[Day case laparoscopic sacral colpopexy for genital prolapse]. / Prise en charge ambulatoire de la promontofixation laparoscopique pour prolapsus génital.

OBJECTIVE: To demonstrate the feasibility of day case laparoscopic sacral colpopexy with the help of a fast tracking protocol. METHODS: Three motivated patients suffering from external cystocele have been strictly selected from September 2011 to October 2011 according to criteria such as Body Mass Index, ASA score, comorbidities et French day case rules. Laparoscopic sacral colpopexies consisted in anterior and posterior polyesther meshes sutured with non-resorbable wires. We are used to proceed through a SILS(©) unique ombilical port. We have used standard and straight laparoscopic instruments and laparoscope. The bladder catheter has been removed two hours after surgery, the patients have been encouraged to stand up and they have received a light meal before Chung score has been quoted. The patients have been discharged in the evening before 7 pm. RESULTS: The patients are 65, 67 and 66 years old, two of them had a past history of pelvic surgery. We did not deplore any complication during the procedure, no blood loss, no laparoscopic conversion (additional trocar); the procedures durations were 92, 120 and 124 min. These three patients have not been readmitted. Clinical examination has been scheduled between 6 and 8 weeks after surgery. We did not describe any pelvic or parietal complication, no early recurrence. CONCLUSION: We have demonstrated here the feasibility in good security conditions of day case laparoscopic sacral colpopexy for genital prolapse. A fast tracking protocol is essential and selecting the patients is required.

[Concept of interdisciplinary pain therapy]. / Konzept der interdisziplinären Schmerztherapie.

The diagnosis and therapy of pain is routine in common practice of almost all clinical fields. Whilst acute pain may be controlled fairly easily, the treatment of chronic pain patients may be frustrating if conventional approaches for analgesia are chosen. Only a specialized and multidisciplinary procedure is beneficial for advanced stages of pain chronification. Precisely, an adequate treatment program has to consider biological, psychological and social aspects of chronic pain.

[Patient acceptance of patient-controlled intranasal analgesia (PCINA)]. / Patientenakzeptanz gegenüber der patientenkontrollierten intranasalen Analgesie (PCINA).

UNLABELLED: Patient-controlled intravenous analgesia (i.v.-PCA) represents the gold standard in the management of acute postoperative pain. However, in many countries i.v.-PCA is rarely used. Recent clinical studies demonstrated that intranasal fentanyl titration provides a rapid and safe form and pain management. In the present study we investigated patients' acceptance and assessment of patient-controlled intranasal analgesia (PCINA) and compared it to intravenous PCA and the customarily prescribed pain therapy. MATERIAL AND METHODS: After approval by the local ethics committee and written informed consent, 79 ASA physical status I or II patients were investigated on the first postoperative day following orthopaedic surgery. The patients were allocated either to the PCINA group (a maximum of 0.025 mg fentanyl over 6 min), to the i.v.-PCA group (0.025 mg fentanyl bolus, lockout interval 6 min) or to a group of patients who received the customarily prescribed pain management. Following the 8-h investigation period, the patients were questioned regarding their satisfaction with the pain therapy using a 6-point rating scale (ranging from 1 = very good to 6 = not acceptable). The patients were furthermore asked to name the advantages and disadvantages of their pain management. RESULTS: Three patients in the i.v.-PCA group had to be excluded due to pain at the injection site and one patient in the PCINA group because of a surgical complication. Seventy-five patients were finally included, 25 patients per group. No statistically significant intergroup differences regarding age, weight, height and initial pain intensity (evaluated by a 101-point numeric rating scale) were demonstrated. The patients' satisfaction with the mode of pain management was significantly higher in the PCINA (median "good") and in the i.v.-PCA group (median "good") than in the group who received the customarily prescribed pain management (median "satisfactory"). This difference was statistically significant (P = 0.0001). No statistically significant difference was demonstrated between the PCINA and i.v.-PCA groups. The patients in the PCINA and in the i.v.-PCA group stated as main advantages the rapid onset of action and good pain relief (n = 25 and n = 25, respectively), as well as their independence from the doctor or nurse (n = 12 and n = 13). The main disadvantages were pain on injection in the i.v.-PCA group and too frequent fentanyl administrations in the PCINA group (n = 6). DISCUSSION: The results demonstrate that the patients' satisfaction with PCINA is comparable to that with i.v.-PCA. Both PCINA and i.v.-PCA were assessed as superior to the customarily prescribed pain management (P = 0.0001). Patients' acceptance of a given form of pain management is mainly related to its efficiency. However, side effects such as pain on injection with i.v.-PCA, or frequent opioid administration with PCINA, must be considered when assessing a method of pain control. Patients' global assessment includes both efficiency and side effects. PCINA represents an interesting alternative non-invasive method for postoperative pain management.