scholarly journals Rectus sheath catheters provide equivalent analgesia to epidurals following laparotomy for colorectal surgery

2015 ◽  
Vol 97 (7) ◽  
pp. 530-533 ◽  
Author(s):  
ECG Tudor ◽  
W Yang ◽  
R Brown ◽  
PM Mackey
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Malignant Disease ◽  
Colorectal Resection ◽  
Rectus Sheath ◽  
Pain Scores ◽  
Average Pain ◽  
Open Colorectal Resection ◽  
The Mean ◽  
Mean Time

Introduction Rectus sheath catheters (RSCs) are increasingly being used to provide postoperative analgesia following laparotomy for colorectal surgery. Little is known about their efficacy in comparison with epidural infusion analgesia (EIA). They are potentially better as they avoid the recognised complications associated with EIA. This study compares these two methods of analgesia. Outcomes include average pain scores, time to mobilisation and length of stay. Methods This was a 33-month single centre observational study including all patients undergoing elective open or laparoscopic-converted-to-open colorectal resection for both benign and malignant disease. Patients received either EIA or RSCs. Data were collected prospectively and analysed retrospectively. Results A total of 95 patients were identified. Indications for surgery, operation and complications were recorded. The mean time to mobilisation was significantly shorter in patients who had RSCs compared with EIA patients (2.4 vs 3.5 days, p<0.05). There was no difference in postoperative pain scores or length of stay. Conclusions RSCs provide equivalent analgesia to EIA and avoid the recognised potential complications of EIA. They are associated with a shorter time to mobilisation. Their use should be adopted more widely.

Postoperative continuous catheter-infused local anesthetic reduces pain scores and narcotic use after lower extremity revascularization

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 262-270 ◽  
Author(s):  
William Shutze ◽  
William P Shutze Jr ◽  
Purvi Prajapati ◽  
Gerald Ogola ◽  
Jordan Schauer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Lower Extremity ◽  
Local Anesthetic ◽  
Wound Complications ◽  
X Rays ◽  
Readmission Rates ◽  
Pain Scores ◽  
Average Pain ◽  
Revascularization Procedures ◽  
Lower Extremity Revascularization

Objective Postoperative pain following lower extremity revascularization procedures is traditionally controlled with narcotic administration. However, this may not adequately control the pain and puts the patient at risk for complications from opiate use. Here we report an alternative strategy for pain management using a continuous catheter-infused local anesthetic into the operative limb. Design Retrospective case–control study. Methods Patients undergoing lower extremity revascularization procedures using continuous catheter-infused local anesthetic were compared to similar patients undergoing similar procedures during the same time period who did not receive continuous catheter-infused local anesthetic. Records were reviewed for pain scores, narcotics consumption, length of stay, need for postoperative chest X-ray, supplemental oxygen use, wound complications, and 30-day readmission. Results There were 153 patients (mean age 69.5 years) from September 2011 to December 2014 who underwent common femoral artery procedures, femoral-popliteal bypass, femoral-tibial bypass, popliteal aneurysm repair, popliteal to pedal bypass, popliteal artery thrombo-embolectomy, sapheno-popliteal venous bypass, or ilio-femoral bypass. There were no significant differences between the continuous catheter-infused local anesthetic ( n=57) and control ( n=96) groups regarding age, body mass index, cardiac history, diabetes, hypertension, and procedures performed. The continuous catheter-infused local anesthetic group showed better cumulative average pain scores, better high pain scores on postoperative days 1–3, and better average pain scores on postoperative days 2–3 ( P<0.03). The continuous catheter-infused local anesthetic group had lower median narcotics consumption on postoperative days 1–2 ( P=0.02). No differences were found in postoperative length of stay, urinary catheter use, number of postoperative chest X-rays, oxygen use, mobilization, or fever. Wound complications occurred in 8.8% of the continuous catheter-infused local anesthetic group and in 11.5% of controls (P=0.79). Readmission rates were 23% (continuous catheter-infused local anesthetic) and 21% (controls; P=0.84). Conclusion Postoperative continuous catheter-infused local anesthetic reduces pain scores and pain medication use compared to standard opiate therapy in these patients, without increasing wound complication or readmission rates. Continuous catheter-infused local anesthetic appeared to have no effect on the incidence of pulmonary complications, mobilization, or fever.

65Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation in the United States: analysis from national inpatient sample 2016

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Wu ◽  
K Ho
Keyword(s):  
Length Of Stay ◽  
Left Atrial Appendage ◽  
National Inpatient Sample ◽  
Left Atrial Appendage Closure ◽  
Total Cost ◽  
The Us ◽  
Comorbidity Index ◽  
The Mean ◽  
Mean Time ◽  
Related Mortality

Abstract Introduction/Background In recent years, the percutaneous left atrial appendage closure (LAAC) has been gaining its popularity in the US. However its use in the US in recent years has not been well described. Purpose To provide an updated cross-sectional survey of performance of percutaneous LAAC in the US at national database level. Methods We use ICD-10 disease and procedure code to identify all the percutaneous LAAC performed in 2016 in US from national inpatient sample database. The demographic feature, comorbidity, mean time to procedure, mortality, complication rate, length of stay, total cost were described. Procedure related complication Including any vascular, cardiac, respiratory, neurologic and renal complications defined by AHRQ as patient safety indicators. Results There is approximately a total of 7550 percutaneous LAAC performed in the US in 2016. The majority of the patients were elderly (mean age 66.83±0.34), white (80.41%) male (59.04%). The mean Charlson Comorbidity Index score is 1.74, with hypertension (76.75%), diabetes (29.23%) being the most common comorbidity. The mean time to procedure is 1.98±0.11 days. The procedure related mortality is 2.06%, whereas the complication rate is 19.6%. The average length of stay is 10.77 day, with an average total cost of 239.67 thousand dollars. Baseline characterlistisc and outcomes Total percutaneous LAAC (estimated from sample) 7550 Age, years 66.83±0.34 Male, % 59.04 White, % 80.41 Mean Charlson Comorbidity Index 1.74±0.31 Hypertension, % 76.75 Diabetes, % 29.23 CKD, % 21.42 Mean Time to procedure, days 1.98±0.11 Mortality, % 2.06 Length of Stay, days 10.77±0.25 Any Complication, % 19.6 Total Cost, thousand dollars 239.67±10.01 Values are reported as mean ± SD. Categorical variables are represented as frequency. Conclusion A total of 7550 percutaneous LAAC was performed in US in 2016. The procedure related mortality is 2.06%, with an average time to procedure of 1.98 days and a length of stay of 10.77 days.

732 Evaluating the Cost-effectiveness, Efficacy, Safety, and Tolerance of Silver Sulfadiazine Dressings Once Daily versus Twice Daily in the Treatment of Burn Wounds

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S197-S198
Author(s):  
Tomer Lagziel ◽  
Louis Born ◽  
Luis H Quiroga ◽  
Eliana F Duraes ◽  
Benjamin R Slavin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Wound Infection ◽  
Standard Of Care ◽  
Silver Sulfadiazine ◽  
Burn Wound ◽  
Once Daily ◽  
Preliminary Results ◽  
Pain Scores ◽  
Average Pain ◽  
Dressing Change

Abstract Introduction Topical antibacterial agents are an essential component of burn wound management. The aim is to prevent wound infection effectively and promote healing. A poorly treated wound can result in scarring or even sepsis and multi-organ dysfunction in severe cases. Topical Silver Sulfadiazine cream (SSD 1%) has been the gold standard for burn care since 1960s. Due to the immediate burst release of the drug into the exposed areas, application is relatively frequent, usually twice daily. However, it remains unknown whether twice-daily SSD dressings are superior to once-daily. Methods Our institution maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after the change. Our main outcomes recorded are wound infection, average pain scores, average daily narcotic requirements and length-of-stay. Results Preliminary results of 20 pre-change-of-practice and 20 post-change-of-practice patients showed no difference in the outcomes between the two groups. The infection rates were the same for both groups (15%), average pain scores (Graph 1) for the post-change group were slightly higher (pre=5.5, post=5.8; p=0.7), average length-of-stay (Graph 2) was longer in the pre-change group (pre=9.2, post=5.7; p=0.04), and no other surgical complications were reported for patients in either group. Conclusions Preliminary results show that a once-daily dressing change of SSD, has no negative impact on burn wound outcomes. In addition, it is associated with a decreased length-of-stay. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. Changing the standard-of-care to once-daily could prove beneficial. Further patient review will shed more light on the significance of these results, however so far there is no inferiority in wound healing. Applicability of Research to Practice The frequency of dressing changes directly affects staff workload who are required to spend a lot of time carefully changing dressings. In addition, patient discomfort associated with frequent dressing changes including interference with sleep hygiene and increased pain medications could also be avoided. Finally, fewer dressing changes are associated with less medical supplies and hospital utilization without putting the patient at any further risk of infection.

scholarly journals Palliative Care in the Kyrgyz Republic

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 35s-35s
Author(s):  
Bakyt Shaimbetov ◽  
Astra Arzymatova
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Pain Score ◽  
Average Length ◽  
Kyrgyz Republic ◽  
Home Based ◽  
Average Pain ◽  
Palliative Care Services ◽  
The Mean ◽  
Care System

Abstract 55 Currently, there are 22,984 cancer patients registered in the Kyrgyz Republic. In 2014, 5,552 new patients were diagnosed with malignant tumors and 3,219 of them died the same year. Total cancer rates in the country are steadily growing with 89.1 cases/100,000 population in 2012, 89.6 cases/100,000 population in 2013 and 95.1 cases/100,000 population in 2014. With growing cancer prevalence, need for accessible and sustainable palliative care system is rapidly increasing. In 2012, a Strategy of Palliative Care Development in the Kyrgyz Republic for 2012-2016 was proposed to address provision of patient palliative care in the country. As a result, the Kyrgyz government accepted a policy of referring patients to Palliative care facilities based on medical diagnosis and, therefore, these services must be monitored for quality control. We examined developmental progress of palliative care system in the Kyrgyz Republic and its outcomes. Data were collected from 453 terminal cancer patients registered in the Department of Palliative Care of the National Oncology Center. We used the average length of stay and the subsequent place of care as process indicators, as well as changes in the mean pain score as outcome measurements. There were considerable variations among services with regards to the mean length of stay (i.e., 6 to 28 days for each admission) and subsequent place of care, even after stratification by service level. The mean change in average pain score varied from −1.5 to 2.1, and remained significant after case-mix adjustment. We discovered significant variations in palliative care services quality in relation to the average length of stay, subsequent places of care as well as alterations in the average pain score. Continuous evaluation of changes in the establishment and outcomes of palliative care services will assist in the development of comparative analysis and evaluation of public policies of the national Palliative Care system. In accordance with the Soros Foundation-Kyrgyzstan, a new initiative is currently being implemented by the National Center of Oncology: “Creating an integrated palliative care service model at home.” The purpose of this project is expansion of home-based end-of-life services provided by a multidisciplinary team for terminal patients in the city of Bishkek. As a part of the initiative, 87 patients have already received home-based palliative care assistance. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from either author.

scholarly journals P192 Crystallising care: improving hospital gout management

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Benjamin D Clarke ◽  
Mark D Russell ◽  
Andrew I Rutherford ◽  
James B Galloway ◽  
John Stack
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
British Society ◽  
Published Data ◽  
Incidence Trends ◽  
Joint Aspiration ◽  
Difficult Condition ◽  
The Mean ◽  
Clinical Records ◽  
Mean Time

Abstract Background Gout is the most common cause of a hot swollen joint, and a major contributor to inpatient rheumatology workload. Recently published data demonstrated that hospital admissions due to gout increased by 59% in England from 2006 - 2017. The mean length of stay for a gout admission was 6 days in 2017; a figure that has not changed significantly over the last decade. We hypothesised that a key contributing factor to prolonged hospital stays in patients presenting with gout attacks is delayed joint aspiration and synovial fluid analysis. We investigated time to joint aspiration, and time taken to obtain a crystal analysis result, in acute rheumatology referrals at a large tertiary centre. Methods Electronic Health Records (EHR) system data were accessed for all joint aspirate crystal analyses in a 4-month window in 2017. EHR system documentation contains all clinical notes, electronic referrals, and laboratory requests with indicative coded timestamps. Pre- and post-aspirate differential diagnoses were compiled from the clinical record. Manual verification of the clinical records ascertained whether there was any delay in discharge pertaining to a crystal analysis. For representation, time figures were rounded to the nearest hour. Results Over a 4-month period, 38 patients who had been referred to the inpatient rheumatology team at King’s College Hospital had crystal analysis performed following joint aspiration; 24 from an emergency department setting, and 14 from an inpatient ward setting. The proportions of these cases by articular distribution (with the specific joint aspirated in brackets) were: 55% monoarthritis (knee), 16% oligoarthritis (knee), 16% polyarthritis (knee), 10% polyarthritis (wrist), 3% monoarthritis (elbow). Mean time from rheumatology referral to joint aspiration was 7 hours (range 1-21; median 5; IQR 3-8). The mean time from sample acquisition to crystal analysis result was 20 hours (range 1-95; median 16; IQR 4-21). Discharges for 17/38 (45%) patients were pending crystal analysis results, of which 10/17 (59%) patients were discharged without results. Rheumatology clinician pre-test diagnostic accuracy was 55%. Comparing pre-aspirate diagnosis with final diagnosis, proportionately septic arthritis was over-diagnosed, whilst gout was under-diagnosed. Conclusion Gout remains a difficult condition to promptly differentiate and treat in hospital. Clinician workload and joint aspiration burden are rising due to global incidence trends. A move to establish a “7-day NHS” and significant bed pressures have developed since the British Society for Rheumatology (BSR) hot swollen joint guideline was published. In our centre, inadequate crystal diagnostics appear to be driving prolonged length of stay. Further evaluation of causal factors in the delay of recognition, referral and diagnostics is required. Through application of quality improvement methodology, process-mapping and driver diagrams we plan to implement a point-of-care testing (POCT) and door-to-needle (DTN) programme, researching how to improve the gout patient’s experience. Disclosures B.D. Clarke None. M.D. Russell None. A.I. Rutherford None. J.B. Galloway None. J. Stack None.

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

2020 ◽  
Vol 37 (8) ◽  
pp. 619-623 ◽  
Author(s):  
John David Prologo ◽  
Sivasai Manyapu ◽  
Zachary L. Bercu ◽  
Ashmit Mittal ◽  
Jason W. Mitchell
Keyword(s):  
Computed Tomography ◽  
Pelvic Pain ◽  
Pudendal Nerve ◽  
Intractable Pain ◽  
Pelvic Neoplasms ◽  
Ct Guided ◽  
Patient Demographics ◽  
Pain Scores ◽  
The Mean ◽  
Mean Time

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

scholarly journals Three Ports Laparoscopic Resection for Colorectal Cancer: A Step on Refining of Reduced Port Surgery

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Anwar Tawfik Amin ◽  
Tarek M. Elsaba ◽  
Gamal Amira
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Colorectal Resection ◽  
Intraoperative Complications ◽  
Perioperative Period ◽  
Reduced Port Surgery ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Reduced Port ◽  
Mean Time

Background. Reduced port surgery (RPS) is becoming increasingly popular for some surgeries. However, the application of RPS to the field of colectomy is still underdeveloped. Patients and Methods. In this series, we evaluated the outcome of laparoscopic colorectal resection using 3 ports technique (10 mm umbilical port plus another two ports of either 5 or 10 mm) for twenty-four cases of colorectal cancer as a step for refining of RPS. Results. The mean estimated blood loss was 70 mL (40–90 mL). No major intraoperative complications have been encountered. The mean time for passing flatus after surgery was 36 hours (12–48 hrs). The mean time for oral fluid intake was 36 hours and for semisolid food was 48 hours. The mean hospital stay was 5 days (4–7 days). The perioperative period passed without events. All cases had free surgical margins. The mean number of retrieved lymph nodes was 14 lymph nodes (5–23). Conclusion. Three ports laparoscopy assisted colorectal surgeries looks to be safe, effective and has cosmetic advantages. The procedure could maintain the oncologic principles of cancer surgery. It’s a step on the way of refining of reduced port surgery.

scholarly journals Centromedian–Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 731
Author(s):  
Mahmoud Abdallat ◽  
Assel Saryyeva ◽  
Christian Blahak ◽  
Marc E. Wolf ◽  
Ralf Weigel ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Central Pain ◽  
Test Stimulation ◽  
Pain Scores ◽  
Average Pain ◽  
The Mean ◽  
Deep Brain

Introduction: The treatment of neuropathic and central pain still remains a major challenge. Thalamic deep brain stimulation (DBS) involving various target structures is a therapeutic option which has received increased re-interest. Beneficial results have been reported in several more recent smaller studies, however, there is a lack of prospective studies on larger series providing long term outcomes. Methods: Forty patients with refractory neuropathic and central pain syndromes underwent stereotactic bifocal implantation of DBS electrodes in the centromedian–parafascicular (CM–Pf) and the ventroposterolateral (VPL) or ventroposteromedial (VPM) nucleus contralateral to the side of pain. Electrodes were externalized for test stimulation for several days. Outcome was assessed with five specific VAS pain scores (maximum, minimum, average pain, pain at presentation, allodynia). Results: The mean age at surgery was 53.5 years, and the mean duration of pain was 8.2 years. During test stimulation significant reductions of all five pain scores was achieved with either CM–Pf or VPL/VPM stimulation. Pacemakers were implanted in 33/40 patients for chronic stimulation for whom a mean follow-up of 62.8 months (range 3–180 months) was available. Of these, 18 patients had a follow-up beyond four years. Hardware related complications requiring secondary surgeries occurred in 11/33 patients. The VAS maximum pain score was improved by ≥50% in 8/18, and by ≥30% in 11/18 on long term follow-up beyond four years, and the VAS average pain score by ≥50% in 10/18, and by ≥30% in 16/18. On a group level, changes in pain scores remained statistically significant over time, however, there was no difference when comparing the efficacy of CM–Pf versus VPL/VPM stimulation. The best results were achieved in patients with facial pain, poststroke/central pain (except thalamic pain), or brachial plexus injury, while patients with thalamic lesions had the least benefit. Conclusion: Thalamic DBS is a useful treatment option in selected patients with severe and medically refractory pain.

scholarly journals RATIONAITY AND INTERVENTION EFFICIENCY OF CLINICAL PHARMACIST IN USAGE PAINKILLERS AFTER OPERATION

2021 ◽  
Vol 62 (3) ◽  
Author(s):  
Bui Dang Phuong Chi ◽  
Bui Dang Minh Tri ◽  
Bui Tung Hiep ◽  
Tran Nhat Anh
Keyword(s):  
Adverse Effects ◽  
General Surgery ◽  
Pain Treatment ◽  
Pain Scores ◽  
Post Operative Pain ◽  
The Mean ◽  
Group 2 ◽  
Surgery Department ◽  
Mean Time ◽  
Group 1

Objectives: To evaluate the rationality and effectiveness of clinical pharmacist’s intervention in the use of painkillers for post-operative pain treatment at the General Surgery Department of Cai Nuoc General Hospital. Objects and methods: Cross-sectional descriptive study on 172 patients (patients) undergoing surgery at General Surgery Department, Cai Nuoc General Hospital. Results: There were 38.95% of patients studied with adverse effects when using painkillers. The average duration of painkiller use after surgery was 5.6 ± 4.0 days. The differences in the mean time to take the drug between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. On 2 research groups, in general, the average VAS score after 1 day surgery was 4.2 ± 1.9 points and after 7 days was 1.1 ± 0.8 points. Increase the reasonable rate in choosing drugs group 2 with reasonable rate was had a reasonable rate of 68.18%, much higher than group 1 with 46.43%. Conclusion: The incidence of adverse effects was low. The differences in the mean time to take the drug 70.45%, much higher than group 1 with 42.86%; drug dose, group 2 had reasonable rate was 82.95%, much higher than group 1 with 55.95%; the rationality of drug use, group 2 between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. Increase the rationality of drug selection, drug dosage, and general rationality of post-operative pain treatment.

scholarly journals Epidurinės nejautros poveikis skausmo malšinimui ir žarnyno funkcijos atsitaisymui po gaubtinės ir tiesiosios žarnos rezekcijos

2008 ◽  
Vol 6 (3) ◽  
pp. 0-0
Author(s):  
Renatas Tikuišis ◽  
Povilas Miliauskas ◽  
Narimantas Evaldas Samalavičius ◽  
Giedrė Rudinskaitė
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Colorectal Surgery ◽  
Epidural Analgesia ◽  
Colorectal Resection ◽  
Solid Food ◽  
Postoperative Pain Relief ◽  
Control Group ◽  
Narcotic Analgesics ◽  
Open Colorectal Resection

Renatas Tikuišis, Povilas Miliauskas, Narimantas Evaldas Samalavičius, Giedrė RudinskaitėVilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas / tikslas Palyginti su sistemine analgezija opiatais, atliekant atviras gaubtinės ir tiesiosios žarnos operacijas, epidurinė nejautra efektyviau malšina skausmą ir ją sukėlus sumažėja pooperacinio žarnų nepraeinamumo dažnis. Šio tyrimo tikslas – nustatyti epidurinės analgezijos poveikį skausmo malšinimui ir žarnyno funkcijos atsitaisymui po gaubtinės ir tiesiosios žarnos operacijų. Ligoniai ir metodai Tyrime dalyvavo 50 ligonių, kuriems buvo atlikta gaubtinės arba tiesiosios žarnos rezekcija. Tai buvo perspektyvusis tyrimas, kuris truko dvejus metus. Atsitiktinės atrankos būdu ligoniai buvo suskirstyti į tiriamąją (T) ir kontrolinę (K) grupes. Po 25 ligonius pateko į kiekvieną grupę. T grupės ligoniams buvo taikyta epidurinė nejautra, o K grupės – švirkščiami narkotiniai analgetikai į veną ir penkis raumenis. Buvo vertinamas narkotinių analgetikų suvartojimas, skausmo intensyvumas po operacijos, žarnyno funkcijos atsitaisymo laikas ir laikas, kai ligonis pradėjo vartoti kietą maistą. Rezultatai Abi grupės pagal operacijos apimtį ir ligonių charakteristiką buvo labai panašios. T grupės ligoniams reikėjo mažiau narkotinių analgetikų, jiems skausmo intensyvumas buvo mažesnis, jų žarnyno veikla atsitaisė anksčiau ir jie anksčiau pradėjo vartoti kietą maistą, palyginti su K grupės ligoniais. Išvada Epidurinės analgezijos metodas yra pranašesnis už intraveninį skausmo malšinimo metodą, taip pat mažiau suvartojama narkotinių analgetikų. Epidurinė analgezija pagreitina žarnyno funkcijos atsitaisymą, todėl ligoniai anksčiau pradeda valgyti kietą maistą po atvirų gaubtinės ir tiesiosios žarnos operacijų. Reikšminiai žodžiai: epidurinė analgezija, intraveninė analgezija, gaubtinės žarnos rezekcija, tiesiosios žarnos rezekcija Influence of epidural analgesia on postoperative pain relief and gastrointestinal recovery after colorectal resection Renatas Tikuišis, Povilas Miliauskas, Narimantas Evaldas Samalavičius, Giedrė RudinskaitėVilnius University, Institute of Oncology, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Backgound / objective Epidural analgesia provides superior analgesia with a lower incidence of postoperative ileus as compared with systemic opiate analgesia in open colorectal surgery. The aim of this study was to determine the effects of epidural analgesia on the outcome after colorectal surgery. Patients and methods Fifty patients were enrolled in this investigation. Open colorectal resection was performed for all these patients. The patients were randomly assigned into two groups: the study group (T) and the control group (K). Epidural analgesia was used for 25 patients of group T, and intravenous-intramuscular analgesia was used for 25 patients of group K. Consumption of narcotic analgesics, pain intensity, gastrointestinal recovery time and solid food tolerated time were investigated. Results There were no significant differences in the type of operations and preoperative patients’ characteristics between the groups. Consumption of narcotic analgesics was lower in group T, and analgesia was more effective in the epidural group. The mean time of peristalsis and solid food tolerance was earlier in group T as compared with group K. Conclusion Epidural analgesia provides a significant benefit as regards analgesic consumption, postoperative pain relief and the recovery of gastrointestinal function in patients undergoing open colorectal resection. Keywords: epidural analgesia, intravenous analgesia, colorectal surgery

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