scholarly journals ANALGESIC UTILIZATION IN POSTOPERATIVE CARE AT A TERTIARY CARE TEACHING HOSPITAL IN NEPAL

2003 ◽  
Vol 42 (147) ◽  
pp. 148-150
Author(s):  
G P Rauniar ◽  
M A Naga Rani ◽  
B P Das ◽  
C S Agrawal
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Retrospective Analysis ◽  
Postoperative Period ◽  
Pain Assessment ◽  
Postoperative Care ◽  
Tertiary Care ◽  
Opioid Analgesics

ABSTRACTA retrospective analysis of analgesics used in postoperative pain in abdominal surgery was done to developbase line data. Appendectomy and cholecystectomy each formed 38.63% while hernia repair constituted22.74% of all the abdominal surgeries (422). NSAIDs were the most commonly prescribed group of analgesicsboth during the hospital stay (99.52%) and at the time of discharge (86.01%). Opioid analgesics (4.73%)was used in the immediate postoperative period mainly to supplement the NSAIDs. Diclofenac (88.86%)was the most commonly prescribed analgesic to in-patients and either diclofenac (47.63) or a fixed dosecombination of ibuprofen and paracetamol (32.46%) was the most commonly prescribed at the time ofdischarge. The administered dose of diclofenac was higher than the recommended dose. Utilization ofanalgesics during postoperative period may be rationalised by pain assessment charts and regular feedbackto the precribers.Key Words: Analgesic utilization, post operative, abdominal surgery.

scholarly journals Assessment of pain during rest and during activities in the postoperative period of cardiac surgery

2014 ◽  
Vol 22 (1) ◽  
pp. 136-143 ◽  
Author(s):  
Larissa Coelho de Mello ◽  
Silvio Fernando Castro Rosatti ◽  
Priscilla Hortense
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Postoperative Complications ◽  
Postoperative Period ◽  
Pain Assessment ◽  
Descriptive Study ◽  
Deep Breathing ◽  
Cohort Design ◽  
Surgical Recovery ◽  
Over Time

OBJECTIVE: to assess the intensity and site of pain after Cardiac Surgery through sternotomy during rest and while performing five activities. METHOD: descriptive study with a prospective cohort design. A total of 48 individuals participated in the study. A Multidimensional Scale for Pain Assessment was used. RESULTS: postoperative pain from cardiac surgery was moderate during rest and decreased over time. Pain was also moderate during activities performed on the 1st and 2nd postoperative days and decreased from the 3rd postoperative day, with the exception of coughing, which diminished only on the 6th postoperative day. Coughing, turning over, deep breathing and rest are presented in decreased order of intensity. The region of the sternum was the most frequently reported site of pain. CONCLUSION: the assessment of pain in the individuals who underwent cardiac surgery during rest and during activities is extremely important to adapt management and avoid postoperative complications and delayed surgical recovery.

scholarly journals Comparison of Tubeless Mini Percutaneous Nephrolithotomy with Conventional Technique in a Tertiary Care Center

2022 ◽  
Vol 19 (1) ◽  
pp. 34-36
Author(s):  
Dipesh Kumar Gupta ◽  
Arun Gnyawali ◽  
Deepak Jaiswal
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Care Center ◽  
Tertiary Care ◽  
Postoperative Blood Loss ◽  
Routine Practice ◽  
Standard Group ◽  
Nephrostomy Tube ◽  
Analgesic Requirement

Introduction: Mini Percutaneous Nephrolithotomy (mPCNL) is a safe and efficient method for management of nephrolithiasis. Post procedure nephrostomy tube drainage is considered as the standard practice. In recent years, tubeless mPCNL with the use of double J (DJ) stent alone has replaced the placement of the nephrostomy tube. Aims: This study intends to evaluate the safety and efficacy of tubeless Mini Percutaneous Nephrolithotomy. Methods: A total of 80 patients with Nephrolithiasis, admitted to Urology Unit of Nepalgunj Medical College, between September 2018 and September 2019 were enrolled in the study and divided into two groups: Tubeless group where tube was omitted and Standard Group where it was placed. The two groups were compared with respect to hemoglobin drop and blood transfusion requirement, hospital stay and analgesic requirement in the post-operative period. Results: Mean age of the patients was 34.30 ± 13.19 years. Mean stone size was 19.03 mm. The mean change in hemoglobin after standard mPCNL was 1.68 gm/dl and that in the tubeless group was 1.11 (p=0.018). The tubeless group had a significantly (p=0.001) shorter hospital stay (3.05 ± 1.23 days) compared to standard group (3.85 ± 0.86). The postoperative pain as assessed by visual analogue scale, was more in the standard group necessitating additional analgesia. It was significantly higher in the standard group at 12, 24, 48 hours, as compared to the tubeless group. Conclusion:  Placement of nephrostomy tube can be omitted as a routine practice as Tubeless mini PCNL has an added advantage of significantly reduced postoperative pain, less analgesic requirement, shorter hospital stay, less postoperative blood loss.

scholarly journals Postoperative Pain After Robot-Assisted Laparoscopic Ventral Hernia Repair

2021 ◽  
Vol 8 ◽  
Author(s):  
Per Lindström ◽  
Göran Rietz ◽  
Åsa Hallqvist Everhov ◽  
Gabriel Sandblom
Keyword(s):  
Postoperative Pain ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Robot Assisted ◽  
Potential Benefits ◽  
Onlay Mesh ◽  
Da Vinci Si

Background: Robot-assisted ventral hernia repair, when performed correctly, may reduce the risk for pain and discomfort in the postoperative period thus enabling shorter hospital stay. The aim of the present study was to evaluate postoperative pain following robot-assisted laparoscopic repair. The approach was selected after an intraoperative decision to complete the repair as: (1). Transabdominal Preperitoneal Repair (TAPP); (2). Trans-Abdominal RetroMuscular (TARM) repair; or (3). Intraperitoneal Onlay Mesh (IPOM) repair depending on anatomical conditions.Methods: Twenty ventral hernia repairs, 8 primary and 12 incisional, were included between 18th Dec 2017 and 11th Nov 2019. There were 8 women, mean age was 60.3 years, and mean diameter of the defect was 3.8 cm. The repairs were performed at Södersjukhuset (Southern General Hospital, Stockholm) using the Da Vinci Si Surgical System®. Sixteen repairs were completed with the TAPP technique, 2 with the TARM technique, and 2 as IPOM repair.Results: Mean hospital stay was 1.05 days. No postoperative infection was seen, and no recurrence was seen at 1 year. At the 30-day follow-up, fifteen patients (75%) rated their pain as zero or pain that was easily ignored, according to the Ventral Hernia Pain Questionnaire. After 1 year no one had pain that was not easily ignored.Conclusion: The present study shows that robot-assisted laparoscopic ventral hernia is feasible and safe. More randomized controlled trials are needed to show that the potential benefits in terms of shorter operation times, earlier discharge, and less postoperative pain motivate the extra costs associated with the robot technique.

scholarly journals Retrospective Analysis of Clinical Outcome of Intraoperative Epidural Steroid Injection Versus No Steroid Injection after Standard Lumbosacral Discectomy

2020 ◽  
Vol 16 (1) ◽  
pp. 33-36
Author(s):  
Suresh Pandey ◽  
Suraj Bidari
Keyword(s):  
Postoperative Pain ◽  
Clinical Outcome ◽  
Hospital Stay ◽  
Retrospective Analysis ◽  
Steroid Injection ◽  
Outcome Measurement ◽  
Epidural Steroid Injection ◽  
Vas Score ◽  
Steroid Group ◽  
Epidural Steroid

Background: Despite operative decompression of neural structure with discectomy in the indicated cases of lumbosacral disc herniation, many patients continue to experience back pain and leg pain in the postoperative period. Use of intraoperative local epidural steroid injection has been in practice to reduce this complications but there are concern and controversies regarding its benefit and risk. So this study aims to analyze clinical outcome in terms of reduction in pain, hospital stay, postoperative use of analgesics and risk associated with the use of intraoperative epidural steroid  locally and comparison to those who did not receive steroid. Methods: This was a retrospective analysis of total of 44 patients, 28 patients who received Epidural Steroid Injection (ESI) locally after lumbosacral standard discectomy and comparison of the outcome with results of 16 patients with standard lumbosacral discectomy who did not receive ESI. Outcome measurement was done between two groups in terms of postoperative pain VAS scale, use of analgesics, hospital stay and complications if any. Results: There were total of 44 cases (28 steroid group and 16 no steroid group) with mean age of 39.93 years, male 27 and female 17 who underwent standard discectomy and followed up for at least one year. Overall, preoperative mean VAS score for pain improved from 7.95 to 1.55 at 1 year after operation which was significant p<0.05. On comparison of 24 hour postoperative VAS score and  hospital stay between the groups with steroid and no steroid, it was mean of 5.32 versus 6 and 4.43 days versus 5.25 days (p<0.05) respectively which was significant. All the patients in no steroid group needed both NSAID and opioids for the postoperative pain management whereas only 12 (42.8%) patient needed addition of opioids in steroid group. There was no difference in VAS score at 1week and 1 year. There was no complications in either of the group.  Conclusions: Use of intraoperative ESI help to reduce early postoperative pain, hospital stay and use of opioids without adding further risk or complication.

COMPARATIVE ANALYSIS OF THE RESULTS OF PLASTIC INGUINAL HERNIA LAPAROSCOPIC AND TRADITIONAL METHODS

2021 ◽  
pp. 27-31
Author(s):  
Diyar Akhmet ◽  
◽  
Zhasulan Baimakhanov ◽  
Erik Nurlanbayev ◽  
Askar Matkerimov ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Comparative Analysis ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Postoperative Period ◽  
Laparoscopic Hernia Repair ◽  
Traditional Methods ◽  
Scientific Center ◽  
Duration Of Hospital Stay ◽  
Analgesic Therapy

Purpose of the study. Conduct a retrospective comparative analysis of the results of laparoscopic and traditional methods of inguinal hernia repair, patients treated at the surgical departments at “A.N. Syzganov National Scientific Center of Surgery”, Almaty, Kazakhstan. Materials and methods. In the period from January 2017 to December 2020 137 patients were operated at the “A.N. Syzganov National Scientific Center of Surgery” in a planned manner for inguinal hernia and all patients were divided into 2 main groups: operated by traditional methods and laparoscopic method. Results.The data of the analysis suggests that the laparoscopic method of hernioplasty has an advantage over the traditional methods. Conclusion. Based on a comparative analysis of the indicators of patients in both groups, it can be concluded that the duration of the operation for laparoscopic hernia repair is 92.3 minutes, significantly more than with traditional methods, which is 79.4 minutes. Despite this, the duration of analgesic therapy in the postoperative period with laparoscopic hernia repair is 2.4 days, and the duration of hospital stay after surgery is 3 days, much less than with traditional methods, in which the duration of analgesic therapy in the postoperative period is 3, 3 days, and the duration of hospital stay after surgery is 4.6 days. This analysis suggests that laparoscopic hernioplasty has an advantage over traditional methods.

“PROSPECTIVE RANDOMISED COMPARATIVE STUDY OF USE OF FIBRIN GLUE VS. TACKERS AS METHOD OF MESH FIXATION IN LAPAROSCOPIC TRANSABDOMINAL PRE-PERITONEAL (TAPP) HERNIA REPAIR”

2021 ◽  
pp. 73-75
Author(s):  
Ashish Andhare ◽  
Hari S. Mahobia ◽  
Abhishek Bansal
Keyword(s):  
Postoperative Pain ◽  
Hernia Repair ◽  
Comparative Study ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hernia Recurrence ◽  
Seroma Formation ◽  
Group B ◽  
Time Required

BACKGROUND: Fixation of mesh in pre-peritoneal space is an important step in laparoscopic TAPP hernia repair. Mesh dislocation is one of the most frequent causes responsible for recurrence. Of the many factors inuencing postoperative pain, the technique of xation has been reported to be one of the most signicant determinants. So mesh xation with adhesives instead of mechanical devices has been proposed as a mean to reduce the incidence of postoperative pain. AIM: To compare clinical outcome and morbidity of xation of mesh using brin glue and tackers in trans-abdominal pre-peritoneal inguinal hernia repair METHODOLOGY: We did a prospective randomized comparative study in which we enrolled 50 patients undergoing laparoscopic hernia repair (TAPP). Those who met our inclusion criteria were randomized for study purpose after obtaining informed consent, in 25 patients mesh xed with tackers (group A) and in other 25 patients mesh xed with brin glue (group B). Patients were compared for intraoperative time required for mesh xation, early and late postoperative pain, time required to resume normal daily physical activity, length of hospital stay, hernia recurrence and seroma formation. Postoperative follow up was done up to six months. RESULTS: Two groups were comparable in terms of demographic variables. We observed that postoperative pain, time required resuming normal daily activity and incidence of seroma formation was less in group B (Mesh xed with glue). There was no signicant difference in length of hospital stay in both groups and no evidence of hernia recurrence in both groups during follow up period. CONCLUSION: It can be concluded that xation of mesh with brin glue when compared with tackers, seems to reduce postoperative pain, time to resume daily activities and incidence of seroma formation with no difference in length of hospital stay, early hernia recurrence with longer operative time.

scholarly journals Inguinal hernia repair – TEP or TAPP?? A comparative analysis between both the laparoscopic procedures in a tertiary care center

2020 ◽  
Vol 11 (6) ◽  
pp. 84-88
Author(s):  
Atia Zaka Ur Rab ◽  
Sheikh Saif Alim ◽  
Wasif Mohammad Ali ◽  
Syed Amjad Ali Rizvi
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Prospective Study ◽  
Hospital Stay ◽  
Inguinal Hernia Repair ◽  
Tertiary Care ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Normal Work

Background: Inguinal hernia surgery is one of the most common elective procedures performed by the surgeons and has evolved from open to the laparoscopic technique. Aims and Objectives: This prospective study was conducted to find out intra-operative and post-operative outcomes in patients undergoing TEP and TAPP for inguinal hernia repair. Materials and Methods: A prospective study was conducted on 50 adult patients who underwent laparoscopic inguinal hernia repair between November 2017 to November 2018. It was a randomized study and equal number of patients were allocated to TAPP and TEP group based on the surgeon’s preference. Results: Operative time [p<0.0001], intensity of pain (VAS) was significantly higher in TAPP compared to TEP in the immediate post-operative period (6 hours) and during hospital stay [p=0.0299]. No significant difference observed in VAS between TEP and TAPP during follow up [after 1 week (p=0.2298), 2 weeks (p=0.2337), and 4 weeks (p=0.3944)]. Both TEP and TAPP were comparable in terms of Intra-operative and Post-operative complications {seroma [during hospital stay (p=0.1573), after 1 week (p=0.6375), after 2 weeks (p=0.5513)]; haematoma [during hospital stay (p=0.1492), after 1 week (p=0.3125)]} and Conversion (p=0.3125), and Length of hospital stay (p=0.3960). Time to resume normal work [p<0.0001] was significantly more in TAPP than TEP. Conclusion: TEP has a definite edge over TAPP taking into consideration the lesser intensity of post-operative pain during hospital stay, shorter duration of surgery and relatively early return to normal work associated with the former procedure. TEP should therefore be regarded as the procedure of choice for inguinal hernia repair.

scholarly journals Post-operative Paediatric Pain Assessment and Management at a Tertiary Health Facility, Southern Nigeria: Surgeons’ Perspectives and Practice

2020 ◽  
pp. 35-42
Author(s):  
G. K. Eke ◽  
P. E. Okoro
Keyword(s):  
Postoperative Pain ◽  
Health Facility ◽  
Postoperative Analgesia ◽  
Pain Assessment ◽  
Opioid Analgesics ◽  
Postoperative Pain Management ◽  
Assessment Tools ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Southern Nigeria

Introduction: Whereas advances in perioperative care of children continue to be made with increasing evidence-based practice for postoperative analgesia, inadequate relief of postoperative pain resulting in significant morbidity and mortality is still being reported. Objective: To appraise surgeons' perspectives and practice of paediatric post-operative pain assessment and management at a tertiary health facility in southern Nigeria. Methods: In this cross-sectional survey carried out between September and December 2019, a semi-structured and self-administered questionnaire was distributed to surgeons/trainees in departments/units where paediatric patients undergo both major and minor surgeries. Their perspectives and practice of postoperative pain assessment and management were analysed using SPSS version 20.0. Results: Seventy-nine respondents completed the survey, including 19(24%) consultants, 32(40.5%) senior registrars, and 22(27.9%) junior registrars. Two-third of respondents (n=51, 64.6%) had more than 10 years working experience post-graduation. Involving parents/caregivers to assess postoperative pain was the most common strategy used by respondents (n=69, 87.3%), and most of them (n=67, 84.8%) do not make use of any pain assessment tools.  Non-pharmacologic strategies for postoperative pain management were applied/prescribed sometimes (n=20, 25%) or rarely (n=20, 25%). Paracetamol and NSAIDs were the commonest non-opioid analgesics used while pentazocine was the commonly used opioid. Many respondents (n=66, 83.5%) had never prescribed morphine for postoperative analgesia in children. Seventeen percent of respondents do not prescribe postoperative analgesia to newborns. Conclusion: Findings of this study show that the practice in our institution falls short of the recommended multimodal approach to paediatric postoperative pain care. Development of standard protocols and training of providers of postoperative care are recommended.

scholarly journals A COMPARATIVE AND RANDOMIZED STUDY BETWEEN TRANS ABDOMINAL PRE-PERITONEAL VERSUS TOTALLY EXTRA-PERITONEAL LAPAROSCOPIC TECHNIQUES OF INGUINAL HERNIA REPAIR

2020 ◽  
pp. 26-29
Author(s):  
Nikhil Agrawal ◽  
Swapnil Sen
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Inguinal Hernia Repair ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Statistical Hypothesis ◽  
Categorical Variables ◽  
Chi Squared

A hernia, an abnormal protrusion of an organ or tissue through a defect in its surrounding wall is a very common surgical problem. Approximately 75% of all hernias are usually groin hernias, among which 95% are inguinal region hernias. Various methods of repair have been employed which have progressed from open repair to various laparoscopic approaches. There is insufficient data to draw conclusions about the relative effectiveness of the two laparoscopic methods. Overall superiority of the two laparoscopic methods has not been demonstrated in available literature. AIM: The purpose of this study is to compare the clinical effectiveness and relative efficiency of laparoscopic TAPP and laparoscopic TEP for inguinal hernia repair. MATERIALS AND METHODS: Hospital based comparative randomised study on 100 patients admitted in General Surgical wards with Inguinal hernia at a tertiary care centre of Eastern India. Randomization in two groups was done by lottery system. A well designed proforma containing various parameters under study was used for data collection. Baseline information were collected via structured interview using predesigned questionnaire. For statistical analysis data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS version 24 and GraphPad Prism version 5. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Two-sample t-tests for a difference in mean involved independent samples or unpaired samples. Paired t-tests were a form of blocking and had greater power than unpaired tests. A chi-squared test (χ2 test) was any statistical hypothesis test wherein the sampling distribution of the test statistic is a chi-squared distribution when the null hypothesis is true. Unpaired proportions were compared by Chi-square test or Fischer’s exact test, as appropriate. RESULTS: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP. Visceral injury and vascular injury were found more in TAPP as compared to TEP but this was not statistically significant. Seroma, port site hernia, persisting numbness and mesh/deep infection was higher in group-A (TAPP) as compared to group-B (TEP) but this was not statistically significant. Conversion to open procedure and persistent pain were comparable among the two methods. Hernia recurrence rates were higher in the TEP group in this study although it was statistically insignificant. CONCLUSION: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP.

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