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1.
Br J Anaesth ; 124(2): 214-221, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31771788

RESUMO

BACKGROUND: Post-surgical pain that lingers beyond the initial few-week period of tissue healing is a major predictor of pain chronification, which leads to substantial disability and new persistent opioid analgesic use. We investigated whether postoperative medical complications increase the risk of lingering post-surgical pain. METHODS: The study population consisted of patients undergoing diverse elective surgical procedures in an academic referral centre in the USA, between September 2013 and May 2017. Multivariable logistic regression, adjusting for confounding variables and patient-specific risk factors, was used to test for an independent association between any major postoperative complication and functionally limiting lingering pain 1-3 months after surgery, as obtained from patient self-reports. RESULTS: The cohort included 11 986 adult surgical patients; 10 562 with complete data. At least one complication (cardiovascular, respiratory, renal/gastrointestinal, wound, thrombotic, or neural) was reported by 13.3% (95% confidence interval: 12.7-14.0) of patients, and 19.7% (19.0-20.5%) reported functionally limiting lingering post-surgical pain. After adjusting for known risk factors, the patients were twice as likely (odds ratio: 2.04; 1.78-2.35) to report lingering post-surgical pain if they also self-reported a postoperative complication. Experiencing a complication was also independently predictive of lingering post-surgical pain (odds ratio: 1.95; 1.26-3.04) when complication data were extracted from the National Surgical Quality Improvement Program registry, instead of being obtained from patient self-report. CONCLUSIONS: Medical complications were associated with a two-fold increase in functionally limiting pain 1-3 months after surgery. Understanding the mechanisms that link complications to pathological persistence of pain could help develop future approaches to prevent persistent post-surgical pain.


Assuntos
Dor Crônica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Dor Pós-Operatória/epidemiologia
2.
Spine (Phila Pa 1976) ; 44(22): 1558-1563, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689250

RESUMO

STUDY DESIGN: Retrospective. OBJECTIVE: To examine the relationship between American Society of Anesthesiologists (ASA) score and inpatient pain and narcotics consumption following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Higher ASA scores have been previously linked to increased postoperative complication rates, healthcare costs, length of stay, and hospital readmissions. However, to our knowledge, there have not been previous investigations into the association between ASA scores and postoperative inpatient pain and narcotics utilization following ACDF. METHODS: Patients who underwent a single-level, primary ACDF were retrospectively reviewed and stratified into two cohorts based on ASA score less than or equal to 2 or ASA score more than 2. ASA score was tested for association with demographic variables and perioperative characteristics using student's t test, chi-squared analysis, and Fisher exact test. Inpatient pain scores and narcotics consumption on each postoperative day were then compared between cohorts using bivariate linear regression. RESULTS: Two hundred eleven patients who underwent ACDF were included: 184 had an ASA score less than or equal to 2 and 27 had an ASA score more than 2. Higher ASA score was associated with older age, higher comorbidity burden as measured by the modified Charlson Comorbidity Index (CCI), and lower prevalence of obesity. Higher ASA scores were associated with longer duration of hospital stay, while other perioperative characteristics were similar between ASA score cohorts. There were no differences in inpatient Visual Analog Scale (VAS) pain scores, or hourly, daily, and cumulative inpatient narcotic consumption between cohorts on any postoperative day. CONCLUSION: This retrospective investigation demonstrated that a higher ASA score is associated with increased operative time following ACDF. However, ASA score was determined not to be an independent risk factor that can predict postoperative pain or narcotics consumption among patients who undergo ACDF. Therefore, postoperative pain in the inpatient setting can be managed with similar modalities regardless of ASA score for patients undergoing ACDF. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Entorpecentes , Dor Pós-Operatória , Fusão Vertebral/efeitos adversos , Humanos , Entorpecentes/administração & dosagem , Entorpecentes/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos
3.
Spine (Phila Pa 1976) ; 44(22): 1599-1605, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689255

RESUMO

STUDY DESIGN: Prospective observational study OBJECTIVE.: The aim of this study was to record daily opioid use and pain levels after 1-level lumbar decompression or microdiscectomy. SUMMARY OF BACKGROUND DATA: The standardization of opioid-prescribing practices through guidelines can decrease the risk of misuse and lower the number of pills available for diversion in this high-risk patient population. However, there is a paucity of quantitative data on the "minimum necessary amount" of opioid appropriate for post-discharge prescriptions. METHODS: At two institutions between September 2017 and 2018, we prospectively enrolled 85 consecutive adult patients who underwent one-level lumbar decompression or microdiscectomy. Patients with a history of opioid dependence were excluded. Daily opioid consumption and pain scores were collected using an automated text-messaging-based platform for 6 weeks or until consumption ceased. Refills during the study period were monitored. Patients were asked for the number of pills left over and the method of disposal. Opioid use was converted to oral morphine equivalents (OMEs). Results are also reported in terms of "pills" (oxycodone 5 mg equivalents) to facilitate clinical applications. Risk factors were compared between patients in the top and bottom half of opioid consumption. RESULTS: Total opioid consumption ranged from 0 to 118 pills, with a median consumption of 32 pills (236.3 OME). Seventy-five percent of patients consumed ≤57 pills (431.3 OME). Mean Numeric Rating Scale pain scores declined steadily over the first 2 weeks. By postoperative day 7 half of the study population had ceased taking opioids altogether. Only 22.4% of patients finished their initial prescription, and only 9.4% of patients obtained a refill. CONCLUSION: These data may be used to formulate evidence-based opioid prescription guidelines, establish benchmarks, and identify patients at the higher end of the opioid use spectrum. LEVEL OF EVIDENCE: 2.


Assuntos
Analgésicos Opioides , Descompressão Cirúrgica , Discotomia , Vértebras Lombares/cirurgia , Dor Pós-Operatória , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/estatística & dados numéricos , Discotomia/efeitos adversos , Discotomia/estatística & dados numéricos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia
4.
BMC Surg ; 19(1): 159, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664989

RESUMO

BACKGROUND: Inferior epigastric vascular anatomical landmarks for anterior inguinal hernia repair is an alternative surgical procedure. We present our experience and outcome of the way. METHODS: We performed a retrospective analysis of 230 patients who received anterior tension-free hernia repair between May 2016 to May 2017. Among these cases, 120 were performed using the traditional transinguinal preperitoneal (TTIPP) technique while 100 were performed using the vascular anatomic landmark transinguinal preperitoneal (VALTIPP) technique. Between these two groups, we compared the operation time, length of hospital stay, complication rates, and the visual analog scale (VAS) for pain at 2 days, 3 months, and 6 months after surgery. RESULTS: Surgery was well-tolerated in both groups with no significant hemorrhage or complications. The operation times for the VALTIPP and TTIPP groups were 42.52 ± 9.15 and 53.84 ± 10.64 min (P < 0.05), respectively. Ten patients in the VALTIPP group and 17 patients in the TTIPP group reported sensations of foreign bodies (P < 0.05). The VAS pain score in VALTIPP patients at 2 days (4.0 ± 0.5), 3 months (1.0 ± 0.3), and 6 months (0.9 ± 0.3) were significantly lower when compared with those of TTIPP patients (5.3 ± 0.9 at 2 days, 1.8 ± 0.4 at 3 months, and 1.1 ± 0.1 at 6 months, p < 0.05). No statistically significant differences were found in age, gender, BMI, hernia type and location, follow-up period, incidence of post-operative seromas, recurrence rate, or length of hospital stay. CONCLUSION: Anterior inguinal hernia repair using inferior epigastric vascular anatomical landmarks may lead to reduced operation times, reduced sensations of foreign bodies, and reduced post-operative pain. This technique is simple, practical, and effective in the management of inguinal hernias.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Recidiva , Estudos Retrospectivos , Seroma/epidemiologia
5.
Medicine (Baltimore) ; 98(41): e17520, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593122

RESUMO

BACKGROUND: Evidence suggests that dry CO2 insufflation during laparoscopic colorectal surgery results in greater structural injury to the peritoneum and longer hospital stay than the use of warm, humidified CO2. We aimed to test the hypothesis that warm, humidified CO2 insufflation could reduce postoperative pain and improve recovery in laparoscopic colorectal surgery. METHODS: One hundred fifty elderly patients undergoing laparoscopic colorectal surgery under general anesthesia from May 2017 to October 2018 were randomly divided into 3 groups. The primary outcomes were resting pain, cough pain, and consumption of sufentanil at 2, 4, 6, 12, 24, and 48 hours postoperatively. Quality of visual image, hemodynamic changes, esophageal temperature, mean skin temperature, mean body temperature, recovery time, days to first flatus and solid food intake, shivering, incidence of postoperative ileus, length of hospital stay, surgical site infections, patients and surgeon satisfaction scores, adverse events, prothrombin time, activated partial thromboplastin time, and thrombin time were recorded. RESULTS: Group CE patients were associated with significantly higher early postoperative cough pain and sufentanil consumption than the other 2 groups (P < .05). Compared with group CE, patients in both groups WH and CF had significantly reduced intraoperative hypothermia, recovery time of PACU, days to first flatus and solid food intake, and length of hospital stay, while the satisfaction scores of both patients and surgeon were significantly higher (P < .05). Prothrombin time, activated partial thromboplastin time, and thrombin time were significantly higher in group CE from 60 minutes after pneumoperitoneum to the end of pneumoperitoneum than the other 2 groups (P < .05). The number of patients with a shivering grade of 0 was significantly lower and grade of 3 was significantly higher in group CE than in the other 2 groups (P < .05). CONCLUSION: Use of either warm, humidified CO2 insufflations or 20°C, 0% relative humidity CO2 combined with forced-air warmer set to 38°C during insufflations can both reduce intraoperative hypothermia, dysfunction of coagulation, early postoperative cough pain, sufentanil consumption, days to first flatus, solid food intake, and length of hospital stay.


Assuntos
Dióxido de Carbono/efeitos adversos , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Peritônio/lesões , Idoso , Analgésicos Opioides/uso terapêutico , Cirurgia Colorretal/normas , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Umidade/efeitos adversos , Hipotermia/etiologia , Insuflação/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Satisfação do Paciente/estatística & dados numéricos , Tremor por Sensação de Frio/fisiologia , Sufentanil/administração & dosagem , Sufentanil/uso terapêutico
6.
Enferm. clín. (Ed. impr.) ; 29(5): 297-301, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184154

RESUMO

Objetivo: El objetivo de nuestro estudio es conocer la vivencia del dolor posquirúrgico en adolescentes intervenidas quirúrgicamente para la corrección de escoliosis idiopática adolescente (EIA). Método: Estudio cualitativo con enfoque fenomenológico interpretativo, mediante entrevistas semiestructuradas; 7 participantes mujeres, entre 12 y 21 años, fueron entrevistadas entre el tercer y quinto día posterior a la intervención quirúrgica para la corrección de EIA. Los discursos fueron grabados y transcritos verbatim. Para el análisis, se utilizó el análisis de contenido. Resultados: Las categorías constituidas fueron: factores influyentes, valores e ideas, mecanismos de afrontamiento y áreas de mejora. La experiencia dolorosa se presenta como elemento determinante durante la recuperación, estando influida por el propio individuo, por el apoyo recibido y el entorno. Los principales valores e ideas que tienen a cerca del proceso se basan en la información prequirúrgica, que consideran insuficiente. Para afrontar la situación hacen uso de la distracción, la relajación y el consumo de fármacos. Según los informantes, aumentar la información recibida sobre el proceso, facilitar las visitas y la incorporación de técnicas complementarias, mejoraría el control del dolor. Conclusiones: El dolor es el eje central del proceso influido por diversos factores. Los mecanismos de afrontamiento de las pacientes ayudan al manejo de este para lo que también exponen diferentes mejoras


Objective: The aim of our study is to learn about the post-surgical pain experience in adolescents undergoing surgical correction of Adolescent Idiopathic Scoliosis (AIS). Methods: Qualitative study with an interpretative phenomenological approach. Through semi-structured interviews, 7 informants, women aged between 12 and 21, were interviewed between the third and fifth day after being surgically treated for AIS correction. The speeches were recorded and transcribed verbatim. Content Analysis method was used to analyse the discourse. Results: The categories established were: influential factors, values and ideas, coping mechanisms and improvement areas. Painful experience is a determining factor during recovery, influenced by the individuals themselves, as well as by the support received, and the environment. Their main values and ideas about the process are based on pre-surgical information, which they consider insufficient. In order to cope, they use of distraction, relaxation and drug consumption. According to the informants, increasing the information they are given about the process, facilitating visits and incorporating complementary techniques would improve pain control. Conclusions: Pain is the main focus of the process and is influenced by several factors. The patients' coping mechanisms help in its management. They also put forward different improvement areas


Assuntos
Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Escoliose/cirurgia , Dor Pós-Operatória/epidemiologia , Autocuidado , Dor Pós-Operatória/psicologia , Dor Pós-Operatória/terapia , Cuidados Pós-Operatórios/psicologia
7.
Med. clín (Ed. impr.) ; 153(8): 312-318, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185415

RESUMO

Antecedentes y objetivos: El dolor postoperatorio es frecuente en los hospitales. Se han desarrollado guías de práctica clínica para el control del dolor postoperatorio (GPCDP) y para mejorar su tratamiento. El objetivo fue evaluar la prevalencia e intensidad del dolor postoperatorio y las pautas analgésicas, antes y después de la implementación de una GPCDP. Material y método: Estudio observacional que incluyó 2estudios transversales realizados en 2períodos (anterior y posterior a la implementación de una GPCDP). Incluyó a pacientes adultos postoperados el primer día de ingreso en plantas de cirugía. Las variables demográficas, clínicas y farmacológicas se recogieron de las historias clínicas; la intensidad del dolor, mediante entrevista con los pacientes. Resultados: Se incluyó a 306 pacientes en el primer período y 317 en el segundo. No hubo diferencias respecto a las variables demográficas y clínicas de los pacientes en los 2períodos. La prevalencia del dolor fue del 92% (IC 95%: 87-95%) en el primer período y del 77% (IC 95%: 72-82%) en el segundo (p <0,05). El dolor más frecuente en las últimas 24 h fue moderado o intenso en el 53% (IC 95%: 48-59%) de los pacientes en el primer período y en el 33% (IC 95%: 28-38%) de los pacientes en el segundo (p <0,05). Conclusiones: Tras la implementación de la GPCDP se observó un descenso de la prevalencia e intensidad del dolor de los pacientes, pero sin llegar a ser óptimo. Son necesarias medidas continuadas de formación y evaluación del dolor para un tratamiento adecuado a lo largo del tiempo


Background and objectives: Postoperative pain is common in hospitals. Clinical practice guidelines for the control of postoperative pain (CPGPP) have been developed to improve its treatment. The objective of this study was to evaluate the prevalence and intensity of postoperative pain and analgesic norms, before and after the implementation of a CPGPP. Material and method: An observational study was carried out that included 2cross-sectional studies in 2separate periods, before and after implementation of the CPGPP. Adult patients postoperated on the first day of admission in the surgery plants were included. Demographic, clinical and pharmacological variables were collected from clinical histories. The intensity of the pain was collected through individual interviews with patients. Results: We included 306 patients in the first period and 317 in the second. There were no differences between patients' demographic and clinical variables and the 2periods. The prevalence of pain was 92% (IC 95%: 87%-95%) in the first period and 77% (IC 95%: 72%-82%) in the second (P <0.05). The most frequent pain in the last 24hours was moderate or intense in 53% (IC 95%: 48%-59%) of patients in the first period and in 33% (IC 95%: 28%-38%) of the patients in the second (P <0.05). Conclusions: After the implementation of the CPGPP, a decrease in the prevalence and intensity of pain in patients was observed, but without reaching an optimal level. Continued pain training and assessment measures are therefore necessary for proper pain treatment over time


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Padrões de Prática Médica , Analgesia/métodos , Estudos Transversais , Medição da Dor/métodos , Análise Estatística , Análise de Variância
8.
Urology ; 134: 103-108, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31536742

RESUMO

OBJECTIVE: To measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery. METHODS: Using claims data, we identified adults who underwent outpatient URS for treatment of upper tract stones between January 2008 and December 2016 and filled an opioid prescription attributable to URS. We then measured the rate of new persistent opioid use-defined as continued use of opioids 91-180 days after URS among those who were previously opioid-naive. Finally, we fit multivariable models to assess whether new persistent opioid use was associated with the amount of opioid prescribed at the time of URS. RESULTS: In total, 27,740 patients underwent outpatient URS, 51.2% of whom were opioid-naïve. Nearly 1 in 16 (6.2%) opioid-naïve patients developed new persistent opioid use after URS. Six months following surgery, beneficiaries with new persistent opioid use continued to fill prescriptions with daily doses of 4.2 oral morphine equivalents. Adjusting for measured sociodemographic and clinical differences, patients in the highest tercile of opioids prescribed at the time of URS had 69% higher odds of new persistent opioid use compared to those in the lowest tercile (odds ratio, 1.69; 95% CI, 1.41-2.03). CONCLUSION: Nearly 1 in 16 opioid-naive patients develop new persistent opioid use after URS. New persistent opioid use is associated with the amount of opioid prescribed at the time of URS. Given these findings, urologists should re-evaluate their post-URS opioid prescribing patterns.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Dor Pós-Operatória , Padrões de Prática Médica , Ureteroscopia , Cálculos Urinários/cirurgia , Adulto , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Demografia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Urologistas/estatística & dados numéricos
9.
Anaesthesia ; 74(12): 1542-1550, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31531850

RESUMO

Patients with obstructive sleep apnoea are at increased risk of adverse postoperative outcomes, such as cardiac and respiratory complications. It has been hypothesised that obstructive sleep apnoea also increases the risk for postoperative delirium and acute postoperative pain. We conducted a retrospective, observational study investigating the relationship of obstructive sleep apnoea with postoperative delirium and acute postoperative pain severity. Patients were classified as being at high risk for obstructive sleep apnoea if they had been diagnosed with this condition, or if they were positive for more than four factors using the 'STOP-BANG' screening tool. Adjusted logistic regression was used to investigate the association between obstructive sleep apnoea and postoperative delirium, and multivariable linear regression to study the relationship between obstructive sleep apnoea and postoperative pain severity. The incidence of postoperative delirium was 307 in 1441 patients (21.3%; 95%CI 19.2-23.5%). In unadjusted analysis, high risk for obstructive sleep apnoea was associated with delirium, with an odds ratio (95%CI) of 1.77 (1.22-2.57; p = 0.003). After adjustment for pre-specified variables, the association was not statistically significant with odds ratio 1.34 (0.80-2.23; p = 0.27). The mean (SD) maximum pain (resting or provoked) reported for the entire cohort was 63.8 (27.9) mm on a 0-100 mm visual analogue scale. High risk for obstructive sleep apnoea was not associated with postoperative pain severity (ß-coefficient 2.82; 95%CI, -2.34-7.97; p = 0.28). These findings suggest that obstructive sleep apnoea is unlikely to be a strong risk factor for postoperative delirium or acute postoperative pain severity.


Assuntos
Delírio do Despertar/complicações , Dor Pós-Operatória/complicações , Apneia Obstrutiva do Sono/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Delírio do Despertar/epidemiologia , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Inquéritos e Questionários , Adulto Jovem
10.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2203-2211, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31399786

RESUMO

PURPOSE: To evaluate postoperative pain following Descemet membrane endothelial keratoplasty (DMEK). METHODS: Seventy-one patients completed perioperatively (day before surgery, day of surgery, 1st, 2nd, and 3rd day after surgery) four different questionnaires (a hospital internal protocol, QUIPS, PainDETECT®, and SF36) regarding their pain and other clinical parameters such as constipation, tiredness, vertigo, sleep disorders, concentration disorders, nausea, and emesis. All standardised questionnaires were evaluated to quantify average pain intensity as well as maximum pain intensity (NRS, 0 [no pain] to 10 [maximal pain], respectively). Analgesic treatment and intraocular pressure (IOP) during the perioperative stay were documented. RESULTS: Mean average pain intensity was 0.70 ± 1.64 before surgery, 1.97 ± 2.05 on the day of surgery, 1.39 ± 1.68 on day 1, 0.87 ± 1.36 on day 2, and 0.81 ± 1.24 on day 3 after surgery. Maximum pain intensity was 0.65 ± 1.81 before surgery, 3.35 ± 2.98 on the day of surgery, 2.68 ± 2.99 on day 1, 1.49 ± 2.15 on day 2, and 1.26 ± 2.02 on day 3 after surgery. During the first three postoperative days, over 90% of the patients stated no or well tolerable pain. Eighty-three percent had postoperatively no need for analgesics at all. On the first two postoperative days, maximum IOP correlated significantly with reported increased maximum pain intensity (p = 0.043 and p = 0.029, respectively). All patients had very little problems with constipation, tiredness, vertigo, sleep disorder, concentration disorders, nausea, and emesis. CONCLUSIONS: DMEK is associated with low postoperative pain intensity. Strong pain increase may indicate IOP elevation and should be further investigated and treated. CLINICAL TRIAL REGISTRATION: German Clinical Trial Register (DRKS00013995).


Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Pressão Intraocular/fisiologia , Dor Pós-Operatória/etiologia , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Prognóstico , Estudos Prospectivos , Inquéritos e Questionários
11.
World Neurosurg ; 132: e739-e745, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415893

RESUMO

OBJECTIVE: To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS: The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS: All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS: Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.


Assuntos
Cimentos para Ossos/uso terapêutico , Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/efeitos adversos , Avaliação da Deficiência , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Medição da Dor , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Viscosidade
12.
Medicine (Baltimore) ; 98(28): e16450, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305475

RESUMO

Persistent postsurgical pain (PPP) is defined as the discomfort that lasts >3 months postoperatively. The primary aim of this retrospective study was to estimate the risk of developing moderate-to-severe PPP after primary total knee arthroplasty (TKA). The secondary goal was to explore potential predictors of this outcome.Data were collected via hospital arthroplasty registry and chart review. The risk of moderate-to-severe PPP, defined as ≥4 on the numerical rating scale (NRS) at minimum of 3 months post-surgery, was calculated. Multivariable logistic regression was used to estimate the association of patient demographics, diagnoses, length of hospital stay, and preoperative NRS with the odds of developing PPP. Exploratory, simple logistic regression was used to estimate the association of perioperative factors with the odds of developing PPP on a subset of patients (n = 72).The risk of PPP after TKA was 31.3% (95% confidence interval [CI]: 27.5-35.0) (n = 578). Every 2-point increase in baseline NRS was associated with 1.66 (95% CI: 1.37-2.03) times the odds of developing PPP (P < .001). African-Americans (vs whites) had 1.82 (95% CI: 1.03-3.22) times the odds of developing PPP (P = .040). Exploratory analysis suggested that the adductor canal saphenous nerve (vs femoral nerve) blocks were associated with 2.87 (95% CI: 1.00-8.26) times the odds of developing PPP (P = .049).This study estimated a high risk (31.3%) of moderate-to-severe PPP after primary TKA. This study suggested that higher preoperative pain scores might be associated with greater odds of developing PPP. Moreover, this study suggested the possibility that racial differences and types of peripheral nerve blocks might be associated with greater odds of developing moderate-to-severe PPP after TKA surgery. However, the evidence obtained from our exploratory analysis of limited data certainly requires further exploration in large-scale studies.


Assuntos
Artroplastia do Joelho , Dor Crônica/epidemiologia , Dor Pós-Operatória/epidemiologia , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Bloqueio Nervoso , Medição da Dor , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
13.
Am Surg ; 85(6): 620-624, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267903

RESUMO

The aim of this study was to compare the outcomes of lightweight and heavyweight mesh on postoperative recovery in laparoscopic total extraperitoneal (TEP) inguinal hernia repair. PubMed, Embase, Science Citation Index, and the Cochrane Library were used to search for published clinical randomized controlled trials, which compared lightweight meshes with heavyweight meshes in TEP inguinal hernia repair. The outcomes were calculated as risk ratios with 95 per cent confidence intervals using RevMan 5.2. Eight randomized controlled trials were included. Compared with a heavyweight mesh, the lightweight mesh led to a higher incidence of recurrence (risk ratio = 2.52, 95% confidence interval 1.10-5.81; P = 0.03). There was no significant difference in chronic moderate to severe pain, foreign body sensation, and seroma. The use of lightweight mesh is not recommended for TEP inguinal hernia repair.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas/efeitos adversos , Intervalos de Confiança , Feminino , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Seroma/epidemiologia , Seroma/fisiopatologia , Resultado do Tratamento
14.
Anaesthesia ; 74(10): 1277-1281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31273773

RESUMO

We randomly allocated 50 women scheduled for radical mastectomy to pectoral nerves-2 (PECS-2) block (n = 25) or no block (n = 25), 20 and 22 of whom we analysed for the primary outcome of a cumulative 24-h postoperative morphine dose. We gave intra-operative sufentanil, magnesium, dexamethasone and droperidol. Participants received regular postoperative paracetamol, ibuprofen and patient-controlled intravenous morphine. Pectoral nerves-2 block reduced mean (SD) cumulative 24 h postoperative morphine dose from 9.7 (8.9) mg to 5.0 (5.4) mg and 48 h morphine dose from 12.8 (12.5) mg to 6.0 (6.5) mg, p = 0.04 for both. The mean (SD) pain scores 24 h and 48 h after surgery were similar with or without block: 0.8 (1.4) vs. 1.2 (1.9), p = 0.39; and 0.2 (0.4) vs. 0.9 (1.8), p = 0.09, respectively. Rates of postoperative nausea, vomiting and pruritus were unaffected. Rates of chronic pain at six postoperative months were 2/19 and 2/18 after block and no block, respectively, p = 0.95.


Assuntos
Mastectomia Radical/métodos , Bloqueio Nervoso , Nervos Torácicos , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Prurido/induzido quimicamente , Prurido/epidemiologia , Resultado do Tratamento
15.
Bone Joint J ; 101-B(7_Supple_C): 98-103, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256646

RESUMO

AIMS: The aim of this study was to determine the general postoperative opioid consumption and rate of appropriate disposal of excess opioid prescriptions in patients undergoing primary unilateral total knee arthroplasty (TKA). PATIENTS AND METHODS: In total, 112 patients undergoing surgery with one of eight arthroplasty surgeons at a single specialty hospital were prospectively enrolled. Three patients were excluded for undergoing secondary procedures within six weeks. Daily pain levels and opioid consumption, quantity, and disposal patterns for leftover medications were collected for six weeks following surgery using a text-messaging platform. RESULTS: Overall, 103 of 109 patients (94.5%) completed the daily short message service (SMS) surveys. The mean oral morphine equivalents (OME) consumed during the six weeks post-surgery were 639.6 mg (sd 323.7; 20 to 1616) corresponding to 85.3 tablets of 5 mg oxycodone per patient. A total of 66 patients (64.1%) had stopped taking opioids within six weeks of surgery and had the mean equivalent of 18 oxycodone 5 mg tablets remaining. Only 17 patients (25.7%) appropriately disposed of leftover medications. CONCLUSION: These prospectively collected data provide a benchmark for general opioid consumption after uncomplicated primary unilateral TKA. Many patients are prescribed more opioids than they require, and leftover medication is infrequently disposed of appropriately, which increases the risk for illicit diversion. Cite this article: Bone Joint J 2019;101-B(7 Supple C):98-103.


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
16.
Bone Joint J ; 101-B(7_Supple_C): 22-27, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256653

RESUMO

AIMS: Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. PATIENTS AND METHODS: We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use. RESULTS: Patients undergoing UKA had a second opioid prescription filled 50.2% of the time, compared with 60.5% for TKA (p = 0.006). After controlling for potential confounders, patients undergoing UKA were still less likely to require a second prescription than those undergoing TKA (adjusted odds ratio (OR) 0.58, 95% confidence interval (CI) 0.42 to 0.81; p = 0.001). Continued opioid use requiring more than five prescriptions occurred in 13.7% of those undergoing TKA and 5.8% for those undergoing UKA (p = 0.001), and was also reduced in UKA patients compared with TKA patients (adjusted OR 0.33, 95% CI 0.16 to 0.67; p = 0.022) in multivariate analysis. The continued use of opioids after six months was 11.8% in those undergoing TKA and 8.3% in those undergoing UKA (p = 0.149). The multivariate models for second prescriptions, continued use with more than five, and continued use beyond six months yielded concordance scores of 0.70, 0.86, and 0.83, respectively. CONCLUSION: Compared with TKA, patients undergoing UKA are less likely to require a second opioid prescription and use significantly fewer opioid prescriptions. Thus, orthopaedic surgeons should adjust their patterns of prescription and educate patients about the reduced expected analgesic requirements after UKA compared with TKA. Cite this article: Bone Joint J 2019;101-B(7 Supple C):22-27.


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/métodos , Uso de Medicamentos/tendências , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Idoso , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Dor Pós-Operatória/epidemiologia , Padrões de Prática Médica , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
17.
Dan Med J ; 66(6)2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31256774

RESUMO

INTRODUCTION: Reducing intra-abdominal pressure from 12 mmHg to 6-8 mmHg during laparoscopy may reduce pain after minor laparoscopic procedures. We hypothesised that post-operative pain following ambulatory laparoscopic surgery was a limiting factor for day surgery. The primary aim of the study was to analyse risk factors for hospital admittance following laparoscopic ambulatory surgery. METHODS: In this explorative prospective uncontrolled study, patients were included consecutively from 1 June 2013 to 31 March 2015 in an ambulatory setting using a standardised anaesthetic and post-operative multimodal analgesic regimen. Patients underwent the following three surgical procedures: laparoscoscopic cholecystectomy and laparoscopic inguinal and umbilical hernia repair. In the post-anaesthesia care unit, pain was repeatedly recorded using a visual analogue scale. The need for intravenously administered on-demand sufentanil was registered. The main reason for admittance to hospital was registered in a structured questionnaire. RESULTS: A total of 1,212 consecutive patients were included. Post-operative pain was the main reason for admittance in 14 patients, and 97% of all patients were discharged after a median of 5 h post-operatively (range: 0.4-5.0 h). CONCLUSION: In patients undergoing ambulatory laparoscopic surgery using a perioperative multimodal analgesic regimen, pain was the limiting factor for discharge in 1% of patients operated in an ambulatory set-up. FUNDING: none. TRIAL REGISTRATION: Danish Data Protection Agency: 2012-58-0004, Danish Health Authority: 3-3013-1435/1, Clinicaltrial.gov: NCT02782832.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Hospitalização/estatística & dados numéricos , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Colecistectomia Laparoscópica/efeitos adversos , Dinamarca/epidemiologia , Feminino , Hérnia Inguinal/cirurgia , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Adulto Jovem
18.
BMC Musculoskelet Disord ; 20(1): 275, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31159799

RESUMO

BACKGROUND: Higher tourniquet pressures may be associated with an increased risk of complications. We aimed to determine (1) whether a lower tourniquet pressure [systolic blood pressure (SBP) + 120 mmHg] is as effective as conventional tourniquet pressure (SBP + 150 mmHg) in providing a bloodless surgical field and decreasing blood loss, and (2) whether lowering the tourniquet pressure decreases tourniquet-related complications compared to conventional inflation pressure. METHODS: One hundred and sixty knees in 124 patients undergoing total knee arthroplasty (TKA) were randomly allocated to either conventional (n = 80) or lower inflation pressure group (n = 80). The quality of the initial surgical field and occurrence of intraoperative blood oozing, hemoglobin drop, drained volume and calculated blood loss were assessed as efficacy variables. Safety outcome variables included post-operative pain, tourniquet site skin problems (ecchymosis, bullae, skin necrosis), and other tourniquet-related complications such as nerve palsy, venous thromboembolism, and delayed rehabilitation. RESULTS: A comparable bloodless surgical field was successfully provided in both groups (100% vs. 99%, p = 1.000). One case in the conventional pressure group and two cases in the lower pressure group showed intraoperative blood oozing (p = 1.000), which was successfully controlled after an increase of 30 mmHg in the tourniquet inflation pressure. There was no difference in the hemoglobin drop, drained volume, and calculated blood loss. The two groups did not differ in any safety outcomes such as post-operative pain, thigh complications, and other tourniquet related complications. CONCLUSION: This study demonstrates that a tourniquet inflation pressure of 120 mmHg above the SBP is effective method during TKA. TRIAL REGISTRATION: The trial was with ClinicalTrials.gov ( NCT01993758 ) on November 25, 2013.


Assuntos
Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Osteoartrite do Joelho/cirurgia , Pressão/efeitos adversos , Torniquetes/efeitos adversos , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Pressão Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Projetos Piloto , Estudos Prospectivos , Falha de Tratamento
19.
Ann R Coll Surg Engl ; 101(7): 472-478, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155896

RESUMO

BACKGROUND: Promotion of healing of the anal wound after fistulotomy may help accelerate recovery and return to work. The present study aimed to assess the effect of marsupialisation of the edges of the laid open fistula track on wound healing after anal fistulotomy for simple anal fistula. METHODS: This was a prospective randomised trial on patients with simple anal fistula. Patients were randomly assigned to one of two groups; group I underwent anal fistulotomy and group II underwent anal fistulotomy and marsupialisation of the edges of the laid open track. Outcomes of the study were time to achieve complete wound healing, operation time, postoperative pain and complications. RESULTS: Sixty patients of mean age of 40.8 years with simple anal fistula were randomly divided into two equal groups. No significant differences between the two groups regarding operation time (16.8 vs 18.4 minutes; P = 0.054), postoperative pain score (1.6 vs 1.2; P = 0.22), and complication rates were recorded. Group II achieved complete healing in a significantly shorter duration than group I (5.1 vs 6.7 weeks; P < 0.0001). CONCLUSION: Marsupialisation of the edges of the laid open fistula track after fistulotomy resulted in quicker wound healing with similar complication and recurrence rates to lay open fistulotomy alone.


Assuntos
Canal Anal/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Dor Pós-Operatória/diagnóstico , Fístula Retal/cirurgia , Cicatrização , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Recidiva , Fatores de Tempo , Resultado do Tratamento
20.
Ann R Coll Surg Engl ; 101(7): 519-521, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155898

RESUMO

INTRODUCTION: Daycase trauma surgery is an evolving and a novel approach. The aim of our study was to report our experience of daycase trauma surgery with a focus on safety, patient experience, complications and limitations. MATERIAL AND METHODS: Patients scheduled and operated on a daycase trauma list from January 2013 to December 2016 were included in the study. Age, sex, case mix, readmissions within 48 hours, complications, patient satisfaction, reasons for overnight stay and cost effectiveness were evaluated. RESULTS: A total of 229 procedures were carried out. The mean age of the patients was 44.3 years (range 16-85 years) . There were 128 men and 101 women, 178 upper-limb and 51 lower-limb cases. Only 2.6% of the patients had stayed overnight for pain control, physiotherapy and neurological observations; 94.5% of the patients were satisfied. The mean visual analogue scale score for satisfaction was 8.7. There were no admissions within 48 hours of discharge and one complication with failure of ankle fixation. The estimated cost saving was £65,562. CONCLUSION: We conclude that a daycase trauma service is safe, cost effective, and yields high patient satisfaction. It reduces the burden on hospital beds and a wide range of upper- and lower-limb cases can be performed as daycase trauma surgery with adequate planning and teamwork.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Sistema Musculoesquelético/lesões , Procedimentos Ortopédicos/estatística & dados numéricos , Dor Pós-Operatória/epidemiologia , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/economia , Procedimentos Cirúrgicos Ambulatórios/métodos , Análise Custo-Benefício , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/métodos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Readmissão do Paciente/estatística & dados numéricos , Segurança do Paciente , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Reino Unido , Adulto Jovem
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