Effect of Elastic Abdominal Binder on Pain and Functional Recovery Following Gynecologic Cancer Surgery: A Randomized Controlled Trial

Background and Objectives: Clinicians have been using elastic abdominal binder for stabilizing incision site after major abdominal surgery. However, the benefits of that practice have never been formally assessed. The aim of this study was to examine the effects of the use of elastic abdominal binder on postoperative pain and recovery of gynecologic cancer patients. Materials and Methods: One-hundred and nine women diagnosed with cervical, endometrial, or ovarian cancer, who underwent open abdominal surgery were assigned randomly into two groups: intervention (56 patients) and control (53 patients). The women in the intervention group applied abdominal binder from postoperative day 1. For the control group, the women did not wear the binder or similar devices. The primary outcomes were pain and functional recovery. Subgroup analysis on participants age ≥ 50 was also performed. Results: For the entire study cohort, the baseline, postoperative day 1, and postoperative day 2 pain scores in the intervention group were significantly lower than the control group. However, there was no significant difference between the groups for postoperative day 3 pain score and for the change in pain scores from the baseline value. Of note, the age ≥ 50 subgroup represented a more balanced cohort with comparable baseline pain scores between the study groups. For this population, the pain scores for postoperative day 1–3 were significantly lower in the intervention group. The intervention group had a longer six-minute walking distance on postoperative day 3 with a trend toward a smaller difference in the day 3 distance from the baseline. Conclusions: The potential benefits of abdominal binder use in reducing postoperative pain and improving functional recovery after open gynecologic cancer surgery could be demonstrated only in those age ≥ 50.

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Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020583 ◽

2021 ◽

Vol 18 (2) ◽

pp. 583

Author(s):

Reem M. Alwhaibi ◽

Noha F. Mahmoud ◽

Mye A. Basheer ◽

Hoda M. Zakaria ◽

Mahmoud Y. Elzanaty ◽

...

Keyword(s):

Physical Therapy ◽

Lower Extremity ◽

Functional Recovery ◽

Intervention Group ◽

Chronic Stroke ◽

Post Treatment ◽

Control Group ◽

Stroke Patients ◽

Significant Difference ◽

Group Post

Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for “Cz-AR”, compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.

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Application of platysma muscle suture after thyroidectomy

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2020.8.4.103 ◽

2020 ◽

pp. 147-150

Keyword(s):

Postoperative Pain ◽

Wound Infection ◽

Intervention Group ◽

Control Group ◽

P Value ◽

Platysma Muscle ◽

Significant Difference ◽

Duration Of Surgery ◽

The Mean ◽

Length Of Hospitalization

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

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The association of the affordable care's Medicaid expansion on survival in gynecologic cancer: A National Cancer Database study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1501 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1501-1501

Author(s):

Anna Jo Smith ◽

Jeremy Applebaum ◽

Amanda Nickles Fader

Keyword(s):

Rural Women ◽

Gynecologic Cancer ◽

Intervention Group ◽

Control Group ◽

Cancer Type ◽

National Cancer Database ◽

Medicaid Expansion ◽

Difference In Differences ◽

Significant Difference ◽

One Year

1501 Background: Under the Affordable Care Act’s 2014 Medicaid expansion, more than 12 million Americans gained health insurance. Whether such gains in insurance improve survival in gynecologic cancer is unknown. This study aims to determine whether Medicaid expansion is associated with improved survival among women with gynecologic cancers. Methods: We conducted a retrospective cohort study using a difference-in-differences study design comparing insurance status, stage at diagnosis, delays in treatment, and one-year survival before and after the ACA’s Medicaid expansion in Medicaid expansion states (intervention group) compared to women in non-expansion states (control group). Using hospital-reported data from the 2010-2016 National Cancer Database, we compared outcomes overall for women ages 40-64 years old with endometrial, cervical, ovarian, or vulva/vaginal cancer and then stratified by cancer type, stage, race, and rural/urban status. We adjusted for patient (area-level income, area-level education, distance traveled for care, comorbidities), clinical (co-morbidities, grade) and hospital (academic facility) characteristics. Results: Our sample included 241,713 women with gynecologic cancer, 119,392 in expansion states and 122,321 in non-expansion states. Post-Medicaid expansion, there was a statistically significant 0.8 % increase in 1-year survival among patients in expansion states compared to non-expansion states (95% CI 0.1-1.5). There was also a significant reduction in uninsurance (-1.1%, 95%CI, --1.5, -0.7) and delays of 30+ days from diagnosis to treatment (-2.4%, 95%CI -3.4, -1.2). There was no significant change in early-stage diagnosis (0%; 95%CI -0.7-0.7). Improvements in one-year survival after Medicaid expansion were driven by ovarian cancer (difference-in-differences 2.2%, 95%CI 0.6-3.8) and in white women (difference-in-differences 0.8%, 95%CI 0.1-1.5), while there was no significant difference in one-year survival for non-white or rural women. Conclusions: The Affordable Care Act’s Medicaid expansion was significantly associated with 1-year survival and insurance access among patients with gynecologic cancer. Insurance expansion efforts in non-Medicaid expansion states may improve survival for women with gynecologic cancer.

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Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Nutrients ◽

10.3390/nu12010264 ◽

2020 ◽

Vol 12 (1) ◽

pp. 264 ◽

Cited By ~ 3

Author(s):

Ho Chiou Yi ◽

Zuriati Ibrahim ◽

Zalina Abu Zaid ◽

Zulfitri ‘Azuan Mat Daud ◽

Nor Baizura Md. Yusop ◽

...

Keyword(s):

Whey Protein ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Cancer ◽

Intervention Group ◽

Oral Feeding ◽

Control Group ◽

Early Oral Feeding ◽

Significant Difference ◽

The Impact

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

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A study of effect of topical anaesthetics on injection pain during immunization in infants

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20202542 ◽

2020 ◽

Vol 7 (7) ◽

pp. 1463

Author(s):

Magesh Kumar ◽

V. Venkateshwar

Keyword(s):

Intervention Group ◽

Injection Pain ◽

Control Group ◽

P Value ◽

Open Label ◽

Topical Anesthetic ◽

Vaccine Injection ◽

Pain Scores ◽

Significant Difference ◽

Group B

Background: Immunization is a necessary aspect of health care of children and injections are there for unavoidable. Many factors affect injection pain during immunization in infants. This study aims to see the effect of use of local anesthetics delivered by various modes for attenuation of vaccine related injection pain in infants and to compare them.Methods: An Open Label Four-Arm Randomized Control Trial of 300 healthy infants of age group 6 weeks to 6 months reported to immunization clinic for immunization with DPT-HiB-Hepatitis B combination vaccine were taken for study. The enrolled subjects were allocated into control group and intervention group (who were applied some form of local anesthesia).Results: Among the four groups of the patients studied we observed a statistical difference in the mean pain scores of the patients recorded at 15 second, 60 second and 5 min after vaccine injection (p value 0.0024 - 0.000). Group A (Infants with topical occlusive LA cream) showed minimum pain scores values at 15 second, 60 second and 5 min after vaccine injection, followed by Group C (Infants with topical LA spray with vapocoolant) whereas Control group (Infants not received any local anaesthesia) and Group B (Infants with topical LA spray without vapocoolant) exhibited the maximum pain scores.Conclusions: Topical occlusive local anesthetic cream and topical LA spray with vapocoolent, were found to be better than topical LA spray without vapocoolant or no topical anesthetic. Use of topical occlusive LA cream led to a lowest pain score. There was no significant difference in the profile of side effects following injection in the four group.

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The Effects of Moderate Neuromuscular Blockade Combined with Transverse Abdominal Plane Block on Surgical Space Conditions During Laparoscopic Colorectal Surgery: A Randomised Clinical Study

10.21203/rs.3.rs-820460/v1 ◽

2021 ◽

Author(s):

Fang Ke ◽

Zijin Shen ◽

Cheng Wu ◽

Lin Zhang ◽

Rong Dong

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Neuromuscular Blockade ◽

Intervention Group ◽

Ordinal Scale ◽

Control Group ◽

Sacral Promontory ◽

Pain Scores ◽

Significant Difference ◽

Space Conditions

Abstract Background Deep neuromuscular blockade may be beneficial on surgical space conditions during laparoscopic surgery. The effects of moderate neuromuscular blockade combined with transverse abdominal plane block (TAPB) on the surgical space conditions during laparoscopic surgery has not been described. We investigated if moderate neuromuscular blockade combined with TAPB would be associated with similar surgical space conditions compared with deep neuromuscular blockade. Methods Eighty patients undergoing elective laparoscopic surgery for colorectal cancer were randomly divided into two groups. The intervention group was treated with moderate neuromuscular blockade (train-of-four (TOF) count between 1 and 3) combined with TAPB (M group), while the control group was treated with deep neuromuscular blockade (D group), with a TOF count of 0 and a post-tetanic count (PTC) ≥ 1. Both groups received the same anesthesia management. The distance between the sacral promontory and the umbilical skin during the operation was compared between the two groups. The surgeon scored the surgical space conditions according to a five-point ordinal scale. Patients’ pain scores were evaluated eight hours after the operation. Results The 95% confidence intervals of the difference in the distance from the sacral promontory to the umbilical skin between the groups were − 1.45–0.77cm. According to the preset non-inferior standard of 1.5cm, (-1.45, ∞) completely fell within (-1.50, ∞), and the non-inferior effect test was qualified. There was no significant difference in the surgical rating score between the two groups. The dosage of rocuronium in group D was significantly higher than that in group M (P < 0.01). The M group had significantly lower pain scores than the D group eight hours after the operation (P < 0.05). Conclusions In laparoscopic colorectal cancer surgery, moderate neuromuscular blockade combined with TAPB can provide surgical space conditions similar to those of deep neuromuscular blockade, and at the same time, reduces the use of muscle relaxants, relieves postoperative pain within 4 hours after operation, shorten the time to extubation and stay in PACU. Trial registration: chictr.org.cn (ChiCTR2000034621), registered on 12, July, 2020

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Comparison of Intraoperative Infusion of Remifentanil versus Fentanyl on Pain Management in Patients Undergoing Spine Surgery: A Double Blinded Randomized Clinical Trial

Anesthesiology and Pain Medicine ◽

10.5812/aapm.115576 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Reza Shariat Moharari ◽

Shervin Shahinpour ◽

Negin Saeedi ◽

Elaheh Sahraei ◽

Atabak Najafi ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Randomized Clinical Trial ◽

Spine Surgery ◽

Intervention Group ◽

Morphine Consumption ◽

Control Group ◽

Scoliosis Surgery ◽

Canal Stenosis ◽

Significant Difference

Background: Remifentanil is an ultra-short-acting opioid which facilitates hemodynamic management. However, there are concerns about postoperative Remifentanil hyperalgesia because of its potent fast onset and offset. Objectives: The aim of this study was to determine visual analog scale (VAS), postoperative pain, and morphine used in two groups after spine surgery. Methods: In this randomized clinical trial study, 60 patients aged 18 - 60 years old, according to the American Society of Anesthesiology (ASA) I - II, who underwent spinal canal stenosis or scoliosis surgery, were divided into two groups. In the control group, patients received 0.07 - 0.1 µg/kg/h intraoperative Fentanyl infusion, and in the intervention group 0.1 - 0.2 µg/kg/min remifentanil was infused during the surgery. Both groups received 15 mg/kg intravenous Acetaminophen 20 minutes before the end of the surgery. Postoperative pain score and morphine consumption were measured 6, 12, 24, and 48 hours after discharge from the post-anesthesia care unit (PACU). Results: During the first 12 hours, VAS and morphine consumption were significantly higher in remifentanil group (P < 0.001). However, no significant difference was found between the two groups in morphine consumption 12 - 48 hours after surgery. Conclusions: These findings suggest that Remifentanil infusion during surgery may increase postoperative pain. Also, VAS and morphine consumption were higher during the first 12 hours.

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Evaluation of Intraperitoneal and Incisional Bupivacaine or Levobupivacaine for Postoperative Analgesia in Ovariohysterectomized Dogs

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.92570 ◽

2019 ◽

Vol 47 (1) ◽

Cited By ~ 1

Author(s):

Musa Korkmaz ◽

Oktay Yilmaz ◽

Zulfukar Kadir Saritas ◽

Ibrahim Demirkan ◽

Jerzy Jaroszewski

Keyword(s):

Postoperative Pain ◽

General Anaesthesia ◽

Postoperative Analgesia ◽

Abdominal Cavity ◽

Companion Animals ◽

Assessment System ◽

Cervix Uteri ◽

Control Group ◽

Pain Scores ◽

Significant Difference

Background: Ovariohysterectomy (OHE) is the most commonly performed elective surgical procedure in companion animals. OHE offers benefits of control of population and decreased risk of potentially life-threatening diseases such as mammarian tumours and pyometra. Traditional OHE intervention causes inflammation and pain due to trauma during organ manipulation. The purpose of this study was to compare the effect of intraperitoneal and incisional administration of bupivacaine (BP) or levobupivacaine (LP) on postoperative analgesia in dogs undergoing the OHE procedure.Materials, Methods & Results: A total of 24 mix-breed bitches aged between 1 - 3 years and weighed 19 - 20 kg were used in this study. The animals were divided into three groups as control (n = 8), BP (n = 8) and LP group (n = 8). The animals were kept under surveillance at the hospitalisation unit of the animal hospital for one day before the elective OHE. The dogs were fasted for 12 h before the surgery, with adlib water consumption. Atropine sulphate 0.045 mg/kg was administered subcutaneously approximately 30 min before general anaesthesia. Midazolam (0.3 mg/kg) was intravenously injected into all dogs for pre-anaesthetic medication. After sedation, anaesthesia was induced with propofol (4 mg/kg, IV) and then the dogs were orotracheally intubated using cuffed endotracheal tubes. General anaesthesia was maintained by administration of 2% isoflurane. The ventral abdomen was prepared aseptically for OHE following the general anaesthesia. All animals were operated on by the same surgeon. During surgery, sprayed bupivacaine 0.5% (4.4 mg/kg) with an equal volume of saline in BP group, levobupivacaine 0.5% (4.4 mg/kg) with an equal volume of saline in LP were then applied over the ovaries, uterine broad ligaments and cervix uteri. After removal of the uterine body, either LP or BP was sprayed to left and right, or cranial and caudal parts of the abdominal cavity. Finally, the incision line was sprayed before closing the skin. The control group received only sprayed saline. The pain evaluation was carried out with modified Melbourne pain scoring scale. To determine cortisol concentrations, blood samples were taken before anaesthesia induction (baseline) and postoperative 0, 0.5, 1, 2, 4, 6, 12 and 24 h. Postoperative pain scores were higher in the control group than BP and LP groups following surgery at 30 min, 1st, 4th, and 6th h. In all groups, cortisol levels increased postoperatively, whereas they decreased more rapidly in BP and LP groups. There was a steady increase at postoperative 0 min, 30 min, 1st, 2nd, 4th and 6th h in the control group and at postoperative 0 min, 30 min and 1 h in BP and LP groups (P < 0.05).Discussion: Intraperitoneal and incisional bupivacaine shows significantly superior postoperative pain management benefits after the closure of skin, compared to untreated dogs and it is also superior to lidocaine treatment at 0.5 h following the visual analogy pain assessment system. In the present study, the observation of lower pain scores in BP group at 0.5, 1, 4 and 6 h as compared to the control group was similar to findings of other studies. LP group also showed decreased pain scores at above-mentioned h without any significant difference. However, only in LP group, pain scores at 24 h were lower than postoperative pain scores. In conclusion, it is suggested that sprayed intraperitoneal and incisional BP and LP are very effective for preventing postoperative pain ovariohysterectomized dogs.

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Efficacy of Listening to Murattal in Reducing the Pain Experienced by ICU Patients

Jurnal Keperawatan Soedirman ◽

10.20884/1.jks.2021.16.3.1567 ◽

2021 ◽

Vol 16 (3) ◽

Author(s):

Iwan Purnawan ◽

Arif Imam Hidayat ◽

Eman Sutrisna ◽

Galih Noor Alivian ◽

Ikit Netra Wirakhmi

Keyword(s):

Healing Process ◽

Intervention Group ◽

Sampling Technique ◽

Wilcoxon Test ◽

Pharmacological Intervention ◽

Control Group ◽

Control Group Design ◽

Icu Patients ◽

Pain Scores ◽

Significant Difference

<p>Background: Pain is one of the main problems in patients with ICU. Inadequate handling can cause adverse effects such as unstable hemodynamics, trigger stress, and thus hinder the healing process. Non-pharmacological intervention is needed to help manage pain in patients with ICU. Purpose: This study aims to identify the effect of murottal listening to pain in ICU patients. Methods: This is a quasi-experiment with pre-test and post-test with control group design. The sampling technique was simple random sampling, consisting of 40 respondents divided into two groups. The Critical Pain Observation Tool (CPOT) is used to measure pain. Statistics using a paired t-test, Wilcoxon-test, and Mann Whitney. Results: Significant decreases in pain scores were observed in treatment groups of 4, 5 to 4,0; p = 0,013. In the control group, there was a significant decrease in pain scores from 4,8 to 4,3; p = 0,001. There was no significant difference between the median decrease in pain in the intervention group (0.001 (-1-2.0) and the control group (0.001 (0.001-1.0)) with p = 0.242. Conclusion: Murottal listening does not have a significant effect on pain in patients of ICU.</p>

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Effect of structured training program on arm dysfunction, lymphedema and quality of life after breast cancer surgery

Journal of the Pakistan Medical Association ◽

10.47391/jpma.101 ◽

2021 ◽

pp. 1-16

Author(s):

Havva Bozdemir ◽

Dilek Aygin

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Intervention Group ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Control Group ◽

Sf 36 ◽

Significant Difference ◽

Quality Of Life Scale

Abstract Objective: The aim of this study the effect of the education given according to daily living activities (DLA) model on arm dysfunction, lymphedema and quality of life in patients undergoing breast cancer surgery. Interventions/Methods: In the design of the research, a randomized controlled experimental model with recurrent measurement was used. The data were collected from 60 patients (control group: 30, Intervention Group: 30) at a teriary hospital. In Research ,Patient Information Form, SPOFIA, KATZ-DLA indeks, arm, shoulder and hand injuries scale (DASH) and quality of life scale short form (SF-36) were used. Three interviews (1st week, 1st and 3rd month) were performed after surgery with patients. Analysis of data; independent T-Test, Chi-squared and Repeated Measures ANOVA were utilized. Results: SPOFIA, DASH and KATZ, GYA scale averages decreased by the time, SF-36 were found to increase the average score. In the intervention group, the measurements of the upper arm circumference are significantly better than the control group and In terms of SPOFIA3, DASH2 and DASH3 scale averages, there is a statistically significant difference between the groups (P < 0.05). Conclusions: KATZ, SPOFIA, SF-36, DASH scale score averages were recovered as the time elapsed after the operation increased. Intervention group was found to recover more early. Implications for Practice: The education programme is effective in the prevention of arm dysfunction and lymphedema and in improving quality of life. Keywords: Breast cancer, lymphedema, daily life activity model, quality of life, Continuous...

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