Prospective-controlled assessment of stress hormones and pain in patients undergoing myomectomy as performed by laparoscopy against laparotomy

Abstract PurposeThe objective of the study is to prospectively assess surgical stress and postoperative pain after myomectomy performed by laparoscopy versus laparotomyMethodsThis prospective, matched, multi-center observational study, took place in the Gynecological Department of the “Papageorgiou" University Hospital and the Centre for Gynecological Endoscopy, “Diavalkaniko” Hospital. Sixty women with symptomatic growth of known uterine leiomyomas or leiomyomas compromising the shape of the uterus participated in the study. Thirty women underwent laparoscopic myomectomy, and another thirty had removal of leiomyomas through laparotomy from November 2016 to February 2018. Three venous samples were obtained from each patient to determine stress hormones (one before surgery, the second at the end of the surgical procedure, and the third on the morning of the first postoperative day), and a questionnaire was administered on the first postoperative day, in which patients indicated the level of pain through a Visual Analog Scale for Pain (VASP).ResultsAdrenocorticotropic hormone (ACTH) and noradrenalin were significantly lower in the laparoscopic group on the first postoperative day (12.68 ± 9.97 pg/ml vs 15.90 ± 9.02 pg/ml, p<0.025) and 20.7 ± 7.28 ng/ml vs 22.33 ± 5.82 ng/ml, p<0.027), respectively. There was no statistically significant difference in cortisol levels on the first postoperative day (11.71 ± 5.82 μg/dl vs 11.81 ± 7.61 μg/dl, p>0.94) and also for β-endorphin levels (4.88 ± 1.57 vs 4.91 ± ng/ml, p>0.61). The postoperative pain was significantly lower in the laparoscopic group on the VASP scale (3.3 ± 1.05 vs 5.67 ± 1.15, p<0.001, respectively).ConclusionLaparoscopy is superior to laparotomy for the surgical removal of leiomyomas in terms of postoperative pain and surgical stress.

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Effect of platelet rich-fibrin on alveolar osteitis incidence following surgical removal of impacted mandibular third molars: A comparative study

Journal of Baghdad College of Dentistry ◽

10.26477/jbcd.v31i4.2723 ◽

2019 ◽

Vol 31 (4) ◽

Author(s):

Ali S. Abdul Kareem ◽

Ali H. Al Hussaini

Keyword(s):

Postoperative Pain ◽

Control Group ◽

P Value ◽

Surgical Removal ◽

Similar Distribution ◽

Extraction Socket ◽

Platelet Rich Fibrin ◽

Significant Difference ◽

Alveolar Osteitis

Background: Postoperative morbidity after extraction of the impacted mandibular third molar (IMTM) is inevitable. One of the most common postoperative complication is alveolar osteitis (AO) which is a painful non healed socket. Many researches were attempted to prevent the occurrence of AO by introducing and applying a new materials inside the extraction socket. Platelet rich fibrin (PRF) is a biological complex fibrin matrix where autologous platelets and leucocytes are present, used to enhance tissue healing process and reduce the early adverse effects of the inflammation. Aims: To evaluate the effect of PRF on the incidence of AO. Also to assess PRF effect on pain, swelling, and trismus following the surgical removal of IMTM and compare it with the control group. Materials and methods: This clinical prospective study was conducted from October 2016 to October 2017 at the Department of Oral & Maxillofacial Surgery, College of dentistry/University of Baghdad; and Al-Sadr Specialized Health Center. A total number of 50 IMTMs were surgically removed from 45 patients who met the inclusion criteria (21 males and 24 females) with age ranged from 16-41 years. The cases were divided into two groups: a study group (25 cases) where PRF were placed inside the extraction socket and control group (25 cases) where traditional surgery were performed. AO, trismus and swelling were assessed at the 2nd and 7th postoperative day. Pain scored by numeric rating scale daily by the patients. Results: The study showed that age, gender, side of impaction, oral hygiene condition, impacted tooth classification, surgical difficulty, and the time of procedure in both control and study groups had nearly similar distribution with non- significant difference. At the 1st follow up period: Trismus (P-value = 0.834) and Swelling (P-value = 0.592) were non- significant between the two groups. AO had overall incidence of 4% occurred only in the control group, while the PRF group had no occurrence (0%), but the difference was statistically non significant. Postoperative pain had no significance difference in both groups. At the 2nd follow up period there was no significant difference regarding trismus, swelling, and incidence of AO between both groups. Conclusion: Local application of PRF can reduce the incidence of AO but not to a significant level. PRF had no effect concerning postoperative pain, swelling, and trismus.

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A comparison of pain registration by Visual Analog Scale and Numeric Rating Scale – a cross-sectional study of primary triage registration

10.1101/2020.11.03.20225367 ◽

2020 ◽

Author(s):

Jofrid Kollltveit ◽

Malin Osaland ◽

Marianne Reimers ◽

Magnus Berle

Keyword(s):

Emergency Department ◽

Visual Analog Scale ◽

Rating Scale ◽

Emergency Admission ◽

Numeric Rating Scale ◽

University Hospital ◽

Analog Scale ◽

Cross Sectional ◽

Significant Difference ◽

Numeric Rating

BackgroundPain is a subjective sensation; self-reporting is important for quantifying pain intensity. There are several different validated tools for this, such as Visual Analog Scale and Numeric Rating Scale. In the clinic, these terms are often used as equivalent. The objective of this study was to examine correlation and agreement between the pain registration tools in triage in an emergency department.Materials and MethodsThe study was performed in the Department of Emergency Medicine at Haukeland University Hospital in the period June-August 2019. We registered the pain score with two tools in 200 unselected patients in emergency admission with pain. In addition, we registrered gender, age, triage and general department affiliation.ResultsWe found a strong correlation between the pain registration tools by Spearmans correlation test (rho=0,930, p<0,001). There were no significant difference between the pain registration tools within the subgroups. Bland-Altman analysis show agreement between the two pain registration tools.ConclusionsIn an Emergency Department triage is it acceptable to use Visual Analog Scale and Numeric Rating Scale as equivalent, as long as the correct terminology is used.

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Effects of intraoperative hypothermia on stress hormon response in surgical patients

Vojnosanitetski pregled ◽

10.2298/vsp210604064z ◽

2021 ◽

pp. 64-64

Author(s):

Snjezana Zeba ◽

Maja Surbatovic ◽

Sonja Marjanovic

Keyword(s):

Surgical Procedures ◽

Surgical Stress ◽

Stress Hormones ◽

Stress Hormone ◽

Hormone Response ◽

Oesophageal Temperature ◽

Time Points ◽

Forced Air Warming ◽

Significant Difference ◽

Forced Air

Background/Aim. Surgical stress itself, as well as hypothermia induced by general anaesthesia, and low ambient temperature activate stress hormone response with changes in catecholamines and counter regulatory hormones. The aim of this study is to investigate the acute hormone stress response in patients who underwent major surgical procedures and the efficiency of external and internal warming methods in alleviation of these changes. Methods. 60 patients who underwent major open abdominal surgical procedures were randomly divided in 4 groups: control non-warmed (C), externally warmed using forced-air warming mattress (W), internally warmed using intravenous amino acids (A), and warmed with combination of external and internal method (A+W). Oesophageal temperature was used as measure of core temperature. Blood samples for hormone measurement were obtained in 2 time points for catecholamines: 90 minutes before and 120 minutes after finishing the surgery; and in additional 2 time points for cortisol, prolactin and testosterone: (24 and 48 hours after surgery). Results. In W and A+W group the temperatures did not significantly differ between time points, but in C and A groups decreased constantly, with statistically significant difference between the anaesthesia induction and 120th minute (35,61?0,42 vs 33,86?0,71 ?C; p<0,000 and 35,81?0,54 vs 34,45?0,41 ?C; p<0,000 , respectively). Catecholamine concentrations in all groups showed significant increase during surgery, with highest values recorded in non-warmed group (777,07?800,08 after vs 106,13?89,63 pg/mL before surgery for epinephrine and 1349,67?984,16 vs 580,53?465,38 for norepinephrine, p<0,000). Concentrations of cortisol and prolactine also showed significant increase at the same time point, with tendency to normalization after 48 hours. Contrary, testosterone concentrations showed decrease after 120 minutes without normalization throughout the entire period of observation. Except for testosterone, changes in all stress hormones were attenuated in warmed groups compared to controls. Conclusions. Regarding both features of surgical stress investigated in this study (hypothermia and stress hormone response), combination of endogenous amino acid-induced hermogenesis and external air warming mattress is most effective.

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Correlation between CGRP Levels and the Neuropathic and Inflammatory Component of Postoperative Pain

Folia Medica ◽

10.3897/folmed.62.e46533 ◽

2020 ◽

Vol 62 (2) ◽

pp. 365-371

Author(s):

Deyan Neychev ◽

Tanya Sbirkova ◽

Maria Ivanovska ◽

Ralitsa Raycheva ◽

Mariana Murdjeva ◽

...

Keyword(s):

Postoperative Pain ◽

Surgical Procedures ◽

Surgical Procedure ◽

Sensory Nerves ◽

Surgical Removal ◽

Strong Positive Correlation ◽

Third Molars ◽

Significant Difference ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Introduction: In surgical procedures, tissue damage results in the release of a number of bioactive substances. Calcitonin gene-related peptide (CGRP) is a peptide released from sensory nerves, which determines its role in pain sensation. Its distribution in tissues determines its role as a primary afferent neurotransmitter. Aim: To determine the effect of CGRP on postoperative pain and reactive inflammatory process after surgical removal of impacted mandibular third molars, as well as the factors that have influence upon the perception of pain. Materials and methods: Forty patients with bilaterally impacted mandibular third molars were included in the study. Venous blood samples were collected before and 24 hours after the surgical procedure in order to test their serum levels of CGRP and procalcitonin. Two weeks later the procedure was repeated. The difficulty of the surgical procedure, its duration and complications were assessed in all patients. Results: The influence of some of the studied factors upon postoperative pain was established. Differences in the sensation of pain between the two sexes were found when comparing pain intensity reported by the patients. Significant difference between pain intensity after the 1st and 2nd surgical procedures (6 hours) was found in females (Z=2.63, p=0.009;), whereas in males the difference was observed at 24 hours (Z=1.99; p=0.047). Regarding the existence of sex-related association, а significant, strong positive correlation between CGRP levels after the 1st and 2nd surgical procedures (24 hours) was found in males (rxy=0.78; p=0.004), whereas in females this correlation was also significant, although moderately significant (rxy=0.44; p=0.020). CGRP levels at the first and second extractions were generally similar in males, and not as much in females. We proved significantly moderate positive association between CGRP and pulse levels measured before the second surgery (rxy=0.37, p=0.021). Conclusion: The results of our study suggest a significant role of CGRP in reactive (neurogenic) inflammation.

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RELATIONSHIP OF ANXIETY AND PREOPERATIVE DEPRESSION WITH POST-OPERATIVE PAIN

Texto & Contexto - Enfermagem ◽

10.1590/1980-265x-tce-2018-0499 ◽

2020 ◽

Vol 29 ◽

Cited By ~ 1

Author(s):

Carlos Alberto Henao Periañez ◽

Marcio Alexander Castillo Diaz ◽

Priscila Lara Vieira Bonisson ◽

Giovana Paula Rezende Simino ◽

Maria Helena Barbosa ◽

...

Keyword(s):

Postoperative Pain ◽

Predictive Factor ◽

Clinical Characteristics ◽

Depression Scale ◽

Preoperative Anxiety ◽

University Hospital ◽

Anxiety And Depression ◽

Preoperative Period ◽

Significant Difference ◽

Relationship Of

ABSTRACT Objectiv:e to analyze the relationship of anxiety and depression in the preoperative period with the presence of pain in the postoperative period. Method: cohort study conducted at a university hospital in the state of Minas Gerais (Brazil), between february and July 2017, with 65 patients. A collection instrument was elaborated for the demographic and clinical characteristics. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression; pain intensity was measured using the Verbal Numerical Scale. Data were submitted to descriptive and inferential statistical analysis. Results: according to demographic and clinical characteristics, most patients were female, with a median age of 44 years and surgical specialty of the digestive tract. In the preoperative period, 31 (47.7%) had anxiety, and nine (13.8%), depression. None of the patients reported pain immediately prior to surgery. The incidence of moderate to severe postoperative pain was 32 (49.2%) patients. There was a statistically significant difference in the distribution of patients with postoperative pain in relation to the presence or absence of preoperative anxiety (p value <0.001). There is no statistically significant difference in the distribution of patients with postoperative pain in relation to the presence or absence of preoperative depression (0.733). In multivariate analysis, preoperative anxiety was a predictive factor for postoperative pain. Depression was not a predictive factor of postoperative pain. Conclusion: It was demonstrated that, regardless of the demographic and clinical characteristics of the studied sample, the presence of anxiety in patients in the preoperative period is a predictive factor of postoperative pain.

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Postoperative Morbidity in Traditional versus Coblation Tonsillectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348941011901106 ◽

2010 ◽

Vol 119 (11) ◽

pp. 755-756 ◽

Cited By ~ 5

Author(s):

Nils Gustavii ◽

Mogens Bove ◽

Christer Dahlin

Keyword(s):

Postoperative Pain ◽

Hospital Readmission ◽

Postoperative Morbidity ◽

Statistical Significance ◽

Postoperative Bleeding ◽

Activity Limitations ◽

Analog Scale ◽

Patient Allocation ◽

Tonsillar Hyperplasia ◽

Significant Difference

Objectives The aim of this study was to compare levels of postoperative pain after traditional (cold steel with bipolar cautery) and Coblation tonsillectomies. Methods Patients with recurrent or chronic tonsillitis, including tonsillar hyperplasia, were randomized to undergo tonsillectomies using either a traditional cutting technique or the Coblation technique. Patients and staff on the relevant wards were blinded regarding patient allocation. Pain, odynophagia, and activity limitations were recorded on a visual analog scale. Analgesics were self-administered, and daily analgesic consumption by patients was reported. All complications were also registered. Results Fifty-seven patients (between 6 and 57 years of age) completed the study. No significant difference was found between the two techniques with regard to reported pain, odynophagia, activity limitations, or use of analgesics. A slight tendency toward decreased pain and decreased use of analgesics in the Coblation group reached statistical significance only when the adult patients were analyzed separately. Two cases of hospital readmission occurred because of postoperative bleeding following Coblation tonsillectomies. Conclusions Overall, the two methods are equivalent in terms of postoperative pain, including the use of analgesics. The risk of postoperative bleeding after the Coblation method requires further evaluation with specifically designed studies.

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DEXMEDETOMIDINE IN PARAVERTEBRAL BLOCK FOR BREAST CANCER SURGERIES- A WAY TOWARDS OPIOID FREE ANAESTHESIA

International Journal of Advanced Research ◽

10.21474/ijar01/12404 ◽

2021 ◽

Vol 9 (01) ◽

pp. 1162-1165

Author(s):

Nimisha Verma ◽

Vighnesh A.M. ◽

Sharad K. Mathur

Keyword(s):

Breast Cancer ◽

Postoperative Pain ◽

Regional Anesthesia ◽

Rating Scale ◽

Surgical Stress ◽

Protective Action ◽

Radical Mastectomy ◽

Paravertebral Block ◽

Breast Cancer Patients ◽

Significant Difference

Introduction:Breast cancer is one of the leading causes of cancer morbidity and mortality in women across the world. One concerning problem that affects breast cancer patients after surgery is pain. Regional anesthesia may reduce cancer propagation by attenuation of the surgical stress response, reduced opioid usage and by the direct protective action of local anaesthetics on cancer cells migration. Therefore regional anesthesia should be considered for all breast cancer surgeries. Aim:The present study was conducted to compare the efficacy of Dexmedetomidine and Fentanyl as an adjunct to 0.5% Ropivacaine in thoracic paravertebral block, along with general anesthesia, in modified radical mastectomy surgeries. Methods: A total of forty patients were included in the study. All patients received the paravertebral block at 3 levels from T2-T4 with 15 ml of drug solution. Perioperative vitals and any complications wererecorded. Postoperative pain was assessed using Numeric Rating Scale (NRS). Results: Statistics did not reveal any significant difference in the degree of intraoperative analgesia, postoperative pain, nausea and vomiting among the two study groups. Conclusion:Among the two drugs, dexmedetomidine offers better hemodynamic stability and hence can be used in place of fentanyl for opioid free anaesthesia management.

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Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502005000500005 ◽

2005 ◽

Vol 20 (5) ◽

pp. 364-367 ◽

Cited By ~ 7

Author(s):

Eduardo Crema ◽

Elisangela Neto Ribeiro ◽

Ana Marcela Hial ◽

Juverson Terra Alves Júnior ◽

Ricardo Pastore ◽

...

Keyword(s):

Open Surgery ◽

Tissue Injury ◽

Surgical Stress ◽

Blood Platelets ◽

Open Cholecystectomy ◽

Laparoscopic Approach ◽

Laparoscopic Group ◽

Serum Cortisol ◽

Surgery Group ◽

Significant Difference

PURPOSE: To compare the behavior of serum cortisol and ACTH levels and platelet kinetics after laparoscopic and open cholecystectomy. METHODS: In this prospective study, 31 patients with symptomatic cholelithiasis submitted to elective cholecystectomy, 17 by the laparoscopic route and 14 by the open route, were compared. Peripheral blood samples were collected on admission of the patient, during anesthetic induction, and 2, 6, 12, 24 and 48 hours after the surgical incision. Platelets were counted in hematoxylin-eosin-stained specimens under a light microscope at 100X magnification. Cortisol and ACTH were measured by chemiluminescence. RESULTS: Cortisol and ACTH levels showed a significant increase (p<0.05) within the first hours after surgery compared to preoperative values. At 2 hours, a significantly higher cortisol concentration was observed in the laparoscopic group compared to the open surgery group (p=0.0365). A return to basal levels during the later postoperative periods (24 and 48 hours) was only observed for ACTH, while serum cortisol continued to be elevated during the same period, being significantly higher in the open surgery group than in the laparoscopic group (p24 = 0.0248 and p48 = 0.032). Different platelet response curves were obtained for the two groups, but their levels were normal at all times studied. No significant difference (p>0.05) between the post- and preoperative periods was observed for either group. CONCLUSION: A hormonal response was observed for both procedures studied, but the surgical stress was higher and longer lasting in open surgery compared to the laparoscopic approach. However, no significant variation in platelet kinetics in response to tissue injury was observed between the two procedures.

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Preemptive effect of amantadine as adjuvant in postoperative analgesia of ovaryhisterectomy in dogs

Research Society and Development ◽

10.33448/rsd-v9i11.10128 ◽

2020 ◽

Vol 9 (11) ◽

pp. e68091110128

Author(s):

Raquel Vieira Niella ◽

Aline Silva Sena ◽

Janaína Maria Xavier Corrêa ◽

Priscila Carvalho Lima Rocha Soares ◽

Taísa Miranda Pinto ◽

...

Keyword(s):

Postoperative Pain ◽

Control Group ◽

Nociceptive Threshold ◽

Postoperative Pain Control ◽

Analog Scale ◽

Analgesic Requirement ◽

Preoperative Administration ◽

Significant Difference ◽

Mechanical Nociceptive Threshold ◽

Preemptive Effect

This study aimed to evaluate the preemptive analgesic effect of amantadine on postoperative pain control in female dogs that underwent ovariohysterectomy. Twenty female dog were randomly assigned to two groups of ten. The control group (CONTROL) received oral placebo capsules, while the amantadine (AMANT) group received 5 mg/kg of oral amantadine one hour before sedation. All the animals were premedicated with 3 mg/kg (IM) meperidine, induced with propofol and maintained with isofluorane. The transanesthetic physiological parameters were recorded, and postoperative pain was evaluated every hour after extubation for six hours with the Dynamic Interactive Visual Analog Scale (DIVAS) and mechanical nociceptive threshold (MNT) and when the necessary analgesic rescue was administered (morphine, 0.2 mg/kg (IM)). During the surgical procedure, there was no significant difference in the variables measured between the two groups. Regarding postoperative pain assessment, there was a significant difference in the DIVAS score (p = 0.004) between the groups, in which AMANT required fewer rescues than did CONTROL (p = 0.03). The MNT was significantly higher in AMANT than in CONTROL (p = 0.03). The results suggested that the preoperative administration of amantadine decreased analgesic requirement in female dogs that underwent elective ovariohysterectomy.

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Combined subcostal and posterior transversus abdominis plane block for postoperative pain relief after abdominoplasty

10.21203/rs.3.rs-31398/v1 ◽

2020 ◽

Author(s):

Haytham El Sayed ◽

A Shaheed Fadhul ◽

Mohamed Al Falalki ◽

M Naser Naser Awad

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Visual Analog Scale ◽

Ventilatory Support ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Postoperative Pain Relief ◽

Transversus Abdominis Plane ◽

Analog Scale ◽

Significant Difference

Abstract Background Abdominoplasty is a common aesthetic surgery. Adequate pain management during the postoperative period is of great importance. Previous studies have failed to achieve safe and reliable effective analgesic techniques beyond the recovery room. This research aims to investigate the outcome of the abdominoplasty operation for the patients' received transversus abdominis plan block in comparison with the non-blocked patients. Methods 58 patients, undergoing elective abdominoplasty, received general anesthesia. Patients were randomly assigned to two equal groups of 29 patients each. Combined subcostal and posterior transversus abdominis plane block group and non-blocked group. For both groups, the standard postoperative analgesic regimen consisted of IV Paracetamol 1 g every 6 hours. Values of visual analog scale values were recorded every 4 hours postoperatively, once the patient had a visual analog scale ≥ 6, IV narcotics administered and visual analog scale recorded every 30 min till pain improved. Results there’s a significant difference between both groups regarding the visual analog scale data, patient ambulation, patients’ need for postoperative mechanical ventilatory support, and also the dosage of narcotics used. Conclusion Transversus abdominis plane block is a promising regional anesthetic technique for postoperative pain relief in abdominoplasty surgery, it offers a longer postoperative analgesic effect duration and fewer analgesic requirements with less postoperative complications.

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