The impact of post PCNL tube type on blood loss and postoperative pain

Objective: To evaluate the impact of nephrostomy tube type on postoperative pain and blood loss following percutaneous nephrolithotomy (PCNL). Methods: This is a prospective non-randomized study performed at Aga Khan University Hospital from July 2017 to June 2018. In this study we prospectively studied adult patients (16 to 65 years) who underwent unilateral PCNL. Patients who had nephrostomy with balloon (12Fr Foley’s catheter) were compared with patients who had nephrostomy without balloon (12Fr Nelaton™ catheter). STONE Nephrolithometry score was used to assess the stone complexity. Mean pain score at six and 24 hours and mean hemoglobin drop at 24 hours was compared between two groups using independent sample t-test, p-value of <0.05 was considered significant. Results: Over one year, 198 PCNL were performed out of which 119 were included for analysis. Sixty-six had nephrostomy tube with balloon and 53 had nephrostomy tube without balloon. Mean STONE score (9.66±1.4 vs. 9.64±1.24) and operative time (72.84±28.34 vs. 86.05±32.1 minutes) was comparable. Mean postoperative pain score at 6 hours and 24 hours postoperative was significantly lower in balloon group as compared to without balloon group. Mean Hemoglobin drop was similar in both groups (p=0.60). Conclusion: The use of nephrostomy tube with balloon after PCNL as this is associated with less pain and comparable hemoglobin drop as compare to nephrostomy tube without balloon. doi: https://doi.org/10.12669/pjms.36.3.1558 How to cite this:Jamil S, Ather MH. The impact of post PCNL tube type on blood loss and postoperative pain. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1558 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Diathermy versus scalpel incisions in elective abdominal surgery: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20183734 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3124

Author(s):

Vikranth S. Nandukar ◽

Mohan Kumar K. ◽

Prakash M. ◽

Suma S.

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Abdominal Surgery ◽

Randomized Study ◽

Wound Complications ◽

P Value ◽

Elective Abdominal Surgery ◽

Tissue Healing ◽

Group A ◽

Group B

Background: Scalpel incisions produce little damage to surrounding tissues. There has been a widespread use of diathermy for hemostasis but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions. Use of diathermy in skin incisions reduces bleeding and makes the incision quicker, but there are no differences in wound burst strength. Objective of the study was to compare the use of diathermy and scalpel incisions in elective abdominal surgery’s to see the variations in incisional time, blood loss during incision, postoperative pain and wound complicationsMethods: This was a prospective randomized study, which included patients above 18 years who underwent elective abdominal surgery. The patients were randomly included into Group A or Group B. In Group A incision was made with a scalpel and in group B with diathermy. Data was analyzed for incisional time, blood loss during incision, postoperative pain and wound complications.Results: There was a significant increase in mean time taken for incision in Group A when compared to Group B. Mean incision blood loss was found to be significantly higher in group A compared to group B patients. Postoperative pain was significantly higher in group A (p value <0.05) on postoperative day 1. Among wound complications, no statistically significant differences were seen between the two groups.Conclusions: Electrocautery incisions were safe, less time consuming, reduced blood loss and had less postoperative pain. We conclude that diathermy could be accepted as an alternative method for surgical skin incisions.

Download Full-text

Smoking and associated unhealthy lifestyle behaviours in patients with chronic cardiac diseases during COVID-19 related lockdown

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.293 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

F Chague ◽

M Boulin ◽

JC Eicher ◽

F Bichat ◽

M Saint-Jalmes ◽

...

Keyword(s):

Screen Time ◽

University Hospital ◽

Weight Increase ◽

Phone Call ◽

P Value ◽

Time Increase ◽

Unhealthy Lifestyle ◽

Lifestyle Behaviours ◽

Coronary Syndrome ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Dijon University Hospital France OnBehalf CLEO-CD Background Lockdown can affect tobacco smoking (TS) behaviours. Purpose To evaluate the impact of lockdown on (TS) and associated lifestyle behaviours in patients with Chronic coronary syndrome (CCS) and congestive heart failure (CHF) Methods CCS and CHF patients were invited to answer to a phone-call questionnaire during the 1st COVID-19 lockdown start Results (Table) 343 questionnaires were fit for analysis, 43 (12.5%) were current smokers (CS). CS were younger (p < 0.001), none stopped and 13 increased their consumption (main reasons were stress and boredom). CS felt more often cramped (p = 0.023). CS who increased their TS consumption showed a trend toward a higher rate of unhealthy lifestyle behaviours Conclusions During the lockdown, more than ¼ of CS with CCS or CHF increased their TS consumption and none quitted. Moreover, TS was often associated with other deleterious behaviours increasing their risk for short and long term Main results Total Non-Smokers Smokers p* N(%) 344 301 43 Age, years 67.7 ± 12.8 69.2 ± 12.2 57.2 ± 12.1 <0.001 Men/Women 229/115 197/104 32/11 0.300 CCS/CHF 220/124 185/116 36/7 0.004 Urban/Rural 163/181 137/164 26/17 0.073 Living alone at home 83(24.3) 68(22.7) 15(34.9) 0.089 COVID screening (PCR) 11(3.2) 7(2.3) 4(9.3) 0.037 Feeling cramped 19(5.5) 13(4.4) 6(14.0) 0.023 Feeling less well 75(21.9) 65(21.7) 10(23.8) 0.842 K6 ≥ 5 81(23.7) 70(23.5) 11(25.6) 0.845 Physical activity decrease 146(42.6) 125(42.1) 21(48.8) 0.323 Screen time increase 154(45.0) 130(43.5) 24(55.8) 0.100 Alcohol consumption increase 14(5.5) 11(4.9) 3(7.5) 0.419 Sleep change 83(24.6) 68(22.5) 15(39.5) 0.083 Weight increase 77(22.4) 64(21.3) 13(30.2) 0.242 Smokers (n = 43) Smoking increase No smoking increase p** Feeling less well 5(38.5) 5(17.2) 0.238 Screen time increase 10(76.9) 14(46.7) 0.104 Weight increase 6(46.2) 7(23.3) 0.173 n(%) or mean ± SD. *p value: Smokers vs non smokers. **p value: Smoking increase vs no smoking increase

Download Full-text

The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

American Journal of Perinatology ◽

10.1055/s-0040-1718574 ◽

2020 ◽

Author(s):

Aleksandra Polic ◽

Tierra L. Curry ◽

Judette M. Louis

Keyword(s):

Interventional Radiology ◽

Blood Transfusion ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Tertiary Care ◽

P Value ◽

Obese Women ◽

Severe Morbidity ◽

The Impact ◽

To Receive

Objective The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. Conclusion Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. Key Points

Download Full-text

Effect of Using Silver Nylon Dressings on Postoperative Pain after Cesarean Delivery

American Journal of Perinatology ◽

10.1055/s-0041-1739521 ◽

2021 ◽

Author(s):

Sheila Connery ◽

Jean Paul Tanner ◽

Linda Odibo ◽

Olivia Raitano ◽

Dusan Nikolic-Dorschel ◽

...

Keyword(s):

Postoperative Pain ◽

Cesarean Delivery ◽

Secondary Analysis ◽

Single Site ◽

Secondary Outcome ◽

P Value ◽

Scar Assessment ◽

Patient Reported ◽

The Impact ◽

Nonopioid Analgesic

Objective Silver dressings have been associated with a decrease in postoperative pain in selected populations, but it is unknown if the benefit can be observed after cesarean deliveries. We sought to evaluate the impact of silver nylon dressings in reducing postoperative pain after cesarean delivery. Study Design A secondary analysis of data from a blinded randomized clinical trial of women undergoing cesarean delivery scheduled and unscheduled at a single site was conducted. Women were recruited for participation from a single site and randomized to a silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient clinic at 1 and 6 weeks after delivery and patient responded to the modified patient scar assessment scale. The primary outcome of this analysis was inpatient opioid and nonopioid analgesic dispensed. The secondary outcome was patient-reported pain at the 1- and 6-week postpartum visits. Data were analyzed using chi-square test, Student's t-test, Fisher's exact test, Wilcoxon–Mann–Whitney's test, and logistic regression where appropriate. A p-value of < 0.05 was considered significant. Results Among the 649 participants, women allocated to the silver nylon dressing group, when compared with the gauze group, were similar in the amount of dispensed opioid and nonopioid analgesic medications (morphine equivalent milligrams of opioids dispensed [82.5 vs. 90 mg, p = 0.74], intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) [120 vs. 120 mg, p = 0.55], and oral NSAIDs [4,800 vs. 5,600 mg in the gauze group, p = 0.65]). After adjusting for confounding variables, postoperative wound infection (adjusted odds ratio [aOR]: 11.70; 95% confidence interval [CI]: 4.51–30.31) at 1-week postoperative and again at 6-week postoperative (aOR: 5.59; 95% CI: 1.03–30.31) but not gauze dressing was associated with patient-reported postoperative pain. Conclusion Among women undergoing cesarean delivery, silver nylon dressing was not associated with a reduction in postoperative pain. Key Points

Download Full-text

Study of Pain Level Control Targets After Arthroscopic Surgery

10.21203/rs.3.rs-253532/v2 ◽

2021 ◽

Author(s):

Wang Xin ◽

Liu Congying ◽

Zhang Xiaole ◽

Wang Hong ◽

Xu Yan ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Score ◽

Pain Control ◽

Rating Scale ◽

Numerical Rating Scale ◽

Arthroscopic Surgery ◽

Daily Activities ◽

Pain Level ◽

Convenience Sampling ◽

The Impact

Abstract Objective: To explore the goal of pain control in patients after arthroscopic surgery.Design: Investigation. Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated.Setting: Department of Sports Medicine,Peking University 3rd Hospital,Beijing, P.R.ChinaSubjects: 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. The patient inclusion criteria were an age of at least 18 years, no history of diagnosis of mental illness, the ability to clearly express his or her pain and an agreement to voluntarily cooperate with the investigators. The exclusion criteria were patients who were unable to complete follow-up.Methods: Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated by administering a homemade questionnaire to 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. Pain was assessed using a digital pain numerical rating scale (NRS) (0-10), and a digital score ranging from 0 to 10 was used for satisfaction with pain control and the impact of pain on aspects of daily living.Results: The pain level was most severe in patients 6-24 hours after arthroscopic surgery, during which pain control satisfaction was at its worst. The pain score was significantly related to the effects of pain on aspects of daily life, and the degree of these effects changed significantly for pain scores greater than 2 points.Conclusion: Pain control 6 to 24 hours after surgery is not satisfactory. It is recommended that a pain score of 2 points is used as the goal for pain control after arthroscopic surgery to guide both doctors and patients to effectively control postoperative pain.

Download Full-text

Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20211817 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1507

Author(s):

Amit Yadav ◽

Lakshman Agarwal ◽

Sumit A. Jain ◽

Sanjay Kumawat ◽

Sandeep Sharma

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Abdominal Surgery ◽

Wound Infection ◽

Skin Incision ◽

P Value ◽

Wound Area ◽

Significant Difference ◽

Group A ◽

Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

Download Full-text

ELECTIVE MIDLINE LAPAROTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1869 ◽

2011 ◽

Vol 18 (01) ◽

pp. 106-111

Author(s):

ARSALAN SIRAJ ◽

ATHAR ABBAS SHAH GILANI ◽

MUHAMMAD FAROOQ DAR ◽

Sohail Raziq

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Wound Infection ◽

Visual Analogue Score ◽

P Value ◽

Midline Laparotomy ◽

Pain Scores ◽

Group A ◽

Insignificant Difference ◽

Group B

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.

Download Full-text

Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1694040 ◽

2019 ◽

Vol 81 (01) ◽

pp. 017-027

Author(s):

Michael Bender ◽

Carolin Gramsch ◽

Lukas Herrmann ◽

Seong Woong Kim ◽

Eberhard Uhl ◽

...

Keyword(s):

Blood Loss ◽

Pain Score ◽

Hospital Setting ◽

University Hospital ◽

Disk Herniation ◽

Training Requirements ◽

Lumbar Disk ◽

Duration Of Surgery ◽

Lumbar Disk Herniations

Abstract Objective Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting. Methods One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique. Results Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4–L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02). Conclusions The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

Download Full-text

Surgical versus sequential hybrid treatment of carotid body tumors

Open Medicine ◽

10.1515/med-2019-0115 ◽

2019 ◽

Vol 14 (1) ◽

pp. 968-976

Author(s):

Bruno Amato ◽

Rita Compagna ◽

Anna Florio ◽

Francesca Calemma ◽

Aldo Rocca ◽

...

Keyword(s):

Blood Loss ◽

Carotid Body ◽

Intraoperative Complications ◽

Operative Procedure ◽

Randomized Study ◽

Cranial Nerves ◽

Carotid Bifurcation ◽

Cervical Region ◽

P Value ◽

Preoperative Embolization

AbstractCarotid body tumor (CBT) are slow-growing tumors that develop in the cervical region at the carotid bifurcation. . In a randomized study, 33 patients were treated for CBT excision: 10 patients performed preoperative embolization (PE) and 23 were treated only by isolated traditional surgery (N-PE). The first group includes patients undergoing preoperative embolization. The second group of patients (N-PE) included 11 males and 12 females. Intraoperative complications were lower in patients treated with a hybrid procedure (PE): sections of the cranial nerves were recorded in 7% of cases compared to 12% of the surgical procedure (P-value = 0.72); while the reversible nerve lesions (P value = 0.21) and the permanent ones (P value = 0.46), were instead similar in both procedures. The comparative blood loss during the operative procedure shows a P-value of 0.02. Operating times, reversible damage of the cranial nerves , incidence of stroke (0% vs1%, P value> 0.99) and post-operative hospital stay (4.1 vs. 4.2 days, P value = 0.91) did not show differences in the two groups of patients. The analysis of the results detects pre-operative embolization of CBT in reducing intraoperative blood loss and resection of the cranial nerves..

Download Full-text

Comparison of Intra-Articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

Austin Journal of Orthopedics & Rheumatology ◽

10.26420/austinjorthopaderheumatol.2021.1098 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Kornah BA ◽

◽

Mansour GM ◽

Mohamed MTI ◽

◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

University Hospital ◽

Postoperative Blood Loss ◽

Soft Tissue Release ◽

P Value ◽

Intravenous Application ◽

Total Knee

Background: Total Knee Arthroplasty (TKA) is widely used in clinical applications. Considerable postoperative blood loss, however, is an unavoidable occurrence due to the extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. Besides, knee flexion and extension activities those begin the day after the operation adds to the problem. Aim of the Work: To compare between the intra-articular and the intravenous application of Tranexamic Acid (TXA) in total knee arthroplasty. Patients and Methods: It is a prospective Double-blinded Randomized controlled trial. This prospective study was conducted at El-Hussein University Hospital & El Agouza Hospital on 30 patients who undergo total knee arthroplasty and fulfill all inclusion and exclusion criteria. Results: The results were the average total blood loss in the drain after 48hrs. In the 1st group was 365±74.722 while average blood loss in the 2nd group was 575±88.976. This indicates a significant decrease in blood loss in the 1st group (intraarticular TXA group) than the 2nd group (intravenous TXA group) the P value <0.001 which is highly significant. It was found that The decrease in Hb level is less in the 1st group than in the 2nd group which indicates less postoperative anemia in the blood count, the P-value <0.05 considered significant.

Download Full-text