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1.
BMC Musculoskelet Disord ; 20(1): 421, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31511076

RESUMO

BACKGROUND: Pain catastrophizing contributes to acute and long-term pain after knee arthroplasty (KA), but the association between pain catastrophizing and physical function is not clear. We examined the association between preoperative pain catastrophizing and physical function one year after surgery, as well as differences in physical function, pain and general health in two groups of patients with high and low preoperative pain catastrophizing score. METHODS: We included 615 patients scheduled for KA between March 2011 and December 2013. Patients completed The Pain Catastrophizing Scale (PCS) prior to surgery. The Oxford Knee Score (OKS), Short Form-36 (SF-36) and the EuroQol-5D (EQ-5D) were completed prior to surgery, and 4 and 12 months after the surgery. RESULTS: Of the 615 patients, 442 underwent total knee arthroplasty (TKA) and 173 unicompartmental knee arthroplasty (UKA). Mean age was 67.3 (SD: 9.7) and 53.2% were females. Patients with PCS > 21 had statistically significantly larger improvement in mean OKS for both TKA and UKA than patients with PCS < 11; 3.2 (95% CI: 1.0, 5.4) and 5.4 (95% CI: 2.2, 8.6), respectively. Furthermore, patients with preoperative PCS > 21 had statistically significantly lower OKS, SF-36 and EQ-5D and higher pain score than patients with PCS < 11 both preoperatively and 4 and 12 months postoperatively. CONCLUSIONS: Patients with high levels of preoperative pain catastrophizing have lower physical function, more pain and poorer general health both before and after KA than patients without elevated pain catastrophizing.


Assuntos
Artroplastia do Joelho/efeitos adversos , Catastrofização/diagnóstico , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/diagnóstico , Idoso , Artroplastia do Joelho/psicologia , Catastrofização/psicologia , Feminino , Nível de Saúde , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Resultado do Tratamento
2.
Surgery ; 166(4): 632-638, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31472973

RESUMO

BACKGROUND: The impact of recent preoperative opioid exposure on outcomes of colorectal surgery is unclear. Our aim was to evaluate the impact of preoperative opioid use on outcomes and opioid prescribing patterns after colorectal surgery. METHODS: We performed a retrospective review of all patients undergoing elective resection at a single institution from 2015 to 2017. Primary outcomes included in-hospital narcotic use and cost. Secondary outcomes included postoperative surgical outcomes and discharge prescribing patterns. RESULTS: A total of 390 patients underwent elective colorectal surgery, of whom 63 (16%) had a recent history of preoperative opioid use. Opioid users had similar age, sex, American Society of Anesthesiologists score, and operative indication compared with opioid-naïve patients (P > .05 for each). Postoperatively, the 30-day readmission rate was greater among opioid users (18% vs 9%, P = .03). Opioid users had greater total narcotic use (218 morphine milligram equivalents vs 111 morphine milligram equivalents, P = .04) and direct costs ($11,165 vs $8,911, P < .01). These patients were also more likely to require an opioid prescription on discharge (90% vs 68%, P < .01) and an opioid refill within 30 days (54% vs 21%, P < .01). CONCLUSION: Recent preoperative opioid exposure among colorectal surgery patients was associated with increased opioid consumption and costs. Moreover, unadjusted analysis was pertinent for more readmissions after surgery among preoperative opioid users. This work underscores the negative impact of preoperative, chronic opioid use on surgical outcomes and highlights the need for developing protocols to minimize perioperative narcotics.


Assuntos
Analgésicos Opioides/administração & dosagem , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Tempo de Internação/economia , Dor Pós-Operatória/tratamento farmacológico , Idoso , Analgésicos Opioides/economia , Estudos de Coortes , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Cirurgia Colorretal/mortalidade , Análise Custo-Benefício , Procedimentos Cirúrgicos Eletivos/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Período Pré-Operatório , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento
3.
J Bone Joint Surg Am ; 101(17): 1575-1585, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483401

RESUMO

BACKGROUND: Anterior knee pain is the most common complication of total knee arthroplasty (TKA). The purpose of this study was to assess whether sagittal femoral component position is an independent predictor of anterior knee pain after cruciate-retaining single-radius TKA without routine patellar resurfacing. METHODS: A prospective cohort study of 297 cruciate-retaining single-radius TKAs performed in 2006 and 2007 without routine patellar resurfacing identified 73 patients (25%) with anterior knee pain and 89 (30%) with no pain (controls) at 10 years. Patients were assessed preoperatively and at 1, 5, and 10 years postoperatively using patient-reported outcome measures (PROMs), including the Short Form-12 (SF-12), Oxford Knee Score (OKS), and satisfaction and expectation questionnaires. Variables that were assessed as predictors of anterior knee pain included demographic data, the indication for the TKA, early complications, stiffness requiring manipulation under anesthesia, and radiographic criteria (implant alignment, Insall-Salvati ratio, posterior condylar offset ratio, and anterior femoral offset ratio). RESULTS: The 73 patients with anterior knee pain (mean age, 67.0 years [range, 38 to 82 years]; 48 [66%] female) had a mean visual analog scale (VAS) score of 34.3 (range, 5 to 100) compared with 0 for the 89 patients with no pain (mean age, 66.5 years [range, 41 to 82 years]; 60 [67%] female). The patients with anterior knee pain had mean femoral component flexion of -0.6° (95% confidence interval [CI] = -1.5° to 0.3°), which differed significantly from the value for the patients with no pain (1.42° [95% CI = 0.9° to 2.0°]; p < 0.001). The patients with and those without anterior knee pain also differed significantly with regard to the mean anterior femoral offset ratio (17.2% [95% CI = 15.6% to 18.8%] compared with 13.3% [95% CI = 11.1% to 15.5%]; p = 0.005) and the mean medial proximal tibial angle (89.7° [95% CI = 89.2° to 90.1°] compared with 88.9° [95% CI = 88.4° to 89.3°]; p = 0.009). All PROMs were worse in the anterior knee pain group at 10 years (p < 0.05), and the OKSs were worse at 1, 5, and 10 years (p < 0.05). Multivariate analysis confirmed femoral component flexion, the medial proximal tibial angle, and an Insall-Salvati ratio of <0.8 (patella baja) as independent predictors of anterior knee pain (R = 0.263). Femoral component extension of ≥0.5° predicted anterior knee pain with 87% sensitivity. CONCLUSIONS: In our study, 25% of patients had anterior knee pain at 10 years following a single-radius cruciate-retaining TKA without routine patellar resurfacing. Sagittal plane positioning and alignment of the femoral component were associated with long-term anterior knee pain, with femoral component extension being a major risk factor. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artralgia/etiologia , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligamento Cruzado Anterior/cirurgia , Artralgia/fisiopatologia , Estudos de Casos e Controles , Feminino , Fêmur , Seguimentos , Humanos , Articulação do Joelho , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Osteoartrite do Joelho/fisiopatologia , Dor Pós-Operatória/fisiopatologia , Patela/cirurgia , Estudos Prospectivos , Desenho de Prótese , Amplitude de Movimento Articular/fisiologia
4.
Iowa Orthop J ; 39(1): 69-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413677

RESUMO

Background: Shoulder arthroplasty has been shown to improve function in patients with advanced shoulder disease. However, the response to surgery and final outcomes are not easily predictable. This study assessed the effect of residual pain, age, sex, diabetes, hypertension, and depression on changes and status at one-year following arthroplasty with respect to shoulder function and overall physical and mental health status. Methods: A retrospective analysis of a prospective cohort of 140 patients tested preoperatively and one-year following shoulder arthroplasty was conducted at our tertiary hospital. Pearson's correlations and multiple regression analysis were performed to test the impact of predictors on shoulder pain and function assessed using the American Shoulder and Elbow Surgery (ASES) questionnaire, and on physical and mental health assessed using the Short Form-12. Results: Pain and female sex were significant predictors of poorer function at one-year (R = .56, p = .001); and with other predictors, they explained 32% of the variability in function. The explained variability of changes in function scores was 15% with pain being the only significant predictor. Physical health was lower in older patients (r = -.31, p < .05) and was less predictable for physical health change scores (12%) and the physical status at one-year (14%). Conclusions: Residual pain is associated with poorer function status and less clinical benefits. Female sex is not associated with less change in function which suggests that men and women get equal benefit from the surgery. Advanced age relates to poorer physical health and to a lesser extent physical change over the year.Level of Evidence: III.


Assuntos
Artroplastia do Ombro/métodos , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/cirurgia , Dor de Ombro/cirurgia , Inquéritos e Questionários , Adulto , Idoso , Artroplastia do Ombro/efeitos adversos , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/reabilitação , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Articulação do Ombro/fisiopatologia , Dor de Ombro/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento
5.
J Coll Physicians Surg Pak ; 29(9): 868-873, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31455484

RESUMO

OBJECTIVE: To determine the effects of the level of the anxiety of the patients on the intraoperative hemodynamic parameters and postoperative pain, patient satisfaction and the stay period at the hospital. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: General Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey, from December 2015 to February 2016. METHODOLOGY: Seventy-two patients were operated for elective cholecystectomy. They were asked to answer state-trait anxiety inventory (STAI) questionnaire. The patients were classified into two groups as high and low anxiety levels. The targeted variables were compared. RESULTS: There has not been found any significant relationship between the level of anxiety and age, gender, marial status, level of education, profession, general anesthesia, comobidity and postoperative shivering. However, patients with high preoperative anxiety scores had unstable hemodynamic parameters (arterial pressure, heart rate, peripheral oxygen saturation) intraoperatively, increased postoperative pain and analgesic consumption with dissatisfaction. CONCLUSION: Preoperative anxiety might cause hemodynamic problems in the intraoperative period, increased analgesic need and lower postoperative satisfaction of the patients in the postoperative period. It would be better to dispel the preoperative anxiety by conselling patient regar anesthesia, surgeon, and the institute.


Assuntos
Ansiedade/complicações , Pressão Sanguínea/fisiologia , Colecistectomia/psicologia , Frequência Cardíaca/fisiologia , Consumo de Oxigênio/fisiologia , Dor Pós-Operatória/etiologia , Adulto , Idoso , Ansiedade/fisiopatologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Satisfação do Paciente , Período Pré-Operatório , Turquia
6.
J Bone Joint Surg Am ; 101(16): 1460-1466, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436653

RESUMO

BACKGROUND: Posterior spinal fusion with pedicle screws is the gold-standard treatment for adolescent idiopathic scoliosis (AIS); however, it is unclear whether this procedure results in improved long-term back pain and health-related quality of life compared with patients not surgically treated for AIS. The aim of the present study was to evaluate back pain and quality of life in surgically managed patients with a minimum follow-up of 5 years compared with patients with untreated AIS and a healthy control group. METHODS: Fifty-five consecutive adolescent patients who underwent posterior pedicle screw instrumentation for AIS by a single orthopaedic surgeon were prospectively enrolled. At a minimum of 5 years postoperatively, 49 patients completed Scoliosis Research Society (SRS)-24 questionnaires, and data on reoperation were collected. Pain and quality-of-life parameters were compared with those of 49 age and sex-matched patients with untreated AIS and 49 healthy controls. RESULTS: The major curve averaged 53° preoperatively and 12° at 2 years postoperatively. One reoperation (pedicle screw removal) was needed because of a new neurological deficit (transient). The SRS-24 pain, function, and total scores improved significantly from preoperatively to 5 years postoperatively (all p ≤ 0.016), with pain scores improving from 4.0 to 4.3 (p = 0.003). There was no association between pain scores and the preoperative major curve, instrumentation below L1, or postoperative rib hump. The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; function scores were significantly lower in the healthy control group compared with the surgical treatment group (p < 0.001). CONCLUSIONS: Patients who underwent posterior spinal fusion with pedicle screws experienced improved back pain and health-related quality of life compared with patients with untreated AIS. Patients in the surgical treatment group had similar health-related quality of life to that of the healthy control group, except for function, which was significantly lower. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Dor nas Costas/etiologia , Dor Pós-Operatória/fisiopatologia , Qualidade de Vida , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Análise de Variância , Dor nas Costas/fisiopatologia , Dor nas Costas/psicologia , Criança , Estudos de Coortes , Feminino , Humanos , Fixadores Internos , Masculino , Análise Multivariada , Medição da Dor , Prognóstico , Valores de Referência , Estudos Retrospectivos , Escoliose/complicações , Escoliose/psicologia , Índice de Gravidade de Doença , Fusão Vertebral/métodos , Resultado do Tratamento , Adulto Jovem
7.
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
8.
Trials ; 20(1): 399, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272502

RESUMO

BACKGROUND: The morbidity of knee arthritis is increasing among aged people and total knee arthroplasty has been its mainstream treatment to date. Postoperative rehabilitation is an important part of the procedure. However, the intense pain during the functional exercise involved has always been a challenge for both patients and health care professionals. The aim of this study is to test the analgesic effect of a mixture of nitrous oxide/oxygeb (1:1) inhalation for patients who are doing functional exercise 1 month after total knee arthroplasty. METHODS/DESIGN: This double-blind, randomized, placebo-controlled study will be implemented in the Rehabilitation Department in the General Hospital of Ningxia Medical University. Patients aged between 50 and 75 years who underwent a primary unilateral total knee arthroplasty are eligible for inclusion. The key exclusion criteria include: epilepsy, pulmonary embolism, intestinal obstruction, aerothorax. The treatment group (A) will receive a pre-prepared nitrous oxide/oxygen mixture plus conventional treatment (no analgesics), and the control group (B) will receive oxygen plus conventional treatment (no analgesics). Patients, physicians, therapists, and data collectors are all blind to the experiment. Assessments will be taken immediately after functional exercise begins (T0), 5 min (T1) after functional exercise begins, and 5 min after functional exercise has finished (T2). Patients will be randomly allocated between a treatment group (A) and a control group (B) in a ratio of 1:1. Primary outcome, including pain severity in the procedure, will be taken for each group. Secondary outcomes include blood pressure, heart rate, oxygen saturation, side effects, knee joint range of motion, Knee Society Score (KSS), rescue analgesia need, and satisfaction from both therapists and patients. DISCUSSION: This study will focus on exploring a fast and efficient analgesic for patients who are doing functional exercise after total knee arthroplasty. Our previous studies suggested that the prefixed nitrous oxide/oxygen mixture was an efficacious analgesic for the management of burn-dressing pain and breakthrough cancer pain. The results of this study should provide a more in-depth insight into the effects of this analgesic method. If this treatment proves successful, it could be implemented widely for patients doing functional exercise in the rehabilitation department. TRIAL REGISTRATION: ChiCTR-INR-17012891 . Registered on 6 October 2017.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Artralgia/prevenção & controle , Artrite/cirurgia , Artroplastia do Joelho/reabilitação , Terapia por Exercício , Articulação do Joelho/cirurgia , Óxido Nitroso/administração & dosagem , Oxigenoterapia , Dor Pós-Operatória/prevenção & controle , Idoso , Analgésicos não Entorpecentes/efeitos adversos , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/fisiopatologia , Artrite/diagnóstico , Artrite/fisiopatologia , Artroplastia do Joelho/efeitos adversos , China , Método Duplo-Cego , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Oxigenoterapia/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
9.
Taiwan J Obstet Gynecol ; 58(4): 514-519, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307743

RESUMO

OBJECTIVE: To share our experience of transition from multiport to single-site robotic surgery for benign gynecological conditions as well as to assess the selection criteria of candidates for robotic single-site supracervical hysterectomy (RSSH). MATERIALS AND METHODS: A retrospective review was conducted on patients undergoing robotic supracervical hysterectomy by a single surgeon in a single institute between June 2014 and December 2017. Patients who underwent additional procedures along with supracervical hysterectomy and who had unexpectant corpus malignancy proved pathologically were excluded from comparisons between patients undergoing RSSH and robotic multiport supracervical hysterectomy (RMSH). RESULTS: Between June 2014 and December 2017, we accomplished 26 RSSH and 57 RMSH. There were no conversions, intraoperative complications, and readmissions within 30 days after surgery. In the RSSH group, the mean uterine weight was 264.6 ± 140.9 g with mean docking time of 15.8 ± 5.5 min, mean console time of 61.1 ± 35.6 min and mean operative time of 140.3 ± 34.4 min. In comparison to the RMSH group, the percentage of overweight/obese patients was lower (p = 0.018) and the uterine size was smaller (p < 0.001) with adenomyosis diagnosed more frequently (p = 0.002) in the RSSH group. While the operative time in the RSSH group was significantly shorter (p = 0.002), the RSSH group took longer time in docking (p < 0.001) and comparable time in console (p = 0.254). In view of chronological change, docking time and console time in the RMSH group remained steady, whereas steep decreases were observed in the RSSH group. The intraoperative blood loss and hemoglobin drop were comparable. The length of hospital stay was significantly shorter in the RSSH group (p = 0.005). CONCLUSION: Transition from multiport to single-site surgery can be smooth for a surgical team experienced in the conventional multiport robotic system. RSSH is safe and feasible in properly selected patients.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/cirurgia , Histerectomia/métodos , Dor Pós-Operatória/fisiopatologia , Procedimentos Cirúrgicos Robóticos/métodos , Centros Médicos Acadêmicos , Adulto , Distribuição de Qui-Quadrado , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Duração da Cirurgia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Índice de Gravidade de Doença , Taiwan , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(29): e16262, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335674

RESUMO

RATIONALE: The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique. PATIENT CONCERNS: Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted. DIAGNOSES: They were diagnosed with primary adenocarcinoma requiring lobectomy of lung. INTERVENTIONS: The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later. OUTCOMES: The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen. LESSONS: Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.


Assuntos
Adenocarcinoma de Pulmão , Adjuvantes Anestésicos , Neoplasias Pulmonares , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Músculos Paraespinais/fisiopatologia , Pneumonectomia , Ropivacaina/administração & dosagem , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/classificação , Idoso , Analgesia Controlada pelo Paciente/métodos , Anestésicos Locais/administração & dosagem , Terapia Combinada/métodos , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Toracoscopia/efeitos adversos , Toracoscopia/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
11.
Trials ; 20(1): 441, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315670

RESUMO

BACKGROUND: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results and was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24-h postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared with a sham block. METHODS: This prospective randomized double-blind multicenter study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anesthesia to one of two groups as follows: (1) bilateral erector spinae block (20 mL 0.25% levobupivacaine) or (2) bilateral sham block (20 mL NaCl 0.9%). Our primary endpoint is 24-h postoperative morphine consumption. Secondary endpoints include 72-h morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first postoperative mobilization, and the Quality of Recovery 40 survey score. DISCUSSION: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-h postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique. TRIAL REGISTRATION: Local ethics committee B300201837508, ClinicalTrials.gov identifier: NCT03825198 . Registered on 31 Jan 2019.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Músculos do Dorso/inervação , Dor nas Costas/prevenção & controle , Levobupivacaína/administração & dosagem , Vértebras Lombares/cirurgia , Morfina/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/efeitos adversos , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Bélgica , Método Duplo-Cego , Feminino , Humanos , Levobupivacaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Morfina/efeitos adversos , Estudos Multicêntricos como Assunto , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Ensaios Clínicos Pragmáticos como Assunto , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Rev Assoc Med Bras (1992) ; 65(6): 825-829, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340311

RESUMO

INTRODUCTION: Assessment of acute postoperative pain is mandatory for effective treatments. Pain trajectories may help professionals improve treatments. It has been suggested that uncontrolled pain in the immediate postoperative period generates higher pain intensities on the following days of hospital stay. OBJECTIVE: To determine the relationship between pain during the first postoperative hour and the first 24 postoperative hours. METHODS: Setting: a general university hospital. Study design: a prospective observational, analytical study of patients undergoing surgical procedures under general anesthesia and hospitalized for at least 24 hours. Five assessments of pain were carried out during the first hour in the recovery room followed by three assessments during the first 24 hours. The slopes of pain trajectories were calculated, and the relationship between them was analyzed. RESULTS: 234 patients were recruited, 31.3% had uncontrolled pain on arrival at the recovery room; at the end of the first 24 hours after surgery, 5.5% of the patients had uncontrolled pain. The first pain intensity score in the recovery room correlated negatively with the slope for the first hour (P1): rS = -0.657 (p = 0.000). Similarly, the first pain intensity score had a negative association with the pain trajectory slope during the hospital stay (P2): rS = -0.141 (p = 0.032). When comparing the two slopes, a nonsignificant negative correlation was found: rS = -0.126. CONCLUSIONS: the trajectory of pain during the first hour does not predict the behavior of the trajectory during the first day after surgery.


Assuntos
Dor Aguda/fisiopatologia , Dor Pós-Operatória/fisiopatologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Distribuição por Sexo , Fatores de Tempo , Adulto Jovem
13.
Biomed Res Int ; 2019: 1716365, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31360703

RESUMO

The transversus thoracis muscle plane block (TTP) block is a newly developed regional anesthesia technique which provides analgesia to the anterior chest wall. Since its introduction, this technique has been utilized for a wide range of surgical procedures as well as nonsurgical indications. Current evidence suggests that the TTP block provides effective analgesia for breast and cardiac surgeries, cardiac device implantation, pericardiocentesis, and acute and chronic pain management. To date, no major complications have been reported. Currently there is an urgent need to standardize the nomenclature of this technique to facilitate accurate communication amongst care providers, researchers, and authors. In this review, we describe the TTP block technique, review the indications and available evidence in clinical practice, and discuss alternative blocks and future prospects.


Assuntos
Analgesia , Músculo Esquelético , Bloqueio Nervoso , Manejo da Dor , Dor Pós-Operatória , Parede Torácica , Feminino , Humanos , Masculino , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/prevenção & controle , Parede Torácica/fisiopatologia , Parede Torácica/cirurgia
14.
Curr Opin Anaesthesiol ; 32(5): 668-673, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31343465

RESUMO

PURPOSE OF REVIEW: Persistent postoperative pain (PPP) is a significant source of morbidity in our population. An excellent opportunity to understand the transition from acute to chronic pain states. Understanding the mechanisms that drive this and modulators that influence this transition is essential to both prevent and manage this condition. RECENT FINDINGS: Although the exact mechanism for the development of PPP is still poorly understood, hypotheses abound. Basic science research with animal models implicates nociceptive and neuropathic pain signals leading to pain sensitization due to persistent noxious signaling. Effects on the inhibitory modulation of noxious signaling in medullary-spinal pathways and descending modulation have also been implicated. SUMMARY: Persistent maladaptive neuroplastic changes secondary to neurotrophic factors and interactions between neurons and microglia may well explain the phenomenon. This article reviews the current thought processes on mechanisms and modulators from a basic science and epidemiological perspective.


Assuntos
Dor Crônica/etiologia , Neuralgia/etiologia , Nociceptividade/fisiologia , Dor Pós-Operatória/etiologia , Animais , Dor Crônica/fisiopatologia , Dor Crônica/terapia , Modelos Animais de Doenças , Humanos , Bulbo/citologia , Bulbo/fisiopatologia , Microglia/fisiologia , Vias Neurais/citologia , Vias Neurais/fisiopatologia , Neuralgia/fisiopatologia , Neuralgia/terapia , Neurônios/fisiologia , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/terapia , Medula Espinal/citologia , Medula Espinal/fisiopatologia , Fatores de Tempo
15.
Plast Reconstr Surg ; 144(2): 246e-251e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348355

RESUMO

Orthognathic surgery is a powerful tool for correction of facial asymmetry and malocclusion. The goal is to achieve good dental function and facial aesthetics. Three-dimensional simulation is used for surgical planning, and bone gaps could be created to achieve facial balance. In this study, customized "spacers" were made using computer-aided design and three-dimensional printing for guides for use during surgery. With the final three-dimensional plan, the skull images were exported to 3-Matic software, where spacers were designed according to the bone gaps. Three-dimensionally-printed spacers were made and used to facilitate positioning and fixation. Consecutive patients with facial asymmetry were recruited in this prospective study. The postoperative outcome was assessed using a visual analogue scale and the three-dimensional facial surface area discrepancy index for subjective and objective evaluation. There were 12 patients and a total of 19 spacers for the Le Fort I and mandibular ramus segments. The spacers worked nicely during the bone fixation process. Mean preoperative and postoperative visual analogue scale scores were 4.83 and 7.14, with a statistically significant improvement for facial symmetry (p = 0.018). Mean preoperative and postoperative facial surface area discrepancy index was 0.95 and 0.98, and the correction of asymmetry was significant (p = 0.009). There were no related surgical complications. All patients were satisfied with the correction of facial asymmetry and malocclusion. The custom-made, three-dimensionally-printed spacers help to achieve surgical precision to correct and prevent facial asymmetry in orthognathic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Assimetria Facial/cirurgia , Má Oclusão/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Medicina de Precisão/métodos , Impressão Tridimensional , Adulto , Estudos de Coortes , Projeto Auxiliado por Computador , Estética , Assimetria Facial/diagnóstico por imagem , Feminino , Humanos , Masculino , Má Oclusão/diagnóstico por imagem , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/terapia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Cirurgia Assistida por Computador/métodos , Taiwan , Resultado do Tratamento , Adulto Jovem
16.
Biomed Res Int ; 2019: 1051629, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236402

RESUMO

Single injections in the anterior region of the thoracic paravertebral space (TPVS) have been reported to generate a multisegmental longitudinal spreading pattern more frequently than those in the posterior region of the TPVS. In this trial, we examined the hypothesis that a continuous thoracic paravertebral block (TPVB) administered through a catheter inserted into the anterior region of the TPVS allows a wider sensory block dispersion. Fifty consecutive patients undergoing video-assisted thoracic surgery were enrolled. Before the surgery, an infusion catheter was inserted into the TPVS through a needle placed adjacent to either the parietal pleura (group A) or internal intercostal membrane (group P) using an ultrasound-guided intercostal transverse approach according to a randomized allocation schedule. A chest radiograph was obtained postoperatively after injection of 10 mL of radiopaque dye through the catheter. Thereafter, 20 mL of 0.375% levobupivacaine was injected via the catheter, followed by commencement of continuous TPVB with 0.25% levobupivacaine at 8 mL/h. The primary outcome was the number of blocked dermatomes at 24 h after surgery. The secondary outcomes included radiopaque dye spreading patterns, the number of segments reached by the radiopaque dye, the number of blocked dermatomes at 2 h after surgery, and pain scores. The median (interquartile range [range]) number of blocked dermatomes 24 h after surgery was 3 (2.75-4 [1-6]) in group A (n = 22) and 2 (1.5-3 [0-7]) in group P (n = 25; p = 0.037). No significant differences in the other outcomes were found between the groups. In conclusion, a continuous TPVB administered using a catheter supposedly inserted into the anterior region of the TPVS allows a wider sensory block dispersion than a catheter inserted into the posterior region of the TPVS. This trial is registered with the UMIN Clinical Trials Registry (UMIN000018578).


Assuntos
Bloqueio Nervoso/métodos , Dor Pós-Operatória/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Vértebras Torácicas/cirurgia , Adulto , Idoso , Cateteres , Meios de Contraste/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Nervos Intercostais/diagnóstico por imagem , Nervos Intercostais/cirurgia , Masculino , Pessoa de Meia-Idade , Agulhas , Dor Pós-Operatória/fisiopatologia , Pleura/diagnóstico por imagem , Pleura/inervação , Pleura/cirurgia , Estudos Prospectivos , Vértebras Torácicas/inervação , Vértebras Torácicas/fisiopatologia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
17.
Bone Joint J ; 101-B(6_Supple_B): 31-36, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31146567

RESUMO

AIMS: Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study's purposes were to determine differences in pain based on surgical approach (direct anterior (DA) vs posterolateral (PL)) and PL approach incision length. PATIENTS AND METHODS: This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year's follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80). RESULTS: A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, sd 12.9 vs 62.7 years, sd 9.7; p < 0.001) and had shorter follow-up (3.3 years, sd 1.3 vs 3.7 years, sd 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% vs 21%; p < 0.001) and groin pain (19% vs 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior thigh, back, or buttock pain between cohorts (p = 0.05 to 0.7). PL approach incision length did not impact the incidence or severity of pain (p = 0.3 to 0.7). CONCLUSION: A significant proportion of patients perceive persistent pain following THA regardless of approach. DA patients reported less trochanteric and groin pain versus PL patients. PL incision length did not influence the incidence or severity of patient-reported pain. Cite this article: Bone Joint J 2019;101-B(6 Supple B):31-36.


Assuntos
Artroplastia de Quadril/métodos , Percepção da Dor/fisiologia , Dor Pós-Operatória/fisiopatologia , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Autorrelato
18.
J Laryngol Otol ; 133(6): 520-525, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31172898

RESUMO

BACKGROUND: Tonsillectomy is one of the most common otolaryngological procedures. Nonetheless, there is still no universally approved 'gold standard' technique. OBJECTIVE: To compare the safety and efficacy of argon plasma coagulation and coblation techniques in tonsillectomy. METHODS: A multi-institutional, retrospective cohort study was conducted, comprising 283 patients who underwent bilateral tonsillectomies performed by a single surgeon between 2014 and 2017. The outcome measures included: operative time, intra-operative blood loss, post-operative pain and post-operative haemorrhage. RESULTS: In the argon plasma coagulation group, mean operative time and post-operative haemorrhage rate were significantly reduced, p = 0.0006 and p = 0.003 respectively. There was no statistically significant difference between the two groups in terms of post-operative pain and intra-operative blood loss. CONCLUSION: The argon plasma coagulation technique is easy, safe and efficacious. Argon plasma coagulation tonsillectomy seems cost-effective compared to coblation tonsillectomy: the single-use disposable electrode tip and wand used in this study cost AUD$76.50 and AUD$380 respectively. Argon plasma coagulation appears to be a favourable alternative to current modalities such as coblation.


Assuntos
Coagulação com Plasma de Argônio/métodos , Tempo de Internação , Segurança do Paciente , Tonsilectomia/métodos , Adolescente , Fatores Etários , Coagulação com Plasma de Argônio/efeitos adversos , Austrália , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Estudos de Coortes , Criocirurgia/métodos , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Tonsilectomia/efeitos adversos , Resultado do Tratamento , Adulto Jovem
19.
Surg Laparosc Endosc Percutan Tech ; 29(4): 255-260, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31162298

RESUMO

BACKGROUND: This retrospective study compared postoperative pain between patients undergoing open thyroidectomy (OT) and bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT). MATERIALS AND METHODS: We analyzed the electronic medical records of 1269 patients who underwent OT or RT at Chung-Ang University Hospital between January 1, 2010 and April 30, 2016. On the basis of the surgical procedure performed, patients were categorized into an OT (n=1128) and a BABA RT (BRT) group (n=141). On the basis of covariates, patients in these groups were matched using propensity score matching (n=86 in each group). RESULTS: After propensity score matching, no intergroup differences were observed in the covariates. The visual analogue scale scores for pain on postoperative day 0 were lower in the BRT than in the OT group (2.57±0.95 vs. 2.28±0.95, P=0.040). However, no statistically significant differences were observed in the use of rescue analgesics, the numerical rating scale score for nausea, and the use of rescue antiemetics. CONCLUSIONS: Pain on postoperative day 0 was lesser in the BRT than in the OT group. Similarly, the severity of nausea was lesser in the BRT group, despite longer operation time and broad dissection performed for docking the robotic arms.


Assuntos
Dor Pós-Operatória/fisiopatologia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Bases de Dados Factuais , Feminino , Seguimentos , Hospitais Universitários , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Medição da Dor , Pontuação de Propensão , República da Coreia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estatísticas não Paramétricas , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Resultado do Tratamento
20.
Surg Laparosc Endosc Percutan Tech ; 29(4): 247-251, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31135709

RESUMO

INTRODUCTION: There are 2 standard techniques of laparoscopic groin hernia repair, totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). TEP has the advantage that the peritoneal cavity is not breached but is, however, considered to be more difficult to master when compared with TAPP. We describe herein our experience of TEP repair of inguinal hernia over the last 14 years. MATERIALS AND METHODS: This study is a retrospective analysis of a prospectively maintained database of all patients with groin hernia who underwent TEP repair in a single surgical unit between January 2004 and January 2018. Patients' demographic profile and hernia characteristics (duration, side, extent, content, and reducibility) were noted in the prestructured proforma. Clinical outcomes included the operation time, intraoperative and postoperative complications, length of postoperative hospital stay, hernia recurrence, chronic pain, recurrence, seroma, and wound infections. Long-term follow-up was carried out in the outpatient department. RESULTS: Over the last 14 years, TEP repair was performed in 841 patients and a total of 1249 hernias were repaired. The mean age of patients was 50.7 years. There were 748 primary and 345 unilateral hernias. The majority were direct (61%) inguinal hernias. Telescopic dissection was the commonest method of space creation. The average operating time was 54.8 and 77.9 minutes for unilateral and bilateral hernias, respectively. With 81 conversions, the success rate for TEP was 93.5%. Seroma was the most common postoperative complication seen in 81 patients. The incidence of chronic groin pain was 1.4%. The follow-up ranged from 3 months to 10 years, and there were only 3 recurrences (<1%). CONCLUSION: In conclusion, TEP repair is an excellent technique of laparoscopic inguinal hernia repair with acceptable complications after long-term follow-up.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Dor Pós-Operatória/fisiopatologia , Peritônio/cirurgia , Telas Cirúrgicas , Adulto , Bases de Dados Factuais , Feminino , Seguimentos , Hérnia Inguinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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