scholarly journals Impact of Timing of Admission in Labour on Subsequent Outcome

2013 ◽  
Vol 2 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Junnu Rayen Janna ◽  
Saleha Begum Chowdhury
Keyword(s):  
Caesarean Section ◽  
Hospital Stay ◽  
Apgar Score ◽  
Caesarean Delivery ◽  
Active Phase ◽  
Cervical Dilatation ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Latent Phase

To examine the effect of timing at which women admitted either in active or latent phase of spontaneous labour on subsequent outcome. This cross-sectional study was conducted at labour ward, department of Obstetrics and Gynaecology, BSMMU hospital, Dhaka, Bangladesh, from August 2007 to November 2007, where data were collected prospectively. A total of 60 women with term, singletone pregnancy, cephalic presentation with spontaneous onset of labour admitted in labour either in active or latent phase were selected for evaluation. Patients with any medical or obstetric complications, rupture of membrane, antenatally diagnosed foetal anomalies or death and with prior caesarean section were excluded from the study. Patients with cervical dilatation at less than 4cm were categorized as latent phase and were in group I. On the other hand, patients with cervical dilatation of 4 cm or more were marked as in active phase and were allocated in group II. Baseline characteristics were compared. Outcome differences were compared using chi-square(X2) test, t test, fisher’s exact test, A ‘p’ value <0.05 considered significant.  Duration of labour, mode of delivery, indication for caesarean section, need for oxytocin, labour analgesia, Apgar score <7, birth weight of baby, maternal PPH and postpartum hospital stay. A total of 60 patients were enrolled during the study period. Of them 35 patients (58.3%)were in group I and 25 patients (41.7%) in group II. Duration of labour was more in early admitted group compared to late admitted group (mean± SD 17.0 ± 2.8 vs 14.3 ± 2.4). Latent phase women needed more caesarean delivery than active phase women (62.9% vs 28.0%). Dystocia was the main indication for caesarean delivery in the present study which was 68.2% and 28.6% in early and late admitted group respectively. Second commonest indication for caesarean section was foetal distress (6 in group I and 5 in group II). Oxytocin for augmentation was used in 62.9% in group I and 56.0% in group II and nulliparae women were the one who needed more augmentation (40.0% in group I, 36.0% in group II). Mean foetal weight between two groups did not reach any significant difference (p>0.05). Apgar score <7 shows insignificant difference between two groups. PPH was found in 5.7% cases and all were from group I. Total postpartum hospital stay was significantly longer in group I than group II (p<0.05). t is shown that early admission to the hospital in low-risk women may negatively affect the outcome of labour and are at increased risk of prolonged labour, more need for analgesia, increased rate of caesarean section, increased PPH and postpartum hospital stay. DOI: http://dx.doi.org/10.3329/cbmj.v2i1.14177 Community Based Medical Journal Vol.2(1) 2013 21-28

scholarly journals A Prospective Study on the Relationship Between Cervical Dilatation at Initial Presentation in Labour and Subsequent Outcome in Nulliparous Women

2014 ◽  
Vol 13 (1) ◽  
pp. 39-41
Author(s):  
Smriti Kona Kabiraj ◽  
Juthi Bhowmik ◽  
Haradhan Deb Nath
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Active Phase ◽  
Fetal Distress ◽  
Cervical Dilatation ◽  
P Value ◽  
Nulliparous Women ◽  
Group I ◽  
Increased Risk ◽  
Group Ii

Background: The spontaneous birth of a live infant can convey a huge degree of both satisfaction and achievement for both the mother and her partner. Many factors influence the variation in rates of caesarean section among hospitals throughout the world. These included patients’ demographic characteristics, underlying medical and obstetric complication, hospital facilities, hospital practice and physician practice style. Objective: The present study was planned to determine how the outcome of women change with timing of admission either in active or latent phase of spontaneous labour.Methods: This was a prospective observational study, which was conducted at labour ward, department of Obstetrics and Gynaecology, BSMMU hospital and DMCH Dhaka, from February 1, 2008 to August 30, 2008, where data were collected prospectively. Patients with any medical or obstetric complications, rupture of membrane antenatally diagnosed fetal anomalies or death and with prior caesarean section were excluded from the study. Patients with cervical dilatation at less than 4cm were in group I. On the other hand, patients with cervical dilatation of 4 cm or more in active phase and these types of patients were allocated in group II.Results: Outcome differences were compared using chi-square(X2) test, fishers exact test, A ‘p’ value <0.05 considered significant. Main outcome variables were duration of labour, mode of delivery, indication for caesarean section, need for oxytocin, labour analgesia, Apgar score <7, maternal PPH and postpartum hospital stay. A total 500 patients were enrolled during the study period. Of them 308 patients were (61.6%) in group I and 192 patients (38.4%) in group II. Dystocia was the main indication for caesarean delivery in early admitted group which was 58.6% and fetal distress in late admitted group which was 37.5%. Second commonest indication for caesarean section was fetal distress which was 31.6% in group I and dystocia 50.0% in group II). Oxytocin for augmentation was used in 70.0% in group I and 30.0% in group II.Conclusion: It is shown that early admission to the hospital in low-risk women may negatively affect the outcome of labour and are at increased risk of prolonged labour, more oxytocin used, increased rate of caesarean section.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i1.19417

Transcervical Drainage for Descending Necrotizing Mediastinitis May Be Sufficient

2011 ◽  
Vol 145 (5) ◽  
pp. 742-747 ◽  
Author(s):  
Ruey-Fen Hsu ◽  
Pei-Yin Wu ◽  
Chi-Kung Ho
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Chart Review ◽  
Medical Center ◽  
Case Series ◽  
Descending Necrotizing Mediastinitis ◽  
Group I ◽  
Significant Difference ◽  
Mediastinal Drainage ◽  
Group Ii

Objective. Descending necrotizing mediastinitis (DNM) is a serious form of mediastinitis with a high mortality rate. It is caused by the downward spread of an oropharyngeal or cervicofascial infection. The optimal surgical approach for this often fatal disease is controversial. This article describes the authors’ experience and characterizes the surgical strategies and treatment outcomes of patients with DNM. Study Design. Case series with chart review. Setting. A tertiary referral medical center. Subjects and Methods. This study conducted a retrospective chart review of patients with deep neck infections treated at a medical center from 1994 to 2007 and identified 29 patients with DNM. The clinical characteristics and outcomes were compared between patients treated with transcervical drainage alone (group I) and those with both cervical and thoracic drainage (group II). Results. There were 20 patients in group I and 9 patients in group II. The overall mortality rate was 10.3%. The mean duration of the hospital stay was 29.3 ± 15.5 days. There was no statistically significant difference in age, sex distribution, or duration from the appearance of symptoms to hospital admission between the 2 groups. The duration of hospital stay, tracheotomy rate, and mortality rate also did not differ significantly between the 2 groups. However, the numbers of surgeries were significantly higher in group II than in group I. Conclusion. Transthoracic mediastinal drainage is not a compulsory therapy, but timely, aggressive, transcervical mediastinal drainage with extensive debridement is very important for a good outcome when treating DNM patients.

scholarly journals Effect of Clinical and Subclinical Hypothyroidism on Fetal Outcomes among Pregnant Women: A Sub-Specialty Department Experience

2021 ◽  
Vol 7 (1) ◽  
pp. 29-32
Author(s):  
Farzana Sharmin ◽  
Mahfuja Asma ◽  
Khandaker Shehneela Tasnim ◽  
Afzal Momin ◽  
Shimul Akhter ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Apgar Score ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Fetal Outcomes ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Medical University

Background: Hypothyroidism can effect on the fetal outcomes during pregnancy. Objective: The purpose of the present study was to compare the effects of clical and subclinical hypothyroidism on fetal outcomes among pregnant women. Methodology: This cohort study was conducted in the Feto-Maternal Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from a period of 6 months dated from September 2019 to February 2020. All cases of the clinical and sub-clinical hypothyroid pregnant women admitted in this department. Fetal outcomes of clinical and sub-clinical hypothyroid pregnant women during delivery were recorded. Findings of the cases recorded carefully. Result: A total number of 75 patients were recruited for this study who were divided in to two group designated as group I or sub clinical hypothyroidism and group II or clinical hypothyroidism. Fetal distress was 22(51.1%) cases in group I and 9(33.3%) cases in group II. The fetal outcome of the study patients had observed that 8(27.6%) and 12(80.0%) of the baby had low (<2.5 kg) birth weight in group I and group II' respectively. In group I most (62.1%) of the baby APGAR score was >7 and 11(73.3%) cases had < 6 APGAR score at 1st minute. Majority of the study patients had >7 APGAR score at 5 min in both groups which was 25(86.2%) and 12(80.0%) in group I and group II respectively. Conclusion: In conclusion there is a significant difference found in overt and sub-clinical hypothyroidism considering fetal stress, IUD and prematurity. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 29-32

scholarly journals Evaluation of idiopathic scoliosis by anterior and posterior arthrodesis

2015 ◽  
Vol 14 (2) ◽  
pp. 88-92 ◽  
Author(s):  
Jean Carlo Frigotto Queruz ◽  
Allan Kato ◽  
Carlos Abreu de Aguiar ◽  
Luiz Muller Avila ◽  
Luis Eduardo Munhoz da Rocha
Keyword(s):  
Idiopathic Scoliosis ◽  
Hospital Stay ◽  
Posterior Approach ◽  
Thoracolumbar Spine ◽  
Average Hospital ◽  
Icu Stay ◽  
Group I ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group Ii

<sec><title>OBJECTIVE:</title><p> To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.</p></sec><sec><title>METHODS:</title><p> The study consists of a comparative retrospective study of two groups of patients with the thoracolumbar spine arthrodesis technique by anterior and posterior approach. Twenty and two patients were sequentially selected, 11 operated by anterior approach - called Group I - and 11 by posterior approach - Group II. Anamnesis and physical examination were performed, as well as length of hospital stay and ICU stay, degree of correction, comorbidities and pre and postoperative radiographic images data were gathered.</p></sec><sec><title>RESULTS:</title><p> The mean age was 13.7 years in Group I and 14 years in Group II. The average hospital stay was 5.81 days for Group I and 5 for Group II. The average ICU stay was 2.81 and 2 days, respectively. Considering the operated levels, Group I presented an average of 4.81 vertebrae (4-6 levels), and Group II presented an average of 6.36 vertebrae (5-11 levels). Complications did not show statistically significant difference.</p></sec><sec><title>CONCLUSION:</title><p> Despite the limited number of patients in groups, it was demonstrated that the posterior approach reduces the number of days of hospitalization and ICU stay. However, it was found increased levels included in the arthrodesis.</p></sec>

scholarly journals Short Course versus Standard Course Antibiotic Treatment for Neonatal Sepsis

2017 ◽  
Vol 13 (1) ◽  
pp. 124-127
Author(s):  
Tahsinul Amin ◽  
Ayesha Najma Nur
Keyword(s):  
Clinical Outcome ◽  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Developmental Delay ◽  
Antibiotic Treatment ◽  
Neonatal Sepsis ◽  
Group I ◽  
Short Course ◽  
Significant Difference ◽  
Group Ii

Introduction: Neonatal sepsis remains an important cause of morbidity and mortality and often requires prompt empiric treatment. However, only a minority of babies who receive antibiotics for suspected sepsis have an infection. Antimicrobial exposure in infancy has important short-term and long-term consequences. There is no consensus regarding empirical antimicrobial regimens. Objective: To compare efficacy and benefits of short course (5 days) over the standard course (7 days) antibiotic treatment for neonatal sepsis. Materials and Methods: The study was a randomized controlled trial done in the neonatal ward in a tertiary level hospital comprising total 100 term neonates equally divided in to two groups by randomization where Group-I (5 days antibiotic therapy) was compared against Group-II (7 days antibiotic therapy) in clinical recovery, hospital stay, morbidity such as seizure, developmental delay etc and mortality. Results: The study results showed that both the Group-I and Group-II were comparable in baseline clinical data and predisposing factors; however, there was no significant difference between the two groups in clinical features e.g. hypotonia (24% vs 26%, p>0.05), poor primitive reflexes (46% vs 52%, p>0.05), temperature instability (34% vs 28%, p>0.05), feeding intolerance (16% vs 14%, p>0.05), apnea / respiratory distress (28% vs 34%, p>0.05) and in clinical outcome e.g. hospital stay (5.24±0.78 vs 7.86±0.42, p>0.05), recovery (86% vs 90%, p>0.05), death (14% vs 10%, p>0.05), seizure disorder (8% vs 6%, p>0.05) and developmental delay (6% vs 4%, p>0.05). Conclusion: This study showed that there was no significant difference between the study groups in clinical outcome, however, short course antibiotic (5 days) is equally effective but economically more beneficial to standard course antibiotic (7 days) therapy for neonatal sepsis. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 124-127

scholarly journals Spinal Anaesthesia Induced Hypotension and Related Adverse Effects in Caesarean Section Delivery and Neonatal Outcome: A Comparison of Using Crystalloid Pre-Loading and Co- Loading in Caesarean Patients

2020 ◽  
Vol 5 (1) ◽  
pp. 90
Author(s):  
Taneem Mohammad ◽  
Moinul Hossain Chowdhury ◽  
Shamima Akter ◽  
Mohammad Abdul Karim Miah ◽  
Mohammad Mohsin ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Adverse Effects ◽  
Spinal Anaesthesia ◽  
Apgar Score ◽  
Neonatal Outcome ◽  
Induced Hypotension ◽  
Group I ◽  
Caesarean Section Delivery ◽  
Group Ii ◽  
The Difference

Background: Volume loading by rapid infusion of crystalloid solution before/during induction of spinal anaesthesia may effectively reduce the incidence of anaesthesia induced hypotension.Objective:To compare the efficacy of crystalloid pre-loading and co-loading to preventhypotension and related adverse effects as well aspoor neonatal outcome in caesarean section delivery under spinal anaesthesia.Methods:This single blinded randomized controlled clinical trial was conducted in the Department of Anaesthesia, Analgesia & Intensive Care, Dhaka Medical College Hospital, Dhaka, between January 2013 and December 2014. A total of 90 patients were selected –45patients of group I received co-loading with Ringer’s lactatesolution, while another 45 patients of group II received a pre-loading of the same fluid.Blood pressure and heart rate were recorded. Ephedrine and adrenaline were administered as needed to treat hypotension.APGAR scores of the newborn were recorded at 1st minute and 5th minute after delivery. Adverse effects like nausea, vomiting, light headedness and shivering was observed all through during operation and post-operative phase in all patients, if any, and recorded.Results:The incidence of hypotension was 17 (37.8%) in group I (co-loading) and 27 (60%) in group II (pre-loading), which was significantly higher in group II (p<0.05).Adverse effects – nausea, vomiting, light headedness and shivering was observed more in group II patients; however, the difference was not statistically significant. In neonates, APGAR score at 1 minute was found ≤7 in 18 (40.0%) from group I, while 28 (62.2%) from group II; the difference was statistically significant (p<0.05). No significant difference was observed in APGAR score at 5 minutes, as found ≤7 in 6 (13.3%) and 3 (6.7%) in group I andgroup II respectively.Conclusion:Severity of hypotension, increased ephedrine requirement and poor APGAR score wereevident in patients who received crystalloid pre-loading group(group II), which meanscrystalloid co-loading group(group I) procedurewas more effective in preventing spinal anaesthesia induced hypotension and secured better neonatal outcome.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 90-95

scholarly journals Carbetocin versus Oxytocin and Misoprostol in prevention of atonic post-partum hemorrhage in high risk patients planed for cesarean delivery

2017 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Author(s):  
Abd El-Naser Abd El-Gaber Ali ◽  
Ahmed Ali M. Nasr ◽  
Hazem H. Ahmed ◽  
Mahmoud I. El- Rasheedy ◽  
Mahmoud Badawy
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Caesarean Delivery ◽  
Post Partum ◽  
Elective Caesarean Section ◽  
High Risk Patients ◽  
Post Partum Hemorrhage ◽  
Group I ◽  
Risk Patients ◽  
Group Ii

Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol.Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 µg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed.Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P <0.001), major PPH was 0, 4 and 6% for the same groups respectively (P <0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II& III (P <0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p <0.0001)Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage. 

scholarly journals Comparative Study on Fetomaternal Outcome after Lower Uterine Segment Caesarean Section and Vaginal Delivery in Eclamptic Patient

2020 ◽  
Vol 15 (1) ◽  
pp. 16-20
Author(s):  
Monika Khandoker ◽  
Swapna Biswas Joy ◽  
Sanjoy Kumar Das ◽  
Ananta Kumar Biswas
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Lower Uterine Segment ◽  
Electrolyte Imbalance ◽  
College Hospital ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
The Difference

Eclampsia has a high prevalence in our country with a high mortality rate. Eclampsia is uniquely a disease of pregnancy and regardless of gestational age. It is recognized that termination of pregnancy is the only definitive care of pathophysiological event in eclampsia. This study was done to observe fetomaternal outcome in Lower Uterine Segment Caesarean Section (LUCS) and vaginal delivery in eclamptic patient. This cross sectional analytical study was carried out in eclampsia department of Obst and Gyane in Dhaka Medical College Hospital from July 2016 to June 2018. A uniform protocol was followed in all cases to have appropriate history, physical findings and laboratory investigations. In this study 98.0% patients were conscious on admission in group I and 96.0% in group II. This study showed significant difference in recurrence of convulsion after delivery between two groups. Recurrence of convulsion was 30% in vaginal delivery group and 6% in the cesarean section group. Total complications were found in 46.0% and 16.0% patients in group I and group II respectively in this study. The difference was statistically significant (p<0.05) between two groups. In this study PPH was the most common complication in both the groups. Abruptio placenta was found more common among the vaginal delivery group. On the other hand, electrolyte imbalance was found more in cesarean section group. Maternal death was only 2% and 1% in group I and group II respectively. In this study live birth was found 64.0% and 79% in group I and group II respectively. Asphyxia was more in neonates in group I than group II which was statistically significant. Referral of asphyxiated babies to NICU was found 63.0% and 56.0% in group I and II respectively. The difference was statistically not significant between two groups. Faridpur Med. Coll. J. Jan 2020;15(1): 16-20

scholarly journals A randomized comparative study of effect of intramuscular valathemate bromide (epidosin) and intramuscular camylofin dihydrochloride (anafortan) on cervical dilatation in labour

2021 ◽  
Vol 10 (12) ◽  
pp. 4488
Author(s):  
Dinesh Mehra ◽  
Madhubala Chouhan ◽  
Shatendra Goyal
Keyword(s):  
Pain Relief ◽  
Comparative Study ◽  
Pain Score ◽  
Active Phase ◽  
Cervical Dilatation ◽  
Study Group ◽  
Medical College ◽  
Group I ◽  
Group Ii ◽  
Vertex Presentation

Background: Our aim is to search for a good cervical dilating agent which is not only more efficacious in cervical dilatation but also effective in relieving pain during labour with no or very little harmful effects on mother and foetus.Methods: The type of study was simple randomized comparative study. The present study was conducted in R. N. T. Medical College, Udaipur between October 2019 and December 2020. 118 patients were selected randomly. Two groups were made each consisting of 59 patients. First group received intramuscular camylofin dihydrochloride, second group received intramuscular (IM) valethamate bromide. Patients included in study group were: primigravidae/multigravidae, singleton full term gestation (37-40 weeks) with vertex presentation, cervical dilatation of ≥3 cm and patient excluded from study group with preclampsia, eclampsia, antepartum haemorrhage, any obstetric complications: cephalo pelvic disproportion, abnormal presentations.Results: Mean duration of active phase of first stage of labor was shorter in group I (313.17 minutes) than in group II (356.3 minutes) but not statistically significant. Mean cervical dilatation rate was significantly more in group I (2.02 cm/hour) than group II (1.81 cm/hour). Anafortan was effective in pain relief with mean pain score 5.31±1.06 while mean pain score for epidosin group was 7.37±1.07.Conclusions: In our study we observed that intramuscular camylofin dihydrochloride (anafortan) was more efficacious than IM valethamate bromide (epidosin) in shortening the duration of labor as well as in pain relief.

scholarly journals Laparoscopy versus laparotomy in the treatment of benign ovarian cyst

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Humaira Akram ◽  
Sohail Khurshid Lodhi ◽  
Tabinda Rana
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Ovarian Cyst ◽  
Preoperative Evaluation ◽  
Normal Activity ◽  
Group I ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Laparoscopic Fenestration ◽  
Group Ii

Objective: To compare laparoscopy with laparotomy in the treatment of benign ovarian cyst in women under 40 years of age. Design: Experimental. Place and duration of study: The study was conducted over a period of one and half year from June 2003 to Nov 2004 in Obstetrics & Gynaecology Department, Unit-III, Lady Willingdon Hospital, Lahore. Subjects & Methods: The sixty consecutive patients of benign ovarian cysts who required surgical treatment underwent either Laparoscopy(group I). or laparotomy (group II). The laparoscopic fenestration, aspiration and cystectomies were performed in group I (30 patients). However, ovarian cystectomies, salpingo-oophorectomy and oophorectomy were performed by laparotomy in group II (30 patients). Results: The comparison was done with respect to duration of surgery intra-operative blood loss, time of mobilization, duration of hospital stay and amount of analgesia used, time to return to normal activity. The amount of analgesics used, time of mobilization, duration of hosp ital stay and time to return to normal activity was less (P<0.05) in Laparoscopy as compared to Laparotomy. There was statistically no significant difference in the duration of surgery, blood loss and post operative morbidity (P>0.05). Conclusion: With appropriate preoperative evaluation, laparoscopic surgery is safe and effective in treating benign ovarian cyst in women under 40 years of age where the risk of malignancy is low. It is associated with early mobilization, less use of analgesia, shorter hospital stay.

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