The Effect of Abuse History on Preoperative and Postoperative Pain Symptoms in Women Undergoing Surgical Treatment of Endometriosis

ABSTRACT CONTEXT AND OBJECTIVES: Effective postoperative analgesia is important for reducing the incidence of chronic pain. This study evaluated the effect of preoperative gabapentin on postoperative analgesia and the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgical treatment. DESIGN AND SETTINGS: Randomized, double-blind controlled trial, Federal University of São Paulo Pain Clinic. METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period), incidence of postoperative neuropathic pain (over a six-month period), need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4) questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome) were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg) did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery.

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Surgical and Non-surgical Treatment of Vertebral Fractures in Elderly

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0826-5180 ◽

2019 ◽

Vol 157 (06) ◽

pp. 654-667 ◽

Cited By ~ 1

Author(s):

Marc Chmielnicki ◽

Axel Prokop ◽

Frank Kandziora ◽

Andreas Pingel

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Vertebral Fractures ◽

Fracture Morphology ◽

Demographic Development ◽

Rapid Improvement ◽

Osteoporotic Vertebral Fractures ◽

Spine Surgeon ◽

Pain Symptoms

AbstractDemographic development in Germany has led to an aging of the population. Particularly for these patients, osteoporosis-induced vertebral fractures represent a significant decrease in quality of life and level of activity. According to current guidelines, the initial treatment of stable osteoporotic vertebral fractures is conservative management with analgesic, anti-osteoporotic, physical therapy, and orthotic measures as first line options. Personal experience, however, suggests that patients benefit from timely surgical treatment through rapid improvement of pain symptoms and thus, more rapid mobilization. The poor bone quality of elderly patients presents the treating spine surgeon a challenge in achieving stable spinal fusion with or without support, for example, through augmentation. Minimally invasive procedures have increasingly established themselves for such purposes in recent years. With over 1000 fracture treatments in the last 3.5 years, we have developed a differentiated treatment concept depending on patient age and fracture morphology, which we would like to introduce. Unstable fractures with posterior edge involvement are stabilized from posterior with a percutaneous fixator. Patients over 60 years were treated percutaneously with a polyaxial screw system. Increased stability was achieved by PMMA cement augmentation of the fenestrated screws. In elderly patients with Magerl A3 fractures without neurologic deficit, the index vertebra is supplementally treated with kyphoplasty (hybrid treatment). In acute, stable osteoporotic vertebral fractures with severe pain despite analgesics, we perform kyphoplasty, which is possible even in high thoracic fractures to T3 with smaller balloons and thinner trocars. Vertebroplasty is another option in the lumbar and lower thoracic spine. Because of invasiveness, extended posterior–anterior correction procedures are generally avoided in this population, which has frequent multiple comorbidities.

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Surgical treatment of hemorrhoids: a critical appraisal of the current options

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000100016 ◽

2014 ◽

Vol 27 (1) ◽

pp. 66-70 ◽

Cited By ~ 12

Author(s):

Marlise Mello CERATO ◽

Nilo Luiz CERATO ◽

Patrícia PASSOS ◽

Alberto TREIGUE ◽

Daniel C. DAMIN

Keyword(s):

Surgical Treatment ◽

Postoperative Pain ◽

Treatment Options ◽

Surgical Techniques ◽

Postoperative Recurrence ◽

Long Term Results ◽

Published Data ◽

Complication Rates ◽

Recurrence Rates

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

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Laparoscopic Versus Open Appendectomy for the Treatment of Complicated Acute Appendicitis

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.8n.1p.15 ◽

2020 ◽

Vol 8 (1) ◽

pp. 15

Author(s):

Alireza Barband ◽

Amir Mangouri ◽

Changiz Gholipouri ◽

Abasad Gharedaghi

Keyword(s):

Laparoscopic Surgery ◽

Surgical Treatment ◽

Postoperative Pain ◽

Acute Appendicitis ◽

Open Surgery ◽

Surgery Group ◽

Significant Difference ◽

Duration Of Surgery ◽

Duration Of Hospitalization ◽

Complicated Acute Appendicitis

Background and Objective: Acute appendicitis is one of the most common and at the same time lethal if not treated promptly. Failure to treat this medical condition in a timely manner then it can lead to major complications that endanger the patient’s health. In these cases, surgical treatment can be done in an open or laparoscopic method. Despite some limited studies comparing the results of these two therapies, there is still insufficient information in patients with this complicated situation. The aim of this study was to evaluate the results of these two therapies in patients with complicated acute appendicitis. Materials and Methods: In this randomized controlled clinical trial, 52 patients with complicated acute appendicitis in the laparoscopic surgery group and 56 patients in the open surgery group were studied. Primary outcomes in this study were duration of surgery and secondary outcomes including wound infection, intra-abdominal abscess, postoperative pain, miscarriage, hospitalization, and need for re-surgery that were compared between the two groups. Results: Both groups were matched for age (mean 31.0 years in laparoscopic surgery group, 30.5 years in open surgery group, p = 0.81) and gender (28 men in laparoscopic surgery group, 32 men in surgical group, p = 0.73). The mean duration of surgery in the laparoscopic group was significantly longer (mean 66.8 vs. 55.1 min, p <0.001). In contrast, mean duration of hospitalization (85.2 vs 98.6 hours, p <0.001) and mean postoperative pain severity (6.3 vs 7.2, p <0.001) was more significant high in open surgery group. In other cases there was no significant difference between the two groups. Conclusion: Although in surgical treatment of complicated acute appendicitis the duration of laparoscopic surgery is longer than the open method, but the duration of hospitalization and pain intensity in laparoscopic method is significantly reduced.

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Efficacy of Mesoglycan in Pain Control after Excisional Hemorrhoidectomy: A Pilot Comparative Prospective Multicenter Study

Gastroenterology Research and Practice ◽

10.1155/2018/6423895 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Gaetano Gallo ◽

Massimiliano Mistrangelo ◽

Roberto Passera ◽

Valentina Testa ◽

Mauro Pozzo ◽

...

Keyword(s):

Postoperative Pain ◽

Multicenter Study ◽

Management Strategies ◽

Postoperative Bleeding ◽

Treated Group ◽

Control Group ◽

Oral Tablet ◽

Postoperative Thrombosis ◽

Pain Symptoms ◽

To Receive

Introduction. Various pain management strategies for patients undergoing open excisional hemorrhoidectomy have been proposed, yet postoperative pain remains a frequent complaint. Objective. To determine whether mesoglycan (30 mg two vials i.m. once/day for the first 5 days postoperative, followed by 50 mg 1 oral tablet twice/day for 30 days) would reduce the edema of the mucocutaneous bridges and thus improve postoperative pain symptoms. Patients and Methods. For this prospective observational multicenter study, 101 patients undergoing excisional diathermy hemorrhoidectomy for III-IV degree hemorrhoidal disease were enrolled at 5 colorectal referral centers. Patients were assigned to receive either mesoglycan (study group SG) or a recommended oral dose of ketorolac tromethamine of 10 mg every 4–6 hours, not exceeding 40 mg per day and not exceeding 5 postoperative days according to the indications for short-term management of moderate/severe acute postoperative pain, plus stool softeners (control group CG). Results. Postoperative thrombosis (SG 1/48 versus CG 5/45) (p<0.001) and pain after rectal examination (p<0.001) were significantly reduced at 7–10 days after surgery in the mesoglycan-treated group, permitting a faster return to work (p<0.001); however, in the same group, the incidence of postoperative bleeding, considered relevant when needing a readmission or an unexpected outpatient visit, was higher, possibly owing to the drug’s antithrombotic properties. Conclusions. The administration of mesoglycan after an open diathermy excisional hemorrhoidectomy can reduce postoperative thrombosis and pain at 7–10 days after surgery, permitting a faster return to normal activities.

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COMPARATIVE STUDY OF POSTOPERATIVE PAIN BETWEEN THE LICHTENSTEIN AND LAPAROSCOPY SURGICAL TECHNIQUES FOR THE TREATMENT OF UNILATERAL PRIMARY INGUINAL HERNIA

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201700030003 ◽

2017 ◽

Vol 30 (3) ◽

pp. 173-176 ◽

Cited By ~ 7

Author(s):

Leandro Mendonça PEDROSO ◽

Renato Miranda DE-MELO ◽

Nelson Jorge DA-SILVA-JR

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Data Analysis ◽

Surgical Treatment ◽

Postoperative Pain ◽

Treatment Options ◽

Surgical Techniques ◽

Lichtenstein Technique ◽

Primary Inguinal Hernia ◽

Lichtenstein Procedure

ABSTRACT Background: There are several surgical treatment options for inguinal hernia; however, there is no consensus on the literature identifying which surgical technique promotes less postoperative pain. Aim: To compare the intensity of postoperative pain between the surgical techniques Lichtenstein and transabdominal pre-peritoneal laparoscopy for the treatment of unilateral primary inguinal hernia. Methods: Were included 60 patients, of which 30 were operated through the Lichtenstein technique and 30 patients through the transabdominal pre-peritoneal laparoscopy. The pain levels were evaluated through the analogue visual scale for 2, 10 and 30 days after the surgery. Additionally, the recurrence rate and the presence of chronic pain and paresthesia were evaluated 12 months after the surgery. Results: Overall, the data analysis showed significant differences on pain levels between the surgical techniques. There were no significant differences between the pain levels for day 2. However, for 10 and 30 days after the surgery, the pain levels were significantly lower for the patients operated through the transabdominal pre-peritoneal laparoscopy technique compared to the Lichtenstein technique. Furthermore, despite no recurrent hernias for both surgical techniques, 32 % of patients operated through the Lichtenstein technique reported chronic pain and paresthesia 12 months after the surgery, compared with 3,6% of patients operated through the transabdominal pre-peritoneal laparoscopy technique. Conclusion: There are differences between the surgical techniques, with the transabdominal pre-peritoneal laparoscopy procedure promoting significantly lower postoperative pain (10 and 30 days) and chronic pain (12 months) compared to the Lichtenstein procedure.

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A comparative study of short term results of open haemorrhoidectomy and stapler haemorrhoidopexy

International Surgery Journal ◽

10.18203/2349-2902.isj20174496 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3358

Author(s):

Chandrasekhar S. Neeralagi ◽

Yogesh Kumar ◽

Surag K. R. ◽

Lakkanna Suggaiah ◽

Preetham Raj

Keyword(s):

Surgical Treatment ◽

Postoperative Pain ◽

Return To Work ◽

Hospital Stay ◽

Stapled Hemorrhoidopexy ◽

Short Term ◽

Post Operative Pain ◽

Duration Of Surgery ◽

Operative Complications ◽

Post Operative Complications

Background: Haemorrhoids are the most common benign anorectal problems worldwide. Treatments of third and fourth degree hemorrhoids include surgical haemorrhoidectomy. Milligan Morgan haemorrhoidectomy (MMH) as described in 1937 has remained the most popular among many techniques proposed. In order to avoid the postoperative drawbacks of Milligan Morgan haemorrhoidectomy, a new surgical treatment for prolapsing haemorrhoids has been described by Longo in 1995, procedure called stapled haemorrhoidopexy which is associated with less postoperative pain and a quicker recovery. The objective of this study was to compare the short-term outcome between stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy.Methods: Prospective randomized study of 120 patients with grade 3 and grade 4 haemorrhoids requiring surgical treatment either MMH or SH, 60 in each group for the period of 18 months from June 2014 to November 2015. Post-operative pain, duration of surgery, duration of hospital stays, post-operative complications and time taken to return to work were compared with mean follow up period of 6 months.Results: Duration of surgery is significantly low in stapled group with P <0.001, duration of hospital stay is significantly low in stapled group with P <0.001, post-operative pain low in staple group with P <0.05, time taken to return to work is significantly early in stapled group with P <0.001. Post-operative complications incontinence not found in the present study but recurrence of two cases in each group noted.Conclusion: Stapled hemorrhoidopexy is associated with less postoperative pain, shorter duration of surgery and hospital stay, earlier return to work as compared with Milligan-Morgan open hemorrhoidectomy. The procedure is not associated with major post-operative complications.

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Harmonic scalpel® hemorrhoidectomy: A painless procedure?

Medicinski pregled ◽

10.2298/mpns0710421i ◽

2007 ◽

Vol 60 (9-10) ◽

pp. 421-426 ◽

Cited By ~ 8

Author(s):

Dejan Ivanov ◽

Sinisa Babovic ◽

Dora Selesi ◽

Mirjana Ivanov ◽

Radovan Cvijanovic

Keyword(s):

Surgical Treatment ◽

Postoperative Pain ◽

Visual Analog Scale ◽

Surgical Approach ◽

Surgical Procedure ◽

Thermal Damage ◽

Harmonic Scalpel ◽

Hemorrhoidal Disease ◽

Disease Stage ◽

Analog Scale

Since the surgical treatment of hemorrhoidal disease has been characterized by intense postoperative pain, recent studies have tried to modify the standard Milligan-Morgans technique. The up-to-date literature, in the experience of authors, has confirmed that the new method of Harmonic Scalpel? hemorrhoidectomy reduces postoperative pain. The aim of our study was to statistically evaluate, based on our experience, the efficacy of this surgical approach in terms of reducing postoperative pain and establishing a stable hemostasis. Seventy-seven (77) patients suffering from hemorrhoid disease, stage III and IV, underwent surgery in our clinic during the last five years. The postoperative pain was determined using the visual analog scale on the 1st, 2nd and 7th postoperative days. Patients were divided into two groups in regard to the surgical procedure applied. The data were statistically processed using the Statistica 7.0 software. We concluded that Harmonic Scalpel? hemorrhoidectomy, due to less thermal damage, statistically significantly reduced postoperative pain with better hemostasis, compared with Milligan-Morgan's method of treating hemorrhoidal disease. .

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PLATE FIXATION OF ODONTOID FRACTURES WITHOUT C1–C2 ARTHRODESIS

Neurosurgery ◽

10.1227/01.neu.0000339117.60613.8c ◽

2009 ◽

Vol 64 (4) ◽

pp. 726-733 ◽

Cited By ~ 7

Author(s):

Patrick Platzer ◽

Gerhild Thalhammer ◽

Anna Krumboeck ◽

Rupert Schuster ◽

Florian Kutscha-Lissberg ◽

...

Keyword(s):

Surgical Treatment ◽

Plate Fixation ◽

Activity Level ◽

Rigid Fixation ◽

Atlantoaxial Joint ◽

Anterior Plate ◽

Odontoid Fractures ◽

Patient Reported ◽

Pain Symptoms ◽

Fracture Compression

Abstract OBJECTIVE Surgical treatment of odontoid fractures that do not allow interfragmentary fracture compression involves either posterior atlantoaxial arthrodesis or additional anterior stabilization using a plate construct. The purpose of this study was to determine the clinical and radiographic outcome after anterior plate fixation of odontoid fractures that were not suitable for anterior screw fixation. METHODS We reviewed the clinical and radiographic records of 9 patients with an average age of 54 years at the time of surgery who had undergone anterior plate fixation of an odontoid fracture. Indications for using a plate construct were odontoid fractures with anterior oblique fracture lines, fractures with comminution or major displacement, and pathological fractures. RESULTS Eight patients returned to their preinjury activity level and were satisfied with their treatment. One patient reported chronic pain symptoms and a notable decrease in cervical spine motion. Using the Smiley-Webster Scale to quantify their clinical outcome, we achieved an overall outcome score of 1.6. Bony fusion was achieved in all patients. Reduction or fixation failed in 2 patients. Reoperation for technical failures was not necessary in any of the patients. CONCLUSION We had promising results using anterior plate fixation for surgical treatment of odontoid fractures that did not allow interfragmentary fracture compression. Because this method avoids the rigid fixation of the atlantoaxial joint in contrast to techniques of posterior cervical arthrodesis, it seems to be a practical option for the management of fracture types that require additional stabilization of the odontoid.

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