A Comparison of Subxiphoid and Intercostal Wound Pain in the Same Patients Following Thoracic Surgery

Background: There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual's subjective experience and therefore difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative time points in the same patients receiving both subxiphoid and intercostal incisions for thoracic disease. Methods: Data from 26 patients who received simultaneous combined intercostal and subxiphoid VATS were retrospectively analyzed from August 2019 to April 2020. All patients received same length subxiphoid and intercostal incisions with or without drain placements. A numerical pain rating scale was administered on postoperative days (POD)-1, POD-2, POD-Discharge, POD-30, POD-90, and POD-180.Results: Bilateral uniportal VATS was performed in 11 patients and unilateral multiportal VATS in 15 patients. In the unilateral VATS group, there were no significant differences in pain reported for subxiphoid and intercostal incisions. However, in the bilateral VATS group, subxiphoid wounds resulted in significantly higher mean pain scores on POD-1, POD-2, and POD-Discharge (p = 0.0003, 0.001, and 0.03, respectively) but lower pain scores on POD-90 (p = 0.03). Conclusions: In the bilateral VATS group, higher late (3 and 6 months) postoperative pain was associated with intercostal incisions as have been reported by previous studies. Interestingly, subxiphoid incisions were found to have higher early (Day 1, 2, and Discharge) postoperative pain than intercostal incisions. More research is needed to better understand the cause of pain in a surgical area previously not thought to be prone to pain.

Pengaruh pemberian minum jahe merah terhadap penurunan intensitas nyeri luka perineum pada ibu nifas di BPM Permata Bunda Tuban

One of the complications experienced by postpartum mothers is the presence of perineal wounds which can cause more severe pain effects (Sumiaty, 2017). One of the non-pharmacological ways to reduce pain is to drink red ginger. The purpose of this study was to determine the effect of drinking red ginger on reducing the intensity of perineal wound pain in postpartum women at BPM Permata Bunda Tuban. This research method is analytic experimental with a pre-experimental design (Static-group comparison design). The sample of this study was 44 postpartum mothers which were divided into 2 groups, namely the control and treatment groups, with a systematic random sampling technique. Data analysis used Sample t-Test (Independent sample t-Test). Based on the results of the study, it was obtained from 22 respondents (postpartum mothers) on the 5th day who were not given drinking red ginger, most of the respondents experienced moderate perineal wound pain as many as 13 (59.10%), while from 22 respondents (postpartum mothers) on the 5th day, most of those who were given red ginger had mild perineal wound pain as much as 12 (54.60%). The results of the analysis using the sample t-test test found that P of 0.000 is smaller than 0.05, then H1 was accepted that there was an effect of giving red ginger to decrease the intensity of perineal wound pain in postpartum mothers at BPM Permata Bunda Tuban

Clinical Study of MEBO Combined with Jinhuang Powder for Diabetic Foot with Infection

Background. To investigate the efficacy and safety of MEBO combined with Jinhuang powder for the treatment of diabetic foot with infection. Methods. From August 2015 to August 2019, patients with diabetic foot in our hospital were divided into the treatment group and control group. The treatment group was treated with moist exposed burn ointment (MEBO) combined with Jinhuang powder, while the control group was treated with MEBO only. Results. After one week of treatment, the effective rate in the treatment group was 100%, and the effective rate in the control group was only 76%. The difference between the two groups was statistically significant ( P < 0.05 ). The wound pain score was 2.40 ± 1.38 in the treatment group and 3.76 ± 1.85 in the control group. The difference was statistically significant ( P < 0.01 ). After one month of treatment, the effective rate of wound healing was 92.0% in the treatment group and 68% in the control group. The difference between the two groups was statistically significant ( P < 0.05 ). Conclusion. MEBO combined with Jinhuang powder is effective in treating diabetic foot with infection wound.

Electrical stimulation for pain reduction in hard-to-heal wound healing

Objective: Despite treatment advances over the past 30 years, the societal impact of hard-to-heal wounds is increasingly burdensome. An unresolved issue is wound pain, which can make many treatments, such as compression in venous leg ulcers, intolerable. The aim of this review is to present the evidence and stimulate thinking on the use of electrical stimulation devices as a treatment technology with the potential to reduce pain, improve adherence and thus hard-to-heal wound outcomes. Method: A literature search was conducted for clinical studies up to August 2020 reporting the effects of electrical stimulation devices on wound pain. Devices evoking neuromuscular contraction or direct spinal cord stimulation were excluded. Results: A total of seven publications (three non-comparative and four randomised trials) were identified with four studies reporting a rapid (within 14 days) reduction in hard-to-heal wound pain. Electrical stimulation is more widely known for accelerated healing and is one of the most evidence-based technologies in wound management, supported by numerous in vitro molecular studies, five meta-analyses, six systematic reviews and 30 randomised controlled trials (RCTs). Despite this wealth of supportive evidence, electrical stimulation has not yet been adopted into everyday practice. Some features of electrical stimulation devices may have hampered adoption in the past. Conclusion: As new, pocket-sized, portable devices allowing convenient patient treatment and better patient adherence become more widely available and studied in larger RCTs, the evidence to date suggests that electrical stimulation should be considered part of the treatment options to address the challenges of managing and treating painful hard-to-heal wounds.

Platelet-Rich Plasma: Optimal Use in Surgical Wounds

Activated platelets release a rich broth of growth factors involved in wound healing. One way to deliver activated platelets to wounds is in the form of platelet-rich plasma (PRP) harvested by centrifuging the patient’s venous blood after activating the platelets with collagen or calcium chloride and/or autologous thrombin, then delicately removing the supernatant, called platelet-poor plasma (PPP). Platelet-rich plasma is usually injected into the lesion and/or applied topically, then sealed in or over the wound using a moisture-retentive dressing. Platelet-rich plasma (often with PPP) has been applied at different times, depths, and frequencies to chronic and acute wounds using various PRP doses and vehicles to achieve widely differing results. Meta-analyses have reported that PRP improved healing rates of open diabetic foot ulcers and venous ulcers1,2 and may reduce pain and surgical site infection (SSI) incidence in open and closed acute surgical wounds. However, inconsistency in study methods and outcome measures limited consistency of pain and SSI results.1 No consistent effect on healing or deep SSI rates was reported as a result of adding 1 intraoperative dose of PRP in the surgical site before closing elective foot and ankle surgery incisions of 250 patients as compared with 250 similar patients receiving the same procedure without PRP.3 After decades of research, ideal parameters of PRP delivery and use on each type of wound remain unclear for improving SSI, acute wound pain, and healing outcomes. This installment of the Evidence Corner reviews 2 surgical studies that may provide clues about optimal PRP use. One triple-blind randomized clinical trial (RCT) focused on irrigation of freshly closed carpal ligament surgical incisions with PRP as compared with PPP.4 Another non-blind RCT explored the effect of injecting PRP into open pilonidal sinus excisions 4 days and 12 days after surgery.5

A Randomized Control Trial of Patient-Controlled Intravenous Analgesia (PCIA) with and Without a Background Infusion Using Sufentanil for Cesarean Section Analgesia

Purpose: Patient-controlled intravenous analgesia (PCIA) is an option for pain cesarean section analgesia. However, the effect of a background infusion on the analgesic requirements of parturients is still debated. In order to attempt to identify the optimal cesarean section analgesia infusion regime, we evaluated the benefit of the background infusion in this randomized study.Patients and methods: 60 Parturients had a PCIA analgesia protocol initiated consisting of a 0.5mL bolus, and compared 2 Groups: no background infusion, 6 min lockout time (Group A). 2 mL/h infusion, 10 min lockout time (Group B). The total amount of sufentanil consumed, two categories of pain scores, sedation score, postpartum hemorrhage, Injection/attempt (I/A) ratio, side effects, satisfaction were calculated for both groups.Results: Group B significantly reduce visual analog scale（VAS）pain scores 6, 12h. Group A and Group B were not significantly different regarding wound pain at rest (VAS-R) and uterine cramping pain (VAS-U) at postoperative 24, 36 hours. In terms of I/A, Group A was lower than Group B, there was no significant difference. Group B showed significantly higher satisfaction than Group A. Total consumption of sufentanil at 36 hours postoperative was much greater in Group B. Group B can significantly reduce the postpartum hemorrhage within 1 hour. The minimal respiration rates were not significantly different among groups. The side effect were not observed among groups. All parturients had the same Ramsey sedation score.Conclusion: In comparison with the without background infusion, total consumption of sufentanil at 36 hours postoperative was much greater in the background infusion, but it can significantly reduce the uterine contraction pain and wound pain of 12 hours after cesarean section, significantly improve patient satisfaction, reduce the postpartum hemorrhage within 1 hour, and does not increase the incidence of PONV and respiratory depression in parturients.

The effectiveness of cold compresses for reducing perinium wound pain

The purpose of this study is to determine the relationship between the independent variable and the dependent variable. Observe before and after cold compress on the sample to be selected. Determines whether Ho will be accepted or rejected and Ha accepted, and vice versa. The number of samples was 30 postpartum mothers with grade I and II episiotomy wounds. The results of the univariate analysis showed that from 30 respondents, 0% of respondents who experienced very mild pain became 11 respondents (36.7%) after cold compresses, 15 respondents (50%) had mild pain to 13 (43.3%), pain moderate as many as 10 (33.3%) respondents to 6 (20%) respondents, severe pain as many as 5 respondents (16.7%) to 0 respondents. The result of p-value = 0,000, which means there is an effect of cold compresses on the healing of perineal wounds.