scholarly journals POST HEMORRHOIDECTOMY PAIN RELIEF

2015 ◽  
Vol 22 (09) ◽  
pp. 1107-1110
Author(s):  
Syed Muhammad Maroof Hashmi ◽  
Shua Nasir ◽  
Lal Shehbaz ◽  
Muhammad Absar Anwar ◽  
Ahmed Ali

Background: The aim of my study is to evaluate post-operative pain reliefon patients who had hemorrhoidectomy. Materials and Methods: 300 patients who hadhemorrhoidectomy were divided equally in to three groups, according to anesthesia type,group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and generalanesthesia was considered to be group 3. Pain relief, post-operative complications, hospitalstaying time were measured and compared between the three groups. Period: Study wasperformed between Jan 2012 to Dec 2014. Results: The study showed that patients who hadlocal anesthesia infiltration and sedation a significant decrease of post-operative total painscores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group IIas compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperativeanalgesia doses in the 3 groups were 120:140:180 respectively, total hospital stayingtime were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients,nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value < 0.05. On the otherhand, spinal anesthesia which is group 2 showed slight decline of patients numbers who hadrespiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia,total cost, hospital staying time, nausea and vomiting have been significantly reduced by localanesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higherrate in post-operative urine retention, headache and hypotension compared to local anesthesiawith sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced inlocal anesthesia with sedation compared to spinal and general anesthesia.

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Xian-Xue Wang ◽  
Quan Zhou ◽  
Dao-Bo Pan ◽  
Hui-Wei Deng ◽  
Ai-Guo Zhou ◽  
...  

Background. Laparoscopic cholecystectomy is usually carried out under general anesthesia. There were a few studies which have found spinal anesthesia as a safe alternative. We aimed to evaluate the postoperative events between spinal anesthesia and general anesthesia in patients undergoing laparoscopic cholecystectomy.Methods. We searched PubMed, Embase, and Cochrane Library (from inception to January 2016) for eligible studies. The primary outcome was the visual analogue scale score. Secondary outcomes included postoperative nausea and vomiting and urine retention 24 hours postoperatively. We calculated pooled risk ratios and 95% confidence interval using random- or fixed-effects models.Results. Eight trials involving 723 patients were listed. Meta-analysis showed that patients in spinal anesthesia groups have lower visual analogue scale score 24 hours postoperatively. There were significant decreases in the occurrence of postoperative nausea and vomiting in spinal anesthesia group when compared with general anesthesia group (odds ratios: 0.38, 95% confidence interval: 0.19–0.76;P=0.006) with heterogeneity accepted (I2=13%;P=0.33), while urine retention rate was increased in patients with spinal anesthesia (odds ratios: 4.95, 95% confidence interval: 1.24–19.71;P=0.02) without any heterogeneity (I2=0%;P=0.98).Conclusions. Spinal anesthesia may be associated with less postoperative pain and postoperative nausea and vomiting compared with general anesthesia.


e-CliniC ◽  
2015 ◽  
Vol 3 (3) ◽  
Author(s):  
Fiska M. Muhammad ◽  
Lucky Kumaat ◽  
Iddo Posangi

Abstract: Pain can be described as an unpleasant sensory and emotional experience associated with tissue damage which has already occured or potentially will be occurred. General anesthesia is oftenly perfomed on a wide range of surgical procedures. There are two techniques of general anesthesia: inhalation anesthesia and intravenous anesthesia. Spinal anesthesia is one of the simplest and most reliable of regional anesthesia technique. This study aimed to compare the pain between general anesthesia and spinal anesthesia 24 hours post operative. This was an analytical prospective study. Samples were 24 patients consisting of 12 patients with general anesthesia and 12 patients with spinal anesthesia. The inclusion criteria were patients aged 20-60 years old, duration of operation 1-4 hours, and the operations were caesarean section and hysterectomy. The pain assessment used VAS score as well as blood pressure, pulse, and respiration. Data were statistically analyzed by using the Mann-Whitney test and showed a p-value 0.876. Conclusion: There was no significant difference in 24-hour-post-operative pain using VAS score among patients with general anesthesia and with spinal anesthesia.Keywords: VAS scores, general anesthesia, spinal anesthesia.Abstrak: Nyeri dapat digambarkan sebagai suatu pengalaman sensorik dan emosional yang tidak menyenangkan yang berkaitan dengan kerusakan jaringan yang sudah atau berpotensi terjadi. Anestesia umum sering dilalukan pada berbagai macam prosedur pembedahan dan terbagi atas anestesia inhalasi dan anestesia intravena. Anestesia spinal merupakan salah satu anestesia yang paling sederhana dan paling dapat diandalkan dari tehnik anestesia regional. Penelitian ini bertujuan untuk mengetahui perbandingan nyeri pada pemberian anestesia umum dan anestesia spinal 24 jam pasca operasi. Penelitian ini menggunakan metode analitik prospektif. Terdapat 24 sampel yang terbagi atas 12 penggunaan anestesia umum dan 12 penggunaan anestesia spinal, dengan kriteria rentang umur pasien 20-60 tahun, lama operasi 1-4 jam serta jenis pembedahan seksio sesarea dan histerektomi. Penilaian nyeri menggunakan skor VAS serta tekanan darah, nadi dan respirasi. Data diolah dengan menggunakan program SPSS versi 20. Hasil uji statistik Mann-Whitney mendapatkan nilai p= 0,876 yang menunjukkan tidak terdapat perbedaan bermakna dari skor VAS. 24 jam pasca operasi dengan anestesia umum dan anestesia spinal. Simpulan: Tidak terdapat perbedaan bermakna nyeri 24 jam pasca operaasi dinilai dengan skor VAS pada pemberian anestesia umum dan anestesia spinal.Kata kunci: Skor VAS, anestesia general, anestesia spinal


2021 ◽  
Vol 17 (2) ◽  
pp. 42-48
Author(s):  
T.V. Ovsiienko ◽  
M.V. Bondar ◽  
O.A. Loskutov

Background. The problem of postoperative nausea and vomiting has attracted the attention of specialists in various fields of surgery and anesthesiology for a long time and has not lost its relevance today, being the subject of active discussion in domestic and foreign literature. It can become an independent cause of other quite serious postoperative complications. The article presents the results of our own study of the use of multimodal low-opioid general anesthesia as one of the methods for the prevention of postoperative nausea and vomiting during anesthetic provision of laparoscopic kidney surgery. Materials and methods. The study involved 50 patients who underwent laparoscopic kidney surgery. To compare the incidence of postoperative nausea and vomiting, patients were randomly divided into three groups. Group 1 (control group) used multimodal general anesthesia with standard doses of opioids; group 2 used multimodal low-opioid general anesthesia with lidocaine, and group 3 used multimodal low-opioid anesthesia with dexmedetomidine. Results. The total average dose of fentanyl used during the entire time of anesthesia in the control group was 373.3 ± 50.8 μg (4.34 μg/kg/h). The total average dose of fentanyl used during the entire time of anesthesia in group 2 was 217.39 ± ± 49.1 μg (1.76 μg/kg/h). The total average dose of fentanyl used during the entire time of anesthesia in group 3 was 308.33 ± ± 51.49 µg (2.44 µg/kg/h). In group 1, vomiting in the postoperative period occurred in 4 patients out of 15 (26.7 % of cases), in group 2 — in 4 patients out of 23 operated (17.4 % of cases), in group 3 — in 1 patient out of 12 (8.3 % of cases). Conclusions. As a result of comparing the incidence of postoperative nausea and vomiting in the patients of the studied groups, it was found that a decrease in the dose of perioperative use of opioids helps to reduce the incidence of this complication, increases the safety of anesthesia, significantly facilitates and accelerates the rehabilitation of patients after laparoscopic surgery on the kidneys.


2021 ◽  
pp. 75-76
Author(s):  
Bharat Bhushan ◽  
Debarshi Jana

Background: Dyslipidemia is very much common in chronic kidney disease patients and is responsible for cardiovascular disease (CKD) which is most common cause of mortality in them. So, it is necessary to study the lipid prole in CKD patients to prevent morbidity and mortality. Methods: Subjects each of 50 in number are grouped into healthy controls (group-1), CKD patients without hemodialysis (group-2), CKD patients with hemodialysis (group-3). After fasting of 12 hours, lipid prole is assessed in all cases. Results: In this study, there is increase in Total cholesterol (TC), Low Density lipoprotein (LDL), very Low-Density lipoprotein (VLDL) and Triglycerides (TG) and decrease in High Density Lipoprotein (HDL) in all CKD patients compared to healthy controls (p-value for each parameter <0.001). There is increase in TC, TG and VLDL in diabetic CKD patients compare to non-diabetic CKD patients and p-value for each parameter is <0.05. It was found that TG and VLDL increase and HDL decrease in group-3 compare to group-2 is statistically signicant (p-value for each <0.05) and no signicant variation in TC and LDL in these groups. Conclusions: Present study demonstrated that there is dyslipidemia in CKD patients irrespective of mode of management, but the derangement is much more common and signicant in CKD with hemodialysis group and they are at risk of cardiovascular disease. It is better to start lipid lowering drugs which decreases disease progression and dyslipidemia.


2020 ◽  
Vol 66 (4) ◽  
pp. 54-60
Author(s):  
Barbara Janota ◽  
Elżbieta Szczepańska ◽  
Karolina Janion

Abstract Introduction A healthy lifestyle, including healthy eating, frequent physical activity, abstention from recreational substances, appropriate amounts of sleep and restricted amounts of television and computer time have a positive impact on the development and health of adolescents. The aim of the study was to assess selected aspects of adolescent lifestyle with a focus on rates of physical activity. Materials and methods The study material included a questionnaire completed by 304 secondary school students. The answers were analysed with respect to the physical activity of the respondents and then grouped accordingly: group 1 consisted of respondents with a low rate of physical activity, group 2 with a moderate rate of physical activity and group 3 with a high rate of physical activity. Differences in the the percentages of healthy behaviour the groups engaged in was assessed using the Kruskal–Wallis ANOVA on ranks test. Post hoc, a 2-way test with Bonferroni correction was performed. A p value of <0.05 was considered statistically significant for all analyses. Results The recommended number of 4–5 meals a day is consumed mostly by individuals from group 2 (52.94%) and to the least extent by those in group 1 (47.17%). The recommended daily consumption of fruit is mostly reported by respondents from group 3 (39.34%) and the least, by those from group 1 (26.42%). Subjects from group 2 are least likely to drink alcohol, which is harmful for one's health (26.47%); this group also includes the largest number of individuals who do not smoke cigarettes (69.12%). The most favorable behaviour with regards to sleep is displayed by subjects from group 3, in which 10.38% of participants slept for the recommended 8–10 h a day. Conclusions The majority of adolescents, regardless of the frequency of physical activity they undertook, had an unhealthy lifestyle. The most favourable lifestyle was led by subjects who performed physical activity between once a week and a few times a month.


2021 ◽  
Vol 15 (10) ◽  
pp. 2622-2624
Author(s):  
Haq dad Durrani ◽  
Rafia Kousar ◽  
Ejaz Iqbal ◽  
Muhammad Abdul Aziz ◽  
Syed Aushtar Abbas Naqvi ◽  
...  

Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2494-2494
Author(s):  
Myriam Ruth Guitter ◽  
Jorge Gabriel Rossi ◽  
Elisa Sajaroff ◽  
Carolina Carrara ◽  
Pizzi Silvia ◽  
...  

Abstract Introduction: Despite the advances observed in the outcome of pediatric acute lymphoblastic leukemia (ALL) treatment during the last 20 years, relapse remains the most common cause of treatment failure in childhood ALL. Several factors have been associated to the prognosis of these patients; however, minimal residual disease (MRD) emerges as a relevant predictor of outcome. Objectives: The aims of this study were to assess MRD by flow-cytometry in relapsed ALL and to evaluate its prognostic impact as a predictor factor of outcome at the end of the induction therapy and prior to hematopoietic stem cell transplantation (HSCT). Patients and Methods: From Aug'10 to Jun'15, 123 ALL patients were treated at our center. MRD determination at least at two time-points during relapse treatment was a requirement for considering a patient eligible for the present study. Sixty-six cases were excluded due to the following causes: 10 patients died during induction, 2 died early in complete remission (CR), 29 did not respond to chemotherapy, in 13 patients MRD determination was not performed: 4 did not have clinical data available, 4 patients were Down Syndrome and 4 children received treatment for relapse in other centers. Thus, fifty-seven patients achieved CR and were evaluated for MRD at two time points. Of them, 56 patients belonged to S4 and S3 and 1 patient to S1 group as defined by the Berlin-Frankfurt-Münster stratification for relapsed ALL. MRD was analyzed by multiparametric flow-cytometry following ALL-IC 2009 guidelines. Negative MRD was defined as disclosing less than 0.1% of blasts. For this analysis, patients were stratified based on MRD levels at two different time points: after end of induction, before HSCT or at any other time point during the follow-up for patients who did not undergo HSCT. Three groups were defined: Group-1: negative at both time points (n= 23), Group-2: positive at 1 time point (n= 13) and Group-3: positive at both time points (n= 21). Patients who relapsed before receiving HSCT were considered Group-3. Twenty-five patients underwent HSCT: 13 of them from Group-1, 9 from Group-2 (2 had positive MRD previous to receive HSCT) and 3 patients from Group-3. HSCT was performed with matched familiar donor in 16 cases and matched unrelated donor in 9 cases. Results: The distribution of events according to receiving or not HSCT was: 5 died due to transplant related mortality (TRM), 9 relapsed after receiving HSCT and 16 during treatment with chemotherapy. With a median follow-up of 16 (range: 6-67) months, overall 3-year EFS probability (EFSp) (SE) was 32 (8)%. The 3-year EFSp was 75 (11)% for Group-1, 24 (14)% for Group-2 and 0% for Group-3 (p-value <0.00001). Comparing patients who did not receive HSCT vs. patients who did, EFSp (SE) was 32 (12)% and 29 (11)% respectively (p-value: non-significant). The EFSp (SE) according to MRD groups in patients who underwent HSCT was: Group-1: 53 (19)%, Group-2: 14 (13)% and 0% for Group-3 (p-value: 0.06). Conclusions: MRD quantification by flow-cytometry demonstrated to be a significant prognostic factor for relapsed ALL. Both, TRM and death in CR rates, were high and should be decreased by improving supportive measures. MRD determination by flow-cytometry in patients who underwent HSCT showed a trend to achieve a better EFSp, thus representing a relevant tool for stratifying relapsed ALL patients in order to achieve a better selection of patients to receive HSCT. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5447-5447
Author(s):  
Divaya Bhutani ◽  
Paul Naylor ◽  
Charles Jaiyeoba ◽  
Joseph P. Uberti ◽  
Voravit Ratanatharathorn ◽  
...  

Abstract Introduction: Clostridium difficile (C.diff) colitis (CDI) continues to be a common complication in recipients of allogeneic stem cell transplantation (AlloSCT). Multiple risk factors were associated with CDI in this patient population including prior CDI, antibiotic prophylaxis and therapy, acute graft versus host disease (aGVHD), etc. Our aim in this study was to evaluate the effect of thymoglobulin used in GVHD prophylaxis on the incidence of CDI in patients undergoing AlloSCT. Methods: We studied 3 consecutive cohorts of AlloSCT recipients. Group1- related donor AlloSCT without thymoglobulin (N=100, transplanted 3/2010-12/2013); group 2 - unrelated donor AlloSCT with thymoglobulin (N=110, transplanted 4/2012-12/2013); and group 3 - unrelated AlloSCT without thymoglobulin (N=100, transplanted 12/2009-12/2011). Majority of patients except three in group 3 were diagnosed with CDI with a PCR based test. Results: All 3 groups were similar with respect to the baseline characteristics (Table 1). The median follow up for the 3 groups was 2 years. At a median follow up of 2 years the incidence of CDI in the three groups were 19%, 26%, 28% respectively, p=0.2 (table 2). The incidence of CDI prior to aGVHD was similar in three groups (18/100, 25/110 and 19/100 in groups 1, 2 and 3 respectively). The incidence of CDI after development of aGVHD was higher in group 3 (1/100, 4/110 and 9/100 p=0.06 in groups 1, 2 and 3 respectively). The incidence of Grade II-IV aGVHD was significantly higher in group 3 (63%) as compared to groups 1 and 2 (49 and 41%) p=0.006 (Table 2). Similarly the incidence of any grade GI GVHD was higher in group 3 (44% Vs 23% and 24%) p=0.0009. The median time to development of aGVHD was similar in all three groups (28 days in groups 1, 31 days in group 2 and 26 days in group 2). Multivariable analysis revealed that none of the factors examined (age, sex, diagnosis, intensity of conditioning, type of transplant, use of thymoglobulin, acute GVHD) was related to development of CDI. Development of GI GVHD tended to increase the risk of subsequent CDI (40% vs 27%, p=0.06). Development of CDI did not increase the risk of development of subsequent GI GVHD (30% vs. 26%). Use of thymoglobulin improved two year overall survival in patients undergoing unrelated transplant (p=0.006). Conclusion: Thymoglobulin use did not affect the overall incidence of CDI in recipients of Allo-SCT. There is a trend towards increased incidence of late onset CDI in patients undergoing unrelated Allo-SCT and not recieving thymoglobulin probably because of higher incidence of GVHD and steroid use. There was no difference in the incidence of CDI in related vs. unrelated transplant recipients. Use of thymoglobulin improved survival in recipients of unrelated Allo-SCT. Table 1. Baseline Characteristics: Related (N=100) unrelated with Thymo (N=110) Allo unrelated without Thymo (N=100) P-value Age Median 54 58 52 NS Gender F 42 47 51 NS M 58 63 49 Race Caucasian 83 99 91 NS Other 17 11 9 Conditioning regimen Myeloablative 76 59 63 NS RIC 24 51 37 Diagnosis Leukemia 47 61 56 NS Lymphoma 30 21 20 MDS 12 20 11 Other 11 8 13 Source of stem cells BM 9 6 10 NS PBSC 91 104 90 HLA match 10/10 94 71 71 NS* 9/10 2 26 21 8/10 13 8 Haploidentical 4 GVHD** Prophylaxis Tac/MMF 97 100 Tac/MMF/Thymo 101 Tac/Sirolimus/Thymo 9 *No difference in HLA match between the groups 2 and 3. **Tac (Tacrolimus); MMF (Mycophenolate Mofetil); THYMO (Thymoglobulin). Table 2. Results: Groups 1. Related 2. Unrelated with Thymo 3. unrelated without Thymo P value Incidence of aGVHD II-IV 48% 41% 63% p=0.006 Incidence of GI GVHD 23% 23.6% 44% p=0.0009 Use of systemic steroids 38% 32% 61% p=0.0001 Overall Incidence of CDI 19/100 (19%) 29/110 (26%) 28/100 (28%) p=0.20 Incidence of CDI prior to GVHD 18/100 (18%) 25/110 (22%) 19/100 (19%) NS Incidence of CDI after onset of GVHD 1/100 (1%) 4/110 (3.6)% 9/100 (9%) p=0.06 Median Overall survival at 2 year f/u 68% 52% 46% p=0.0057 Disclosures Deol: Bristol meyer squibb: Research Funding. Lum:Karyopharm Therapeutics Inc: Equity Ownership; Transtarget.Inc: Equity Ownership. Revankar:Actelion, Merck, Gilead, Astellas: Research Funding; Dara biosciences: Consultancy. Chandrasekar:Merck, Glaxo, Chimerix,: Research Funding.


2016 ◽  
Vol 5 (1) ◽  
pp. 37-42
Author(s):  
Rupak Bhattarai ◽  
Chittarranjan Das ◽  
Bandana Paudel ◽  
Sailoj Jung Dangi

Background Percutaneous Nephrolithotomy, widely used procedure by urologists for removing renal stones nowadays. Generally, it is preferred in general anesthesia but here in our study we have compared it with spinal anesthesia to know its safety and efficacy.Material and Methods Sixty patients of either sex, aged between 20-60 years, ASA – Grade I and II, with stones size larger than 15 mm posted for Percutaneous Nephrolithotomy were randomly selected. Patient was divided in two groups 30 each, Spinal Anesthesia (S) and General Anesthesia (G). Patient’s stones sizes, numbers & location, Anesthesia duration, Surgical duration, Recovery duration, Blood loss and Blood transfusion, Analgesic demand, post-operative Nausea & Vomiting, Patient satisfaction, Hospital stays and Heart Rate and Mean arterial pressure between two groups were compared.Results There was no significant difference in terms of mean age, weight, stones sizes, and numbers and its location. The p value for Anesthesia duration and surgical duration were 0.144 and 0.22 which was insignificant. Recovery duration (p-value 0.007), Blood loss (p-value 0.004) were significantly lesser in spinal anesthesia group. There was no significant difference in nausea and vomiting, patient satisfaction when compared between two groups. But Analgesic demand, Blood Transfusion and Hospital stays significantly found to be decreased in spinal anesthesia groups (p<0.05). The mean of MAP showed no significant difference except in 10 and 20 minutes.Conclusion Spinal anesthesia tends to be as effective as general anesthesia for PCNL and beneficial in terms of recovery duration, blood loss, analgesic demands, hospital stays, hence decrease the cost of patient. Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, Page: 37-42


Author(s):  
K. Vadivelan ◽  
J. S. Poyyamozhi ◽  
G. Dinesh Kumar ◽  
C. Rajan Rushender

Background: Low back pain is the common symptom of the lumbar region that more than 80 percent of people experience in their lifetime. Methods: Quasi-experimental study was conducted with three intervention groups. Ankle mobilization (Group I), Active stretching of calf muscle (Group 2), No Intervention (Group 3). This study was carried out in the Department of Physiotherapy at SRM University, Chennai. 21 subjects were included in the study, with 7 subjects in each group. Results: Median age was found to be 20 (19–21), 19 (18–20) and 21 (20–22) in group 1, group 2 and group 3 respectively and no significant difference was seen between the groups, p value 0.11) There was a significant improvement seen in visual analogue scale, in both the intervention groups before and after intervention. The median and IQR for ankle mobilization group pre and post intervention was 6 (IQR, 5–6) and 4 (IQR, 3–5) respectively, with a p value <0.01. Conclusions: Overall results have shown that both the intervention groups have similar effects in reducing lower back pain and improving lumbar flexion, compared to the control group. 


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