The influence of continuous local wound infusion on postoperative pain in patients undergoing transfemoral amputation

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 381-386 ◽  
Author(s):  
Christian Uhl ◽  
Thomas Betz ◽  
Andrea Rupp ◽  
Markus Steinbauer ◽  
Ingolf Töpel
Keyword(s):  
Pain Management ◽  
Pilot Study ◽  
Local Anaesthetic ◽  
Phantom Pain ◽  
Transfemoral Amputation ◽  
Postoperative Wound ◽  
Stump Pain ◽  
Management Protocol ◽  
Group 2 ◽  
Group 1

Abstract. Summary: Background: This pilot study was set up to examine the effects of a continuous postoperative wound infusion system with a local anaesthetic on perioperative pain and the consumption of analgesics. Patients and methods: We included 42 patients in this prospective observational pilot study. Patients were divided into two groups. One group was treated in accordance with the WHO standard pain management protocol and in addition to that received a continuous local wound infusion treatment (Group 1). Group 2 was treated with analgesics in accordance with the WHO standard pain management protocol, exclusively. Results: The study demonstrated a significantly reduced postoperative VAS score for stump pain in Group 1 for the first 5 days. Furthermore, the intake of opiates was significantly reduced in Group 1 (day 1, Group 1: 42.1 vs. Group 2: 73.5, p = 0.010; day 2, Group 1: 27.7 vs. Group 2: 52.5, p = 0.012; day 3, Group 1: 23.9 vs. Group 2: 53.5, p = 0.002; day 4, Group 1: 15.7 vs. Group 2: 48.3, p = 0.003; day 5, Group 1 13.3 vs. Group 2: 49.9, p = 0.001). There were no significant differences between the two groups, neither in phantom pain intensity at discharge nor postoperative complications and death. Conclusions: Continuous postoperative wound infusion with a local anaesthetic in combination with a standard pain management protocol can reduce both stump pain and opiate intake in patients who have undergone transfemoral amputation. Phantom pain was not significantly affected.

Relationship among anesthesia technique, surgical stress, and cognitive dysfunction following spinal surgery: a randomized trial

2019 ◽  
Vol 31 (6) ◽  
pp. 894-901 ◽  
Author(s):  
Anna A. Ezhevskaya ◽  
Alexei M. Ovechkin ◽  
Zhanna B. Prusakova ◽  
Valery I. Zagrekov ◽  
Sergey G. Mlyavykh ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Pain Management ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
Group 2 ◽  
Cellular Immune ◽  
Inflammatory Changes ◽  
Group 1

OBJECTIVESurgical trauma is known to result in systemic inflammatory changes that can lead to postoperative cognitive dysfunction. In the present study, the authors compared the effects of an epidural anesthesia protocol to those of traditional anesthesia with regard to postoperative inflammatory changes, cellular immunity, and cognitive dysfunction.METHODSForty-eight patients, ages 45–60 years, underwent multilevel thoracolumbar decompression and fusion and were randomly assigned to one of two groups: group 1 (27 patients) had combined epidural and general anesthesia, followed by epidural analgesia for 48 hours after surgery, and group 2 (21 patients) had general anesthesia, followed by traditional opioid pain management after surgery. At multiple time points, data on pain control, cognitive function, cellular immunity, and inflammatory markers were collected.RESULTSGroup 1 patients demonstrated lower pain levels, less systemic inflammation, less cellular immune dysfunction, and less postoperative cognitive dysfunction than group 2 patients.CONCLUSIONSThe use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru)

scholarly journals Pudendal Nerve Block in Male Goats: Comparison of Ischiorectal Fossa and Ischial Arch Approaches Using Low Volume 1% Lignocaine Hydrochloride

2016 ◽  
Vol 39 (1) ◽  
pp. 111-115 ◽  
Author(s):  
Mujeebur Rehman Fazili ◽  
Nida Handoo ◽  
Mohd Younus Mir ◽  
Beenish Qureshi
Keyword(s):  
Nerve Block ◽  
Local Anaesthetic ◽  
Pudendal Nerve ◽  
Rectal Wall ◽  
Ischiorectal Fossa ◽  
Pudendal Nerve Block ◽  
Short Term Exposure ◽  
Group 2 ◽  
Manual Manipulation ◽  
Group 1

AbstractThirty (30) adult male goats were injected xylazine (0.05 mg/kg, IM) and randomly divided into three equal groups. Internal pudendal nerve block was tried using 3.5 ml (on each side) of 1% lignocaine hydrochloride byischiorectal fossa or ischial arch approaches in goats from Group 1 and Group 2 respectively, 15 minutes after giving xylazine. Inadvertent puncture of the rectal wall and prick to the finger placed in the rectum was experienced once in Group 1 animal. None of the animals showed protrusion of the penis without manual manipulation. Prolapse of the prepucial ring was noticed in three animals from Group 1 and two each from Group 2 and 3. The application of mild manual push percutaneously resulted in the exposure of the penis in eight and six animals belonging to Group 1 and Group 2 respectively, 15 minutes after injection of the local anaesthetic. Statistically significant (P>0.05) difference between Group 1 and 2 values was detected only once at 90 minutes following injection of the local anaesthetic. The block lasted longer in animals of Group 1. The exposed organ was flaccid and insensitive. The organ retracted into the prepucial cover within five minutes of its release in all the animals. The penile exposure could not be achieved by similar manipulation in any of the Group 3 animals. From this study it was concluded that the ischiorectal fossa approach is cumbersome and may lead to inadvertent punctures, but the block develops in more number of animals for a longer period than with the ischial arch approach. The outcome of the two techniques did not show statistically significant (P>0.05) difference for most of the assessment period. Reducing the concentration of lignocaine hydrochloride may reduce the chances of continued relaxation of the penis beyond the required period and also the drug toxicity. However, studies using larger volume of 1% lignocaine hydrochloride may be undertaken for short term exposure of the penis without manual manipulation.

Opioid Prescribing in Patients Undergoing Neck Dissections With Short Hospitalizations

2020 ◽  
pp. 019459982095798
Author(s):  
Grace L. Banik ◽  
Kristen L. Kraimer ◽  
Maisie L. Shindo
Keyword(s):  
Pain Management ◽  
Head And Neck ◽  
Neck Dissection ◽  
Opioid Prescription ◽  
Multidisciplinary Collaboration ◽  
Opioid Prescribing ◽  
The Mean ◽  
Preoperative Counseling ◽  
Group 2 ◽  
Group 1

Objective To evaluate postoperative opioid prescribing in patients undergoing neck dissections with short hospitalizations. Study Design Retrospective cohort study. Setting Tertiary academic hospital. Methods The study population included patients who underwent lateral neck dissections with or without an associated head and neck procedure and required hospitalization for ≤3 days from 2012 to 2019. Interventions to decrease opioid utilization, including preoperative counseling, multimodality pain management, and multidisciplinary collaboration, were implemented in September 2016. Patients were divided into 2 groups: preintervention (group 1) and postintervention (group 2). The mean quantity of opioids prescribed during hospitalization, at discharge, and in refills was calculated in morphine milligram equivalents (MME). Results A total of 407 patients were included in the analysis: 223 patients in group 1 and 184 patients in group 2 (42.3% female, 89.4% white; average age, 55.2 years [95% CI, 53.6-56.9]). The mean opioid quantity prescribed in unilateral neck dissection alone decreased from 353.9 MME (95% CI, 266.7-441.2) in group 1 to 113.3 MME (95% CI, 87.8-138.7) in group 2 ( P < .001; effect size, 1.0). Statistically significant decreases in mean opioid quantity prescribed were also observed in unilateral neck dissection in combination with thyroidectomy, parotidectomy, glossectomy, or tonsillectomy. The percentage of patients requiring opioid prescription refills was not statistically different between the groups. Conclusion This study demonstrates that the quantity of opioids prescribed in patients undergoing neck dissections and associated head and neck procedures with short hospitalizations can be reduced to as low as 100 to 125 MME with preoperative counseling, multimodality pain management, and multidisciplinary collaboration.

scholarly journals MON-594 The Peculiarity of the Gut Microbiota in Patients with Different Phenotypes of Obesity (Pilot Study)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Natalia Volkova ◽  
Julia Naboka ◽  
Lilia Ganenko ◽  
Oksana Oksenuk ◽  
Ilia Davidenko ◽  
...  
Keyword(s):  
Pilot Study ◽  
Gut Microbiota ◽  
Nutrition Education ◽  
Control Group ◽  
Metabolically Healthy Obesity ◽  
Detection Frequency ◽  
Group 3 ◽  
Metabolically Healthy ◽  
Group 2 ◽  
Group 1

Abstract Recent studies have shown that obesity is not a homogeneous condition and that there is a subgroup of people with obesity, but without metabolic disturbance. This phenotype of obesity is called “metabolically healthy obesity” (MHO) [1]. More and more data are appearing in the scientific literature, indicating that quantitative and qualitative changes in the gut microbiota (GM) can be a trigger in the development of obesity and metabolic disorders [2]. In order to study the role of GM in the development of various types of obesity, 37 patients were examined, divided into 3 groups: group 1 (n = 11) - healthy people without obesity and overweight (control), group 2 (n = 13) - patients with MHO, group 3 (n = 13) - patients with metabolically unhealthy obesity (MUHO). The basic metabolic parameters were determined for all of them and a quantitative assessment of the condition of the GM was performed using the Real-time PCR method. Results: 1. In people from the control group (group 1) in the GM, compared with formal normative indicators, the number of Lactobacillus spp., Bifidobacterium spp., B. thetaiotaomicron was reduced (p&lt;0.05) and indicators of the total bacterial mass and Enterobacter spp./Citrobacter spp. were increased (p&lt;0.05). 2. In subjects with MHO (group 2), GM changes similar to group 1 were observed. However, in comparison to group 1, Klebsiella spp. and Proteus spp. were recorded in feces in quantities exceeding the formal regulatory. In patients with MUHO (group 3), in addition to changes detected in group 2, C. difficile was found in feces, as well as a significant (p &lt;0.05) decrease in F. prausnitzii and an increase (p &lt;0.05) in the detection frequency of banal E.coli, as well as the more diverse composition of the microbiota. Thus, the data obtained as a result of a pilot study certainly indicate changes in the GM in people with different phenotypes of obesity and in healthy ones. Further study of the GM in patients with various types of obesity, but in a larger groups, is required. Reference: 1) Phillips C.M. Metabolically healthy obesity across the life course: epidemiology, determinants and implications. Ann N.Y. Acad Sci 2017 Mar;139(1):85-100.doi:10.1111/nyas.13230. 2). Giovanna Muscogiuri, Elena Cantone, Sara Cassarano, Dario Tuccinardi, Luigi Barrea, Silvia Savastano, Annamaria Colao & on behalf of the Obesity Programs of nutrition, Education, Research and Assessment (OPERA) group. Gut microbiota: a new path to treat obesity. International Journal of Obesity Supplements 2019 Apr;9(1):10-19. doi: 10.1038/s41367-019-0011-7

scholarly journals Interpleural Administration of Bupivacaine after Cholecystectomy: A Comparison with Intercostal Nerve Block

1989 ◽  
Vol 17 (3) ◽  
pp. 269-274 ◽  
Author(s):  
D. W. Blake ◽  
G. Donnan ◽  
J. Novella
Keyword(s):  
Local Anaesthetic ◽  
Intercostal Nerve ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Pain Scores ◽  
Lower Pain ◽  
Chest X Ray ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Pethidine requirements and verbal pain scores were recorded in 36 patients after cholecystectomy via subcostal incision. All patients also received 20 ml 0.5% bupivacaine with adrenaline 1/200,000. Group 1 (12 patients) received unilateral intercostal nerve blocks. Interpleural catheters were inserted through the 8th intercostal space in the remaining patients; 12 received local anaesthetic via the catheter immediately after surgery (Group 2) and 12 were given local anaesthetic at three hours (Group 3). Small asymptomatic pneumothoraces were noted on chest X-ray in six of the 24 patients with interpleural catheters. Both types of local anaesthesia produced lower pain scores than pethidine alone (P < 0.05) with 25% of intercostal nerve blocks and 63% of interpleural catheters requiring no pethidine in the following three hours. The provision of catheter ‘top-ups’ between six and 18 hours after surgery also resulted in lower pain scores and a reduction in pethidine requirements (P < 0.05).

Is there a role for music in reducing anxiety in plastic surgery minor operations?

2012 ◽  
Vol 94 (3) ◽  
pp. 152-154 ◽  
Author(s):  
H Sadideen ◽  
A Parikh ◽  
T Dobbs ◽  
A Pay ◽  
PS Critchley
Keyword(s):  
Local Anaesthetic ◽  
Clinical Care ◽  
Statistical Significance ◽  
Patient Anxiety ◽  
Vas Score ◽  
The Mean ◽  
Anxiety Levels ◽  
Group 2 ◽  
Surgical Setting ◽  
Group 1

Introduction It is well documented that music plays a role in reducing anxiety levels. Its role in reducing intra-operative anxiety levels in surgical patients while awake is less well known. We report the effects of music on intra-operative patient anxiety in both the elective and trauma plastic surgical setting. Methods Two groups of patients undergoing local anaesthetic surgical procedures were identified: those where music was played in the operating theatre (Group 1) and those where it was not (Group 2). Ninety-six patients were included. Subjectively anxiety was evaluated by the patient with a visual analogue scale (VAS) and objectively by the respiratory rate (RR), both pre and post-operatively. The unpaired t-test was used to evaluate the statistical significance of differences between the groups. Results The mean pre-operative VAS score was similar in both groups (5.7 in Group 1 and 5.8 in Group 2). The mean preoperative RR was 15 breaths per minute in both groups. Post-operatively, the VAS score and RR were both lower in Group 1 (VAS: 3.5 vs 4.9; p<0.01 and RR: 11 vs 13 breaths per minute; p<0.05). Conclusions In the era of the patient centred approach to clinical care, it is crucial to minimise patient anxiety. Music appears to reduce intra-operative anxiety in awake patients in both the elective and trauma plastic surgical setting. Easy listening music and chart classics appear to be suitable genres according to patients. We believe there is a role for a large, multicentre, randomised control study to examine the benefits of music in all local anaesthetic procedures across different specialties.

scholarly journals Medical management in locally advanced and metastatic prostate cancer: Does changes in treatment policy have any specific effect on PSA levels?

2017 ◽  
Vol 89 (4) ◽  
pp. 282 ◽  
Author(s):  
Murat Bagcioglu ◽  
Cristian Surcel ◽  
Serkan Ozcan ◽  
Cristian Mirvald ◽  
Mehmet Ali Karagoz ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Medical Management ◽  
Locally Advanced ◽  
Androgen Deprivation ◽  
Testosterone Levels ◽  
Management Protocol ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Objective: Androgen deprivation therapy (ADT) is commonly used as a first-line treatment for locally advanced and metastatic prostatic cancer (Pca). There is no consensus about which alternative treatment should be used after the failure of initial ADT. We aimed to investigate the effect of changes in treatment on PSA and testosterone levels. Material and methods: A total of 120 patients with an established diagnosis of either locally advanced or metastatic Pca in two different centers. Depending on the type of medical and/or surgical management protocol planned at initial presentation, all cases were divided into three main groups as follows. Group 1 (n: 80) included the patients who underwent medical management during whole follow-up period in whom the initial management protocol was later on switched to another medical treatment with different agents, Group 2 (n: 20) included patients who were initially treated with a medical management protocol and switched to surgical castration during follow-up evaluation and lastly Group 3 (n: 20) included the patients undergoing treated surgical castration as initial treatment modality without any further medical management protocol. Results: Evaluation of our data did clearly demonstrate a statistically significant difference between the initial and final PSA as well as testosterone levels in Group 1 cases. Mean PSA and testosterone levels increased significantly in these cases despite a change in hormonal therapy by using another agent for androgen deprivation. Cases in Group 2 and 3 cases did not show any statistically significant difference with respect to the mean PSA as well as testosterone values during the same follow-up period. Conclusions: Our data clearly indicated that in case of a biochemical progression, switching into another alternative medical treatment was not effective enough in limiting the rising PSA levels in a statistically significant manner when compared with the approaches of switching to surgical castration after initial medical treatment or continuing with regular and close follow-up after initial surgical castration alone.

scholarly journals Clinical efficacy of prebiotics and glycosaminoglycans versus placebo In dogs with food responsive enteropathy receiving a hydrolyzed diet: A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0250681
Author(s):  
Barbara Glanemann ◽  
Yeon-Jung Seo ◽  
Simon L. Priestnall ◽  
Oliver A. Garden ◽  
Logan Kilburn ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Placebo Group ◽  
Pilot Study ◽  
Relapse Rate ◽  
Random Effect ◽  
Dietary Treatment ◽  
Normal Diet ◽  
Power Calculation ◽  
Group 2 ◽  
Group 1

Induction of remission is easily achieved with dietary treatment in dogs diagnosed with Food Responsive Chronic Diarrhea (FRD). Administration of prebiotics and glycosaminoglycans (GAGs) may improve epithelial cell integrity and therefore be useful as adjunct treatment. This study evaluated whether the relapse rate of FRD dogs that are switched back to a normal diet can be influenced using supplemental treatment with prebiotics and GAGs. A randomized, controlled clinical trial (RCCT) was performed in dogs diagnosed with FRD. Dogs were diagnosed based on clinical exclusion diagnosis, endoscopic biopsies showing predominantly lymphoplasmacytic infiltration, and response to dietary treatment. Dogs were randomized to be fed a combination of prebiotics and GAGs (group 1) or placebo (group 2) in addition to a hydrolyzed diet. At week 10, a second endoscopy was performed and dogs were switched back to normal diet. Relapse rate was monitored every 2 weeks after that until week 18. Statistical analysis was performed for each outcome (Canine Chronic Enteropathy Clinical Activity Index (CCECAI), clinicopathological data, endoscopic scoring, mWSAVA histological scoring index (mWSAVA), and number of relapses following switch to normal diet) using a linear mixed effects model for group comparison. Time, group, and their interactions were included as a fixed effect, whereas each dog was treated as a random effect. Of the 35 dogs enrolled into the clinical trial, 10 in each group reached the point of second endoscopy. A total of 13 dogs (n = 8 in group 1 and n = 5 in group 2) reached the trial endpoint of 18 weeks. After switching back to normal diet, none of the dogs in either group relapsed. No significant differences were found over time or between groups for CCECAI, endoscopy scoring and histological scoring. Although there was a clinical worsening in the placebo group after switching back to the original diet, this was not statistically significant (CCECAI p = 0.58). Post-hoc power calculation revealed that 63 dogs per group would have been needed to detect statistically significant differences in CIBDAI between treatment groups. Standard dietary treatment induced rapid clinical response in all cases, however, additional supplementation with prebiotics and GAGs did not significantly improve clinical outcome within 4 months after switching back to normal diet. Since there are very few RCCT published in CE in dogs, this pilot study provides important power analyses for planning of further studies.

scholarly journals Effects of local anaesthetic dilution on the characteristics of ultrasound guided axillary brachial plexus block: a randomised controlled study

2021 ◽  
Author(s):  
Anil Ranganath ◽  
Osman Ahmed ◽  
Gabriella Iohom
Keyword(s):  
Brachial Plexus ◽  
Local Anaesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Performance Time ◽  
Axillary Brachial Plexus Block ◽  
Group 2 ◽  
Plexus Block ◽  
Group 1

Aims: Ultrasound guidance has led to marked improvement in the success rate and characteristics of peripheral nerve blocks. However, effects of varying the volume or concentration of a fixed local anaesthetic dose on nerve block remains unclear. The purpose of our study was to evaluate whether at a fixed dose of lidocaine, altering the volume and concentration will have any effect on the onset time of ultrasound-guided axillary brachial plexus block.Material and methods: Twenty patients were randomised to receive an ultrasound-guided axillary brachial plexus block with either lidocaine 2% with epinephrine (20 ml, Group 2%) or lidocaine 1% with epinephrine (40 ml, Group 1%). The primary endpoint was block onset time. Secondary outcomes included duration of the block, performance time, number of needle passes, incidence of paraesthesia and vascular puncture.Results: The median [IQR] onset time of surgical anaesthesia was shorter in Group 1% when compared to Group 2% (6.25 [5-7.5] min vs 8.75 [7.5-10] min; p=0.03). The mean (SD) overall duration of surgical anaesthesia was significantly shorter in Group 1% compared to Group 2% (150.9±17.2 min vs 165.1±5.9 min; p=0.02). Group 1% had a shorter performance time with fewer needle passes. The incidence of vascular puncture and paraesthesia was similar in the two groups.Conclusion: Ultrasound-guided axillary brachial plexus blocks performed using a higher volume of lower concentration lidocaine was associated with shorter onset time and duration of surgical anaesthesia.

scholarly journals Visual Outcomes of Adding Erythropoietin to Methylprednisolone for Treatment of Retrobulbar Optic Neuritis

2019 ◽  
Author(s):  
Mostafa Soltan Sanjari ◽  
Farzad Pakdel ◽  
Fatemeh Moosavi ◽  
Niloofar Pirmarzdashti ◽  
Marzieh Nojomi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pilot Study ◽  
Optic Neuritis ◽  
Visual Outcome ◽  
Primary Outcome Measure ◽  
Recombinant Erythropoietin ◽  
Human Recombinant Erythropoietin ◽  
Retrobulbar Optic Neuritis ◽  
Group 2 ◽  
Group 1

Purpose: To compare the short-term visual function results and safety of erythropoietin as an add-on to the standard corticosteroid therapy in retrobulbar optic neuritis (RON). Methods: In this prospective pilot study, adult patients with isolated RON with less than 10 days of onset were enrolled. Patients were consecutively assigned to standard intravenous methylprednisolone treatment either in combination with intravenous erythropoietin (20,000 units/day for three days) (group-1) or alone (group-2). Primary outcome measure was best-corrected visual acuity (BCVA), which was assessed up to 120 days from the day the treatment was begun. Systemic evaluations were performed during and after treatment. Results: Sixty-two patients with RON (mean age = 26.6 ± 5.77 years; range = 18–40 years) were enrolled into the study (group-1, n = 35; group-2, n = 27). BCVA three months after the treatment was 0.19 ± 0.55 logMAR and 0.11 ± 0.32 logMAR in group-1 and group-2, respectively (95% CI: –0.61–0.16; P = 0.62). Change in BCVA after three months was 2.84 ± 3.49 logMAR in group-1 and 2.46 ± 1.40 logMAR in group-2 (95% CI: –0.93–1.91; P = 0.57). Pace of recovery was not significantly different between the groups. No complications were detected among patients. Conclusion: Intravenous erythropoietin as an add-on did not significantly improve the visual outcome in terms of visual acuity, visual field, and contrast sensitivity compared to traditional intravenous corticosteroid. This pilot study supports the safety profile of intravenous human recombinant erythropoietin, and it may help formulate future investigations with a larger sample size.

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