, nausea, constipation, epistaxis, vomiting, excitement, and diarrhea. The long duration of the operation was a risk factor for postoperative pain and weariness. A high nutritional status could be a protective factor for postoperative fever.Prolonged operation means complex treatment, such as pulp therapy or extraction. We speculate that the longer the duration is, the more difficult the dental procedures are. The accumulation of discomfort leads to pain. We suspect that children in lower nutritional levels are more likely to suffer from bacteremia or dehydration, resulting in fever.Postoperative pain was the most prevalent complication after the DGA. A decrease in dental procedure duration might reduce the odds of postoperative pain and weariness. A high nutritional status could be a protective factor for postoperative fever. Children with low nutritional status could be more susceptible to postoperative fever.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Geral/métodos , Cárie Dentária/cirurgia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Anestesia Geral/estatística & dados numéricos , Ansiedade/epidemiologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos de Casos e Controles , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Estado Nutricional , Dor Pós-Operatória/epidemiologia , Prevalência , Estudos Prospectivos , Segurança
8.
Med. oral patol. oral cir. bucal (Internet) ; 25(6): e714-e719, nov. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-197177

RESUMO

BACKGROUND: To explore the prevalence of dental anxiety (DA) in patients with third molar extractions and its influence factors and the correlation between DA levels and postoperative pain. MATERIAL AND METHODS: A prospective and descriptive clinical study was performed. All patients who underwent the impacted third molar extraction from October 2017 to February 2019 were enrolled. DA levels were assessed by virtue of the modified dental anxiety scale (MDAS) and pain was assessed with a visual analog scale (VAS). RESULTS: A total of 150 patients were investigated and 136 valid questionnaires were retrieved, with an effective rate of 90.7%. The independent sample t-test and ANOVA results showed that the anxiety level of patients with the third molar extractions was statistically different in gender, teeth extraction experience and self-assessment oral health status. Multiple linear regression analysis with DA as a dependent variable showed that gender and teeth extraction experience were independent factors influencing DA in patients with third molar extractions. Pearson's test showed that there was a significant correlation between DA level in patients and the postoperative pain on the first day (r = 0.542, p = 0.000). CONCLUSIONS: For patients (females, poor oral hygiene and no teeth extraction experience), surgeon should pay more attention to DA of such patients and take measures to reduce the anxiety when removing the third molars. Furthermore, surgeon can recommend oral administration ibuprofen sustained release capsules after surgery


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Dente Serotino/cirurgia , Dente Impactado/cirurgia , Dor Pós-Operatória/epidemiologia , Ansiedade ao Tratamento Odontológico/epidemiologia , Extração Dentária/psicologia , Estudos Prospectivos , Dor Pós-Operatória/etiologia , Medição da Dor , China/epidemiologia
9.
Med Oral Patol Oral Cir Bucal ; 25(6): e714-e719, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33037812

RESUMO

BACKGROUND: To explore the prevalence of dental anxiety (DA) in patients with third molar extractions and its influence factors and the correlation between DA levels and postoperative pain. MATERIAL AND METHODS: A prospective and descriptive clinical study was performed. All patients who underwent the impacted third molar extraction from October 2017 to February 2019 were enrolled. DA levels were assessed by virtue of the modified dental anxiety scale (MDAS) and pain was assessed with a visual analog scale (VAS). RESULTS: A total of 150 patients were investigated and 136 valid questionnaires were retrieved, with an effective rate of 90.7%. The independent sample t-test and ANOVA results showed that the anxiety level of patients with the third molar extractions was statistically different in gender, teeth extraction experience and self-assessment oral health status. Multiple linear regression analysis with DA as a dependent variable showed that gender and teeth extraction experience were independent factors influencing DA in patients with third molar extractions. Pearson's test showed that there was a significant correlation between DA level in patients and the postoperative pain on the first day (r=0.542, p=0.000). CONCLUSIONS: For patients (females, poor oral hygiene and no teeth extraction experience), surgeon should pay more attention to DA of such patients and take measures to reduce the anxiety when removing the third molars. Furthermore, surgeon can recommend oral administration ibuprofen sustained release capsules after surgery.


Assuntos
Dente Serotino , Dente Impactado , Ansiedade ao Tratamento Odontológico/epidemiologia , Feminino , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Extração Dentária , Dente Impactado/cirurgia
10.
Anesth Analg ; 131(5): 1589-1598, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079883

RESUMO

BACKGROUND: Intraoperative monitoring with pupillometry has shown promising results for nociception/antinociception balance monitoring. However, its benefits in clinical practice remain unproven. The aim of this study was to evaluate the efficacy of intraoperative pupillometry monitoring on intraoperative opioid consumption and postoperative pain compared to surgical pleth index (SPI), another widely investigated monitoring. METHODS: American Society of Anesthesiologists (ASA) I-II patients scheduled for elective laparoscopic cholecystectomy were included. This prospective, parallel-arm, single-center study was conducted in 2 steps. First, we evaluated the feasibility of using pupillometry and SPI monitoring compared with conventional hemodynamic monitoring. Next, a parallel-arm, double-blind randomized study compared the peak postoperative pain measured with numerical rating scale (NRS) from 0 (no pain) to 10 (extreme pain) as a primary outcome between pupillometry (pupillometry group, n = 43) and SPI monitoring (SPI group, n = 43) using Mann-Whitney U test. Secondary outcomes included intraoperative remifentanil consumption, postoperative opioid responsiveness (a decrease in NRS by ≥1 after fentanyl administrations), number of analgesic administrations, and opioid-related complications. RESULTS: In the preliminary study (n = 50), remifentanil consumption was less under pupillometry monitoring compared to SPI monitoring, and peak postoperative pain was lower under pupillometry compared to conventional monitoring. In the main study (n = 86), peak postoperative pain and intraoperative remifentanil consumption were lower in the pupillometry group (median [first to third quartile], 5 [4-6]; mean ± standard deviation [SD], 0.078 ± 0.019 µg·kg·minute) compared to the SPI group (7 [5-8] and 0.0130 ± 0.051 µg·kg·minute; P < .001), with the median difference in peak postoperative pain of -1 and its 95% confidence interval between -2 and -0.5. The pupillometry group had better responsiveness to fentanyl (84.6% vs 61.0%; P = .005) and lower number of analgesic administrations (2 [1-2] vs 2 [1-3]; P = .048) compared to the SPI group. CONCLUSIONS: Intraoperative pupillometry monitoring reduced intraoperative remifentanil consumption and postoperative pain. It may be an alternative option for intraoperative opioid control under general anesthesia in adult patients.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Intravenosa , Anestésicos Intravenosos , Monitorização Intraoperatória/métodos , Nociceptividade/efeitos dos fármacos , Propofol , Pupila/efeitos dos fármacos , Remifentanil , Adulto , Idoso , Colecistectomia Laparoscópica , Método Duplo-Cego , Estudos de Viabilidade , Feminino , Fentanila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Período Perioperatório , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(44): e22701, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126307

RESUMO

BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) has routinely performed in recent years for lumbar disc herniation because of the advances in technology of minimally invasive spine surgery. Two common operating routes for PELD have been introduced in the literature: transforaminal approach (TA) and interlaminar approach (IA). The purpose of our current retrospective clinical trial was to study whether the effect of IA-PELD is better than TA-PELD in the incidence of complications and clinical prognosis scores in the patients with L5-S1 lumbar disc herniation. METHODS: Our present research was approved by the institutional review board in the Second Hospital of Nanjing. All the patients offered the informed consent. All the procedures containing human participants were conducted on the basis of the Helsinki Declaration. A retrospective analysis was implemented on 126 patients with L5-S1 disc herniated radiculopathy from March 2016 to March 2018, who were treated with the PELD utilizing the IA technique or the TA technique. Relevant data, such as the patients demographics, surgical duration, length of hospital stay, hospitalization expenses, complications were recorded. In our work, the outcomes of patients were determined at baseline, 6 months, 12 months, and 24 months after treatment. The measure of primary outcome was Oswestry Disability Index score. The other outcomes measured were Numeric Rating Scale pain scale, surgical duration, length of hospital stay, and complications. The software of SPSS Version 22.0 (IBM Corporation, Armonk, NY) was applied for the analysis of all the statistical data. When P value <.05, it was considered to be significant in statistics. RESULTS: This protocol will provide a solid theoretical basis for exploring which PELD approach is better in treatment of lumbar disc herniation. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5988).


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Radiculopatia/cirurgia , Adulto , Avaliação da Deficiência , Endoscopia/efeitos adversos , Estudos de Avaliação como Assunto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Projetos de Pesquisa , Estudos Retrospectivos , Resultado do Tratamento
12.
Niger J Clin Pract ; 23(10): 1407-1413, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047698

RESUMO

Aims: In this study, using Beck depression inventory (BDI), we aimed to determine alterations in the emotional state of patients who had impacted third molars (M3) extracted owing to postoperative pain, edema, and trismus.In this prospective clinical trial, which was conducted at Tokat Gaziosmanpasa University, Faculty of Dentistry, Department of Maxillofacial Surgery Clinic, we studied 60 patients (30 males and 30 females), who were 18-47 years old (the mean of 25.6 years of age). The patients with M3 with moderate preoperative pain intensities, edema, and maximal mouth opening (MMO) data were recorded, and BDI was applied to determine their emotional states. The patients were re-evaluated using BDI to detect alterations in their emotional state owing to pain intensity, edema, and trismus on postoperative second and seventh day. Subjects and Methods: Descriptive statistical analysis, Chi-square, and independent t-test were utilized to interpret the obtained data. Results: According to our findings, a statistically significant relationship was observed between BDI scores and gender on the second postoperative day (P = 0.004), and between MMO and BDI scores on the second and seventh postoperative day (P = 0.012, P = 0.045). Pain intensity scores on the postoperative sixth hour and seventh day were significantly correlated with BDI scores on the postoperative second and seventh day (P = 0.000/ P = 0.000/P = 0.002/P = 0.004/P = 0.010/P = 0.017/P = 0.001/P = 0.000). Conclusions: Our results suggest that the pain and trismus owing to the M3 surgery were significantly correlated with an increase in the postoperative BDI scores.


Assuntos
Depressão/diagnóstico , Edema/psicologia , Dente Serotino/cirurgia , Dor Pós-Operatória/psicologia , Extração Dentária/psicologia , Adolescente , Adulto , Cárie Dentária/epidemiologia , Depressão/epidemiologia , Depressão/psicologia , Edema/epidemiologia , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Extração Dentária/métodos , Extração Dentária/estatística & dados numéricos , Trismo/epidemiologia , Trismo/psicologia , Turquia/epidemiologia , Adulto Jovem
13.
Anesth Analg ; 131(4): 1164-1172, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925337

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common occurrence after cardiac surgery. However, in contrast to other surgical populations, routine PONV prophylaxis is not a standard of care in cardiac surgery. We hypothesized that routine administration of a single prophylactic dose of ondansetron (4 mg) at the time of stopping postoperative propofol sedation before extubation in the cardiac surgery intensive care unit would decrease the incidence of PONV. METHODS: With institutional human ethics board approval and written informed consent, we conducted a randomized controlled trial in patients ≥19 years of age with no history of PONV undergoing elective or urgent cardiac surgery procedures requiring cardiopulmonary bypass. The primary outcome was the incidence of PONV in the first 24 hours postextubation, compared by the χ test. Secondary outcomes included the incidence and times to first dose of rescue antiemetic treatment administration, the incidence of headaches, and the incidence of ventricular arrhythmias. RESULTS: PONV within the first 24 hours postextubation occurred in 33 of 77 patients (43%) in the ondansetron group versus 50 of 82 patients (61%) in the placebo group (relative risk, 0.70 [95% confidence interval {CI}, 0.51-0.95]; absolute risk difference, -18% [95% CI, -33 to -2]; number needed to treat, 5.5 [95% CI, 3.0-58.4]; χ test, P = .022). Kaplan-Meier "survival" analysis of the times to first rescue antiemetic treatment administration over 24 hours indicated that patients in the ondansetron group fared better than those in the placebo group (log-rank [Mantel-Cox] test; P = .028). Overall, 32 of 77 patients (42%) in the ondansetron group received rescue antiemetic treatment over the first 24 hours postextubation versus 47 of 82 patients (57%) in the placebo group (relative risk, 0.73 [95% CI, 0.52-1.00]; absolute risk difference, -16% [95% CI, -31 to 1]); P = .047. There were no significant differences between the groups in the incidence of postoperative headache (ondansetron group, 5 of 77 patients [6%] versus placebo group, 4 of 82 patients [5%]; Fisher exact test; P = .740) or ventricular arrhythmias (ondansetron group, 2 of 77 patients [3%] versus placebo group, 4 of 82 patients [5%]; P = .68). CONCLUSIONS: These findings support the routine administration of ondansetron prophylaxis at the time of discontinuation of postoperative propofol sedation before extubation in patients following cardiac surgery. Further research is warranted to optimize PONV prophylaxis in cardiac surgery patients.


Assuntos
Antieméticos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ondansetron/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Idoso , Arritmias Cardíacas/epidemiologia , Ponte Cardiopulmonar , Método Duplo-Cego , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Resultado do Tratamento
14.
Anesth Analg ; 131(4): 1249-1259, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925346

RESUMO

BACKGROUND: Extended-release (ER) opioids are indicated for the management of persistent moderate to severe pain in patients requiring around-the-clock opioid analgesics for an extended period of time. Concerns have been raised regarding safety of ER opioids due to its potential for abuse and dependence. However, little is known about perioperative prescribing practices of ER opioids. This study assessed perioperative prescribing practices of ER opioids in noncancer surgical patients stratified by type of opioid exposure prior to admission and examined predictors of postoperative opioid administration in oral morphine equivalents (OME). METHODS: This was a retrospective cohort study using the University of California San Francisco Medical Center electronic health record data. This study included 25,396 adult noncancer patients undergoing elective surgery under general anesthesia in the period 2015-2018. The primary study outcome was predictors of postoperative administration of opioids in hospitalized surgical patients. Secondary outcomes included patients discontinued and initiated on ER opioids during their hospital stay. RESULTS: substance use disorder diagnosis and use of opioids, surgery type, and postoperative administration of nonopioid analgesics were associated with postoperative administration of opioids (P < .0001). The estimated adjusted mean (95% confidence interval [CI]) of postoperative administration of OME prior to admission in ER opioid users (170.08 mg; 147.08-196.67) was twice the amount for opioid-naïve patients (81.36 mg; 70.7-93.63; P < .0001). One in 5 prior to admission ER opioid users were weaned off ER opioids while hospitalized without adversely affecting their postoperative pain or hospital length of stay (LOS). Four of 5 patients who used ER opioids prior to admission also received ER opioids after surgery, whereas, 1 in 100 opioid-naïve patients received ER opioids during their hospital stay. CONCLUSIONS: We found significant variability in the perioperative prescribing practices of ER opioids in hospitalized noncancer surgical patients by use of opioids prior to admission and surgery type. Pain medicine practitioners and surgeons may play a significant role tackling the surgery-related risk of exposure to ER opioids and decreasing opioid-related complications.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Período Perioperatório/estatística & dados numéricos , Padrões de Prática Médica , Adulto , Idoso , Analgésicos não Entorpecentes/uso terapêutico , Anestesia Geral , Estudos de Coortes , Preparações de Ação Retardada , Procedimentos Cirúrgicos Eletivos/classificação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados com Narcóticos/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Período Pós-Operatório , Fatores de Risco , Resultado do Tratamento
15.
Niger J Clin Pract ; 23(9): 1260-1265, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913166

RESUMO

Backgound: There are many methods used to alleviate edema, trismus, and pain after impacted third molar (3M) removal, one of which is Kinesio Taping (KT). Aims: This study aimed to evaluate the effectiveness of Kinesio Taping with Web Strip technique on postoperative morbidity after impacted mandibular 3M extraction. Methods: The study employed a split-mouth and controlled randomized clinical trial design. A total of 60 patients were scheduled for surgical extractions of bilateral lower 3Ms. They were randomly divided into two groups, and KT was applied to one group while the others was determined as a control group without KT application. Tape was applied directly after surgery and maintained for postoperative (post-op) 7 days. Pain intensity was recorded subjectively using a Visual Analogue Scale (VAS). Pain and analgesic usage were recorded on the post-op 1st, 2nd, 3rd, and 7th days. Trismus was evaluated before the surgery and on the post-op 2nd and 7th days. Facial edema was analyzed on the post-op 2nd and 7th days by VAS and by measuring the lengths of three lines using a flexible plastic tape measure. Results: VAS pain scores were statistically lower in the KT group on the post-op 1st, 3rd and 7th days. Total analgesic usage was also significantly lower in the KT group. On the post-op 2nd day, measurement of the lengths of three lines showed a statistically less edema in the KT group. Similar results were obtained from the measurement of edema using VAS. Maximum mouth opening was statistically higher in the KT group on the post-op 2nd and 7th day. Conclusion: KT with the web strip technique should be considered more economic and less traumatic than other approaches, as it is free from systemic side effects and is a simple method to carry out to decrease morbidity.


Assuntos
Fita Atlética/estatística & dados numéricos , Mandíbula/cirurgia , Dente Serotino/cirurgia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Dor Pós-Operatória/reabilitação , Trismo/reabilitação , Adolescente , Adulto , Edema/epidemiologia , Edema/etiologia , Edema/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Procedimentos Cirúrgicos Bucais/métodos , Medição da Dor , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/reabilitação , Período Pós-Operatório , Resultado do Tratamento , Trismo/epidemiologia , Trismo/etiologia , Escala Visual Analógica , Adulto Jovem
16.
Medicine (Baltimore) ; 99(30): e21309, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791717

RESUMO

BACKGROUND: Microscopic bilateral decompression (MBD) has been suggested as an alternative to open laminectomy and fusion. Recently, percutaneous biportal endoscopic decompression (PBED) has begun to attract attention. The purpose of this retrospective study was to evaluate postoperative pain, functional disability, symptom reduction and satisfaction, and specific surgical parameters between the MBD and PBED techniques in patients with lumbar spinal stenosis (LSS). METHODS: A retrospective review of LSS patients performed with MBD or PBED technique between May 2015 and June 2018 was conducted. Institutional review board approval in People's Hospital of Ningxia Hui Nationality Autonomous Region was obtained prior to conducting chart review and analysis. We received informed consent from all patients before surgery. The primary outcomes assessed were the preoperative to postoperative changes in leg/back pain and disability/function, patient satisfaction with the procedure, and postoperative quality of life. The secondary outcomes including duration of postoperative hospital stay, time to mobilization, postoperative analgesic use, complication rates, and baseline patient characteristics were prospectively collected. RESULTS: The hypothesis was that the PBED technique would achieve better clinical outcomes as compared to the MBD technique in LSS.


Assuntos
Descompressão Cirúrgica/tendências , Vértebras Lombares/patologia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Avaliação da Deficiência , Endoscopia/métodos , Humanos , Laminectomia/normas , Tempo de Internação/estatística & dados numéricos , Microscopia/instrumentação , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Qualidade de Vida , Estudos Retrospectivos , Fusão Vertebral/normas , Resultado do Tratamento
17.
Rev. Soc. Esp. Dolor ; 27(4): 246-251, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196840

RESUMO

INTRODUCCIÓN: El síndrome de dolor posmastectomía (SDPM) aparece recogido en la nueva clasificación ICD-11 (International Classification of Diseases 11th Revision) como un subgrupo de dolor crónico posquirúrgico. Waltho y Rockwell han consensuado recientemente en un artículo de revisión lo que ellos denominan síndrome de dolor poscirugía mamaria (estos criterios han sido publicados en nuestra lengua en una carta al Director en la RESED), que describen esta situación como un dolor que se produce después de cualquier cirugía de mama; es de, al menos, intensidad moderada, presenta características neuropáticas, se localiza en la mama, pared torácica, axila o brazo ipsilateral, tiene una duración mínima de 6 meses, ocurre al menos el 50 % del tiempo y puede ser exacerbado por los movimientos de la cintura escapular. Es probablemente secundario a una lesión del nervio intercostobraquial o intercostales durante la disección a nivel axilar, lo que explica las características neuropáticas de este dolor. La incidencia documentada de SDPM varía según las publicaciones entre un 11 y un 57 %, bajando a un 5-10 % en caso de que sea severo, destacando que hasta el 65 % de los casos presentan características neuropáticas. El objetivo primario de este trabajo es determinar la frecuencia y la intensidad de la incidencia del SDPM y el secundario identificar posibles factores de riesgo para su desarrollo. MATERIA Y MÉTODOS: Se realizó un análisis retrospectivo de todas las mastectomías parciales o totales con o sin vaciamiento ganglionar realizadas entre el 1 de enero de 2017 y el 31 de diciembre 2017. RESULTADOS: De los 119 pacientes analizados, 30 pacientes refirieron dolor (25,2 %). La intensidad fue leve en 24 pacientes, moderado en 4 y severo en 2. No hubo relación entre el riesgo de dolor crónico y cualquiera de las variables analizadas. DISCUSIÓN: En nuestra opinión, parece necesario realizar nuevos estudios prospectivos que incluyan una definición consensuada del SDPM para evaluar los posibles factores de riesgo que afecten tanto en incidencia, intensidad e impacto en la calidad de vida de nuestros pacientes


INTRODUCTION: The posmastectomy pain syndrome (PMPS) is included in the new ICD-11 (International Classification of Diseases 11th Revision) classification under the postsurgical pain syndrome subset. Waltho and Rockwell have recently consensuated what they call post breast surgery pain syndrome (PBSPS) and conclude that a complete definition of PBSPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50 % of the time; and may be exacerbated by movements of the shoulder girdle. The published incidence of PMPS varies between 11-57 % according to different sources. The incidence lowers to 5-10 % when the pain is judged severe. Up to the 65 % of the patients present neuropathic characteristics. The aim of this article is to primary to determine the frequency and intensity of the incidence of, and seconddly to elucidate possible risk factors to influence its appearance. MATERIAL AND METHOD: A retrospective analysis, of all partial or total mastectomies with or without axillary nodal resection, performed between January the 1st 2017 December 31st 2017, was carried out. RESULTS: A total number 119 patients were studied, 30 of which (25,2 %) declared to feel pain. The intensity was low in 24 patients, moderate in 4 and severe in 2. No relationship was found between the appearance of chronic pain and any of the variables studied. DISCUSSION: We judge necessary to perform new prospective studies which include a consensuated definition of PMPS to clearly elucidate possible risk factors that can contribute either to the incidence, intensity or impact in quality of life of our patients


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Mastectomia/estatística & dados numéricos , Dor Pós-Operatória/epidemiologia , Dor do Câncer/epidemiologia , Neoplasias da Mama/cirurgia , Analgesia/métodos , Complicações Pós-Operatórias/epidemiologia , Incidência , Manejo da Dor/métodos , Medição da Dor/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Estudos Retrospectivos
18.
Br J Anaesth ; 125(3): 346-357, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32611524

RESUMO

BACKGROUND: The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue. METHODS: We searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pain (≥3 months) after breast cancer surgery. We used random-effects meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations approach to rate quality of evidence. RESULTS: We included 187 observational studies with 297 612 breast cancer patients. The prevalence of PPSP ranged from 2% to 78%, median 37% (inter-quartile range: 22-48%); the pooled prevalence was 35% (95% confidence interval [CI]: 32-39%). The pooled pain intensity was 3.9 cm on a 10 cm visual analogue scale (95% CI: 3.6-4.2 cm). Moderate-quality evidence supported the subgroup effects of PPSP prevalence for localized pain vs any pain (29% vs 44%), moderate or greater vs any pain (26% vs 44%), clinician-assessed vs patient-reported pain (23% vs 36%), and whether patients underwent sentinel lymph node biopsy vs axillary lymph node dissection (26% vs 43%). The adjusted analysis found that the prevalence of patient-reported PPSP (any severity/location) was 46% (95% CI: 36-56%), and the prevalence of patient-reported moderate-to-severe PPSP at any location was 27% (95% CI: 10-43%). CONCLUSIONS: Moderate-quality evidence suggests that almost half of all women undergoing breast cancer surgery develop persistent post-surgical pain, and about one in four develop moderate-to-severe persistent post-surgical pain; the higher prevalence was associated with axillary lymph node dissection. Future studies should explore whether nerve sparing for axillary procedures reduces persistent post-surgical pain after breast cancer surgery.


Assuntos
Neoplasias da Mama/cirurgia , Dor Crônica/epidemiologia , Estudos Observacionais como Assunto , Dor Pós-Operatória/epidemiologia , Neoplasias da Mama/epidemiologia , Feminino , Humanos , Prevalência , Índice de Gravidade de Doença
19.
Medicine (Baltimore) ; 99(27): e21071, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629738

RESUMO

BACKGROUND: Only few studies have yet investigated whether perioperative administration of pregabalin can reduce the incidence of postoperative chronic neuropathic pain after total hip arthroplasty (THA). This prospective, randomized study compared placebo with pregabalin in the hope that a lower pregabalin dose would improve analgesia without increasing side-effects after THA. METHODS: This study was a prospective randomized blinded study, with a parallel design and an allocation ratio of 1:1 for the treatment groups. The study was approved by the Institutional Review Board in Weifang People's Hospital and written informed consent was obtained from all subjects before enrolment. A total of 120 patients who meet inclusion criteria are randomized to either pregabalin or placebo group. The primary objective of the study was visual analog scale score. As secondary outcomes, opioid consumption measurement, Harris Hip Score, hip range of motion, patient satisfaction, and complications were made at different time points throughout the study for comparison. RESULTS: The null hypothesis of this study was that pregabalin would reduce pain after THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5669).


Assuntos
Analgésicos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Pregabalina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Estudos de Casos e Controles , China/epidemiologia , Método Duplo-Cego , Humanos , Incidência , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Manejo da Dor/métodos , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Assistência Perioperatória/métodos , Placebos/administração & dosagem , Pregabalina/administração & dosagem , Estudos Prospectivos , Amplitude de Movimento Articular/efeitos dos fármacos , Escala Visual Analógica , Adulto Jovem
20.
Br J Anaesth ; 125(5): 762-772, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32620260

RESUMO

BACKGROUND: We investigated the effects of spinal and general anaesthesia and surgical tourniquet on acute pain and early recovery after total knee arthroplasty (TKA). METHODS: Patients (n=413) were randomised to four parallel groups: spinal anaesthesia with or without tourniquet, and general anaesthesia with or without tourniquet. The primary outcome was patient-controlled i.v. oxycodone consumption over 24 postoperative hours. RESULTS: Results from 395 subjects were analysed. Median i.v. oxycodone consumption did not differ between the four groups (spinal anaesthesia without [36.6 mg] and with tourniquet [38.0 mg], general anaesthesia without [42.3 mg] and with tourniquet [42.5 mg], P=0.42), between spinal (37.7 mg) and general anaesthesia (42.5 mg) groups (median difference -3.1, 95% confidence interval [CI] -7.4 to 1.2, P=0.15) and between tourniquet and no-tourniquet groups (40.0 vs 40.0 mg, median difference -0.8, CI -5.1 to 3.5, P=0.72). Vomiting incidence was higher with spinal than with general anaesthesia (21% [42/200] vs 13% [25/194], CI 1.05 to 3.1, P=0.034). The mean haemoglobin decrease was greater without than with tourniquet (-3.0 vs -2.5 g dl-1, mean difference -0.48, CI -0.65 to -0.32, P<0.001). No differences were observed in pain, pain management, incidences of blood transfusions, in-hospital complications, or length of hospital stay. CONCLUSIONS: For TKA, spinal and general anaesthesia with or without tourniquet did not differ in 24-h postoperative opioid consumption, pain management, blood transfusions, in-hospital complications, and length of hospital stay. Vomiting incidence was higher in the spinal than in the general anaesthesia group. Tourniquet use caused smaller decreases in haemoglobin levels. CLINICAL TRIAL REGISTRATION: EudraCT 2016-002035-15.


Assuntos
Anestesia/métodos , Artroplastia do Joelho/métodos , Torniquetes , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Geral , Raquianestesia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Recuperação de Função Fisiológica , Resultado do Tratamento
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