Postoperative pain scores and opioid consumption in opioid-dependent patients with cancer after intraoperative remifentanil analgesia: A prospective case-controlled study

Background: Opioid dependency is becoming increasingly common among surgical patients with cancer, and can lead to inadequate pain relief during the initial postoperative period. No guidelines are currently available for the management of perioperative and postoperative morphine administration in these patients. As a first approach, the authors assessed the opioid requirements of these patients during the early postoperative period.Methods: A group of 35 consecutive surgical patients with cancer on opioid therapy (opioid-dependent group) for cancer pain were compared to a matched group of 44 surgical opioid-naive patients (control group). All patients underwent major head and neck or abdominal surgery. The following parameters were recorded and compared: preoperative and postoperative morphine consumption, patient-controlled analgesia records and Visual Analog Scale scores, intraoperative remifentanil and desflurane consumption, Bispectral Index monitoring values, heart rate, and blood pressure.Results: Remifentanil requirements were significantly higher (1.4-fold) in the opioid-dependent group compared to the control group (p < 0.05). On postoperative day 1, morphine requirements were significantly higher in the opioid-dependent group (2.3-fold) compared to the control group (p < 0.05). Baseline heart rate was significantly higher in the opioid-dependent group and this difference remained significant during surgery, no significant difference in blood pressure was observed between the two groups.Conclusion: This study shows a 40 percent increase of intraoperative remifentanil requirements in opioid-dependent patients during cancer surgery. Morphine requirements during the postoperative period were increased by up to 140 percent.

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A randomized controlled study of intravenous esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200788 ◽

2020 ◽

Vol 8 (3) ◽

pp. 1103

Author(s):

Ninad Deepak Chodankar ◽

Bhagyashree Shivde

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anaesthesia ◽

Endotracheal Intubation ◽

Elective Surgery ◽

Cardiovascular Responses ◽

Controlled Study ◽

Control Group ◽

Significant Difference ◽

Control Group Group

Background: Objective is to compare the efficacy of intravenous Esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation with control group.Methods: Study was done on 60 adults, ASA grade I or II normotensive patients, undergoing elective surgery under general anaesthesia and willing to participate. These patients where be randomly allocated in to either group C (Control) or E (Esmolol). Group ‘C’ Control group. Group ‘E’, patients were given intravenous Esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. All patients were premedicated, induced and intubated using Thiopentone and Succinyl Choline as per the protocol. Heart Rate (HR), SBP, DBP and MAP were recorded at baseline (taken half an hour prior to anaesthesia), Before sedation, After induction but before intubation, Immediately after endotracheal intubation and Thereafter at 1, 2, 3, 4, 5 and 10 minutes.Results: Heart rate was lower in Group E as compared to Group C, and there was statistically significant difference immediately after intubation till 4 minutes after intubation. While Blood pressure was lower in Group E as compared to Group C, and there was statistically significant difference only immediately after intubation.Conclusions: In Normotensive patients requiring general anaesthesia with laryngoscopy and intubation, authors conclude that intravenous Esmolol 1.5 mg/kg attenuated Heart rate response but fails to satisfactorily prevent rise in blood pressure.

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Optimization of postoperative management of patients undergoing functional endoscopic sinus surgery

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2018-1-26 ◽

2018 ◽

pp. 26-31

Author(s):

Sergey Bezshapochny ◽

Andrey Loburets ◽

Valery Loburets

Keyword(s):

Nasal Cavity ◽

Postoperative Period ◽

Sodium Hyaluronate ◽

Sinus Surgery ◽

Control Group ◽

Nasal Breathing ◽

Traditional Therapy ◽

Significant Difference ◽

Water Salt ◽

Experimental Group

Topicality: The result of surgical treatment depends largely on the chosen method of management of the postoperative period, the main purpose of which is to reduce the effects of surgical trauma. Despite the wide variety of drugs for local and systemic use, the question of pharmacotherapy of the operated sinus remains open to this day. The main properties that a modern drug should possess are safety and high clinical efficacy. Aim: to study the clinical efficacy of topical application of a complex preparation based on a saline solution containing sodium hyaluronate and dexpanthenol in patients with chronic sinusitis after functional endoscopic sinus surgery (FESS). Materials and Methods: Clinical and laboratory studies were conducted on 47 patients with chronic rhinosinusitis who underwent surgery using the FESS technique. Patients were divided into 2 groups according to the principle of the postoperative period. Patients of research group (n=21), except for traditional therapy, was used locally NASOMER (a preparation based on a water-salt solution containing sodium hyaluronate and dexpanthenol); to the control group (n=26) patients entered, in the postoperative period received traditional therapy. Traditional therapy included a toilet of the nasal cavity, the use of short-course topical decongestants, irrigation of the nasal cavity with water-salt solutions. Criteria of clinical effectiveness: data of endoscopy of the nasal cavity, rhinomanometry, activity of the mucociliary transport system. The effectiveness of functional research methods in the postoperative period was determined on the 7th and 14th day of treatment. Results: On the 3rd day of the study, an increase in the swelling of the nasal cavity was observed in patients of both clinical groups, correlated with difficulty in nasal breathing. On the 7th day, a decrease in edema was observed in patients of both groups, but in the experimental group, the index of nasal breathing, according to rhinomanometry, was significantly (p<0.05) different from the control group, and was respectively 1.54±0.14 and 2.04±0.19 kPa/l*s. On the 14th day of the study, no significant difference was observed between these indicators. When studying the activity of the ciliated epithelium of the mucous membrane of the nasal cavity, it was proved that patients of the experimental group on day 7 after surgery showed a statistically significant difference in this indicator compared to the control group (17.8±1.0 and 22.7±2.1 min. respectively). Conclusions: The use of NASOMER after surgical intervention in patients with chronic rhinosinusitis contributes to more effective treatment compared with traditional therapy, as evidenced by the rapid recovery of the main functional parameters according to active posterior rhinomanometry and mucociliary clearance. Based on the results of the studies performed, the use of NASOMER for pharmacotherapy in the postoperative period is recommended for patients who have undergone rhinosurgical interventions with the aim of reducing the period of postoperative rehabilitation as an effective anti-inflammatory and wound-healing agent.

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Anesthetic Effect of Compound Artevacaine Hydrochloride in Patients Undergoing Oral Implantation

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i4.2373 ◽

2021 ◽

Vol 5 (4) ◽

pp. 220-224

Author(s):

Chengxi Chi ◽

Mengmeng Zhao ◽

Jiajing He ◽

Yanli Wang

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Operation Time ◽

Control Group ◽

Study Group ◽

Research Subjects ◽

Implant Surgery ◽

Anesthetic Effect ◽

Significant Difference ◽

Oral Implant

Objective: To investigate and analyze the anesthetic effect of compound artevacaine hydrochloride in patients undergoing oral implantation. Methods: In this study, 60 patients receiving oral implant surgery in our hospital were selected as the research subjects, and the operation time was from July 2019 to March 2021. Patients were randomly selected and divided into groups for the study. 30 patients receiving lidocaine hydrochloride anesthesia were used as the control group, and 30 patients receiving compound artevacaine hydrochloride anesthesia were used as the research group. The anesthetic effect and safety of the two groups were compared and analyzed. Results: The anesthetic effect of the study group was significantly better than that of the control group (P < 0.05). The blood pressure and heart rate in the study group were significantly lower than those in the control group (P < 0.05). There was no significant difference in blood pressure and heart rate between the two groups before anesthesia (P > 0.05). There was no significant difference in the incidence of ADR between the two groups (P > 0.05). Conclusions: For patients undergoing oral implant surgery, choosing compound artevacaine hydrochloride as anesthetic drug has obvious anesthetic effect and can stabilize patients' life indexes. The anesthetic effect is obvious, and there is no obvious adverse reaction, and the clinical value is obvious.

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Assessment of the quality of life of orthodontic and surgical patients. Analysis of the factors that motivate the initiation of treatment within the masticatory system

Journal of Education, Health and Sport ◽

10.12775/jehs.2021.11.06.013 ◽

2021 ◽

Vol 11 (6) ◽

pp. 120-136

Author(s):

Justyna Oliwia Szpyt ◽

Magdalena Gębska

Keyword(s):

Quality Of Life ◽

Open Bite ◽

Surgical Patients ◽

Control Group ◽

Self Confidence ◽

Lower Canine ◽

Significant Difference ◽

The Face ◽

Masticatory System

IntroductionAccording to Angle's classification, a correct bite should have, inter alia, the following regularities: the median line of the face should coincide with the line between the central incisors of the upper and lower arches, the lower incisors should be overlapped by the incisal edges of the upper incisors, the top of the canine in the upper arch is inserted between the lower canine and the tangent premolar, each tooth is in contact with two opposing teeth, adjacent teeth both in the upper and lower arch are in contact with each other. Any deviation from these rules may indicate the presence of a malocclusion. We can distinguish here, for example: posteroclusion, open bite, retrusive occlusion, protrusive occlusion, supraclusion bite. They seem to be important not only in terms of functionality, but also psychology. Research shows that the correction of mandibular prognathism increases the level of self-confidence and self-acceptance, which may improve the quality of life of patients.Purpose of researchThe aim of the study was to check the quality of life of orthodontic and surgical patients as well as what factors motivate these people to start treatment in the area of the masticatory system.Material and methods208 people aged 18 to 55 participated in the survey. They were both people with malocclusion and no malocclusion, who constituted the control group. The questionnaire was created on the basis of standardized OQLQ and OHIP-14 questionnaires. It also included questions about the factors that motivate to start treatment in the masticatory system.ResultsThe most common malocclusion among the respondents was progenia (58.8%), followed by retrogenia (34.3%), then open bite (4%) and posteroclusion (2.9%). According to the OHIP-14 form, statistically significant (p <.0001) higher quality of life was seen in people without a masticatory organ defect, compared to people with the malocclusion. A statistically significant difference (p <.0001) between people with present or recent malocclusion (M = 54.29, SD = 16.71) and people without malocclusion (M = 31.93, SD = 18.31) was also visible in the study with using the OQLQ questionnaire.ConclusionsA malocclusion worsens the comfort and quality of life.Incorrect bite, face and smile aesthetics as well as psychological aspects are the most important factors motivating to undertake surgical and orthodontic treatment.Bruxism and facial pain are not factors prompting the initiation of treatment of malocclusion.

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Evaluation of red cell distribution width (RDW) as a septic marker in comparison with clinical scores and C-reactive protein

QJM ◽

10.1093/qjmed/hcab086.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ali Ahmed Naga ◽

Mohammed Ismaeil Abdel Fattah ◽

Walid Hamed Nofal ◽

Mohammed Abd-elsalam AlMenshawe

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Distribution Width ◽

Clinical Scores ◽

Group I ◽

Significant Difference ◽

Sepsis And Septic Shock

Abstract Background Challenges of diagnosing and treating sepsis only seem more difficult as incidence increases, patients become older and sicker, and pathogenic organisms evolve. New understanding of inflammatory mediators and pathways, immunity, and genetic variability in this disease state suggests that the current definitions of SIRS, sepsis, severe sepsis, and septic shock are oversimplified. Objective The aim of our study is to evaluate the level of RDW, CRP and clinical scores "SOFA and APACHI" as markers in patients with sepsis and their levels on the outcome and resolution of sepsis in ICU. Methodology We conducted a prospective observational controlled study on 90 adult persons of both sex, 45 of them are adult patients and served as the study group (Group I), and the other 45 are healthy adult volunteers and served as the control group (Group II). The study group represented patients admitted to the ICU of Intensive Care Unit at Damanhour Medical National Institute who fulfilled the diagnostic criteria for sepsis, severe sepsis and septic shock on arrival to ICU according to the SCCM/ ESICM/ ACCP/ ATS/SIS International Sepsis Definitions Conference. Results. In the present study we found that CRP measured on admission was not a predictor of mortality, while that measured at day 5 and day 10 predicted mortality, where there was no statistically significant difference in CRP levels between survivors and non-survivors at the day of admission while there were statistically significant differences between survivors and non survivors according to CRP levels at day 5 (p = 0.001*) and at day 10 (p = 0.001*). It was found also that there were statistically significant differences between survivors and non-survivors according to RDW at day 1(p = 0.011*) and at day 5(p = 0.009*), at day 10 was found there was no statistically significant difference between survivors and non-survivors (p = 0.338). Conclusion RDW is a new promising cheap and readily available biomarker that can be able to diagnose patients with sepsis with accuracy comparable to CRP. Also, RDW at admission is able to predict mortality.

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Modified Pro-Self Pain Control to Increase Activity in Patients with Colorectal Cancer

Nurse Media Journal of Nursing ◽

10.14710/nmjn.v7i1.15128 ◽

2017 ◽

Vol 7 (1) ◽

pp. 56

Author(s):

Khoirunnisa’ Munawaroh ◽

Untung Sujianto ◽

Mardiyono Mardiyono

Keyword(s):

Colorectal Cancer ◽

Experimental Design ◽

Activities Of Daily Living ◽

Pain Control ◽

Daily Living ◽

Intervention Group ◽

Control Group ◽

Patients With Cancer ◽

Katz Index ◽

Significant Difference

Background: Barriers to performing activities of daily living are common complaints of patients with cancer. One of the factors causing these barriers is pain. A modified pro-self pain control is a method used to enhance the patients’ ability to cope with pain to increase their activity.Purpose: This study aimed to evaluate the modified pro-self pain control to increase activity in patients with colorectal cancer undergoing chemotherapy.Methods: The present study employed an experimental design. Patients with colorectal cancer undergoing chemotherapy were randomly assigned to the intervention group (n=24) and the control group (n=24). The patients in the control group were given a standard hospital intervention, while the patients in the intervention group were given the modified pro-self pain control for nine days. The data were collected using the instrument of KATZ index and analyzed using the independent t-test.Results: The result of this study showed that there was a higher increase of activity among the patients in the intervention group than in the control group. Independent t-test showed that there was a significant difference between the intervention group and the control group (p=0.00).Conclusion: The modified pro-self pain control was found more effective to increase the activity in patients with colorectal cancer undergoing chemotherapy than that of the standard hospital intervention.

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A Prospective Clinical Evaluation of the Effects of Intraoperative Systemic Anticoagulation in Patients Undergoing Arteriovenous Fistula Surgery

The American Surgeon ◽

10.1177/000313481007601020 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1112-1114 ◽

Cited By ~ 5

Author(s):

Bonnie R. Wang ◽

Vincent L. Rowe ◽

Sung Wan Ham ◽

Sukgu Han ◽

Kaushal Patel ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Postoperative Bleeding ◽

Bleeding Complications ◽

Controlled Study ◽

Control Group ◽

Heparin Group ◽

Av Fistula ◽

Fistula Surgery ◽

Significant Difference ◽

The Difference

No standard presently exists for the use of systemic heparin during angioaccess surgery to decrease the incidence of postoperative thrombotic complications. Our objective was to study the effects of intraoperatively administered heparin on 30-day patency and postoperative bleeding complications in patients undergoing autogenous arteriovenous (AV) fistula surgery. A prospective, double-blinded, randomized controlled study was performed on 48 patients undergoing AV fistula creation from April 2007 through November 2009. Of the 48 patients, 22 were randomized to the control group and received no heparin. Twenty-six were randomized to receive heparin (75 units/kg intravenously) before clamping of the artery. There was no significant difference in 30-day patency between the heparin and control groups (92% vs 86%, P = 0.65), respectively. Three patients (12%) developed hematomas in the heparin group compared with one (5%) in the control group; however the difference was not statistically significant ( P = 0.61). The results suggest that intraoperative administration of heparin has no statistically significant effect on 30-day patency rates or postoperative bleeding complications. Larger trials with longer term follow-up and assessment of maturation rates are needed to determine the effect of intraoperative anticoagulation on these outcomes of arteriovenous fistula surgery.

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Acupuncture and Postoperative Vomiting in Day-Stay Paediatric Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x9602400607 ◽

1996 ◽

Vol 24 (6) ◽

pp. 674-677 ◽

Cited By ~ 20

Author(s):

K. L. Schwager ◽

D. B. Baines ◽

R. J. Meyer

Keyword(s):

Adult Population ◽

Acupuncture Point ◽

Controlled Study ◽

Control Group ◽

Postoperative Vomiting ◽

Double Blind ◽

Paediatric Patients ◽

Transcutaneous Stimulation ◽

Significant Difference ◽

Stimulation Of

The stimulation of the acupuncture point P6 has been used to prevent nausea and vomiting in the adult population. It has, however, been subject to limited comparative evaluation in children. We proposed that stimulation of P6 and the analgesic point Li4 would reduce the incidence of postoperative vomiting. Eighty-four unpremedicated paediatric patients having day-stay surgery (circumcision or herniotomy/orchidopexy) were included in a randomized, double-blind, placebo-controlled study of transcutaneous stimulation of P6 and Li4 or no stimulation. The incidence of vomiting was recorded for 24 hours postoperatively. There was no statistically significant difference in total postoperative vomiting in those patients who were stimulated, compared with the control group (P=0.909), or between any group for postoperative vomiting in the recovery ward, day-stay ward or at home. For all groups, vomiting was more common within the first four hours and more likely to occur in the day-stay ward.

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Application of quality control circle in the treatment of moderate cancer pain in inpatients

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz214 ◽

2020 ◽

Vol 50 (5) ◽

pp. 581-585

Author(s):

Yehuan Liu ◽

Beibei Lin

Keyword(s):

Quality Of Life ◽

Quality Control ◽

Cancer Pain ◽

Pain Control ◽

Management Tool ◽

Control Group ◽

Observation Group ◽

Patients With Cancer ◽

Significant Difference

Abstract Context Pain is one of the most common and intolerable symptoms in cancer patients. But cancer pain control is still negative in China. Objectives This paper explores the application of quality control circle in the treatment of cancer pain in inpatients to improve the quality of life of patients with cancer pain. Method Established a quality control circle group to analyze the current status of cancer pain control in inpatients with moderate cancer pain, set goals, formulate corresponding countermeasures and implement and review them in stages. The plan-do-check-act method was cyclically applied. The Brief Pain Inventory was used to evaluate the cancer pain status of patients with cancer pain hospitalized before (January to April 2016) and after (September to December 2016) the implementation of quality control circle activities. Results The pain control effect of the observation group was significantly better than that of the control group. The mean (standard deviation) of pain severity and pain interference in the observation group were significantly lower than those in the control group (6.21 [2.86] vs 4.31 [2.25], 10.54 [4.10] vs 7.25 [3.77]). There was significant difference after the implementation of quality control circle (P < 0.01). Conclusion Quality control circle activities are used to manage patients with cancer pain, to improve the situation of pain control and to improve the quality of life of patients. This management tool and method is worthy of clinical promotion and application.

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Physiotherapy protocol during initial postoperative period of arthroscopy in horses

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-5655 ◽

2018 ◽

Vol 38 (12) ◽

pp. 2201-2206

Author(s):

Fernanda C. Stievani ◽

Thais S.L. Machado ◽

Kaio B. Bezerra ◽

Marilene M. Silva ◽

Raquel Y.A. Baccarin ◽

...

Keyword(s):

Synovial Fluid ◽

Physical Examination ◽

Postoperative Period ◽

Serum Amyloid A ◽

Serum Amyloid ◽

Control Group ◽

Physical Analysis ◽

Amyloid A ◽

Significant Difference ◽

Significant Change

ABSTRACT: This study evaluated the effects of a physiotherapy protocol applied in joints with osteochondritis dissecans submitted to arthroscopy. Twelve horses totaling twenty joints were used and divided into two uniform groups, according to articular lesion grade. Treated Group (TG) received the physiotherapy protocol (cryotherapy, passive rage motion and controlled exercise) that initiate just after anesthetic recovery and extended for five days. Control Group (CG) remained resting in stall during the same period. Physical examination and synovial fluid analysis were used to evaluate the treatment. The synovial fluid examination consisted of physical analysis (color, aspect, and viscosity), mucin clot evaluation, Serum Amyloid A, Prostaglandin E2 and urea concentration. Synovial samples were collected by arthrocentesis at the beginning of the surgical procedure (D1), 48 hours (D3) and 96 hours (D5) after surgery. Before arthroscopy and daily during the postoperative period joints were evaluated by physical exam: superficial temperature (°C), range of motion (degrees) and circumference (centimeters). The joint physical examination showed no significant difference between groups and neither along the days for the same group. The parameters of synovial fluid showed difference over the moments in each group but didn’t have difference between groups. Color and aspect had the same patterns across moments, in CG fluid had significant change when compared D1 with D3 (color and aspect: p<0.001) and D5 (color: p<0.001; aspect: p<0.05) becoming mostly bloody and cloudy in D3 and D5. However in TG the difference was significant just between D1 and D3 (color and aspect: p<0.05), showing an improvement of synovial fluid in D5 (color and aspect: p>0.05). Viscosity and mucin clot evaluation showed significant change in CG between D1 and D3 (viscosity: p<0.01; mucin clot: p<0.05) and between D1 and D5 (viscosity: p<0.01;mucin clot: p<0.01). In TG no significant difference of viscosity and mucin clot was observed over the moments, showing an early improvement of synovial fluid quality. The Serum Amyloid A concentration showed an extremely significant increase in CG (p<0.001) when compared D1 (1217.13±664.47μg/mL) and D3 (42423.80±52309.31μg/mL). The comparison between D1 and D5 in CG, and across moments in TG, had no statistical difference. The PGE2 eicosanoid remained statistically unchanged all over the time. Urea showed significant increase in D3 when compared to D1 (p<0.001) in CG, and had no variation in TG. The physiotherapy protocol minimized the inflammatory mediators and provided minor alterations in synovial fluid after arthroscopy.

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