Postoperative Pain Management: Efficacy of Caudal Tramadol in Pediatric Lower Abdominal Surgery: A Randomized Clinical Study

Background: One of the methods of pain control after pediatric surgical procedures is regional techniques, including caudal block, despite their limitations. Objectives: In this study, the pain score and complications of caudal tramadol were evaluated in pediatrics following lower abdominal surgery. Methods: In this study, 46 children aged 3 to 10 years were allocated into two equal groups (R and TR) for performing caudal analgesia after lower abdominal surgery. The injectate contained 0.2% ropivacaine 1 mL/kg in the R group (control group) and tramadol (2 mg/kg) and ropivacaine in the TR group. The pain score, duration of pain relief, amount of paracetamol consumption, hemodynamic alterations, and possible complications at specific times (1, 2, and 6 hours) were evaluated in both groups. Results: No considerable difference was observed in the pain score between the groups in the first and second hours (P > 0.05). However, in the sixth hour, the TR group had a significantly lower pain score than the R group (P < 0.05). Compared to the R group, the TR group had a longer period of analgesia and lower consumption of analgesic drugs (P < 0.05). Heart rate and blood pressure differences were not significant between the two groups (P > 0.05). Similarly, the duration of operation and recovery time were not remarkably different between the two groups (P > 0.05). Complications had no apparent differences between these two groups, as well (P > 0.05). Conclusions: In this study, the addition of tramadol to caudal ropivacaine in pediatric lower abdominal surgery promoted pain relief without complications.

Consequences and predisposing factors of self-discharge against medical advice in plastic and hand surgery

Purpose Therapeutic success of surgical interventions is significantly affected by patients’ adherence. Patient autonomy can lead to unreasonable behavior. We analyzed the consequences and predisposing factors of patient self-discharge in a plastic and hand surgery cohort. Study design and setting Data was collected retrospectively in a case–control study with n = 73 patients who had self-discharged in a 10-year time period and n = 130 controls (discharge by the surgeon). Data was collected through the hospital information systems and a particular questionnaire. Statistical analyses were performed via chi-squared test and logistic regression analyses. Results Patients who self-discharged against medical advice had a significantly higher complication rate (p = 0.045) and a higher number of revision operations (p < 0.001). They were more often dissatisfied with the primary inpatient treatment (p < 0.05). Secondly, they lived more often in shared households (p = 0.002; OR 5.387 (1.734–16.732)) or had to take care of their children at home (p = 0.006; OR 1.481 (1.280–1.741)). There was a significantly lower pain score (NAS) on time of self-discharge (p = 0.002) as well as 24 h after self-discharge (p < 0.001) in self-discharged patients. Conclusion Self-discharge was associated with predisposing factors and poorer outcomes. Patient autonomy can lead to health-compromising behavior and patients should be counseled accordingly.

The Effect of Perioperative Vitamin C on Postoperative Analgesic Consumption: A Meta-Analysis of Randomized Controlled Trials

Because the analgesic effect of vitamin C against acute pain remains poorly addressed, this meta-analysis aimed at investigating its effectiveness against acute postoperative pain. A total of seven randomized controlled trials with placebo/normal controls were identified from PubMed, Cochrane Library, Medline, Google Scholar, and Embase databases. Pooled analysis showed a lower pain score (standardized mean difference (SMD) = −0.68, 95% CI: −1.01 to −0.36, p < 0.0001; I2 = 57%) and a lower morphine consumption (weighted mean difference (WMD) = −2.44 mg, 95% CI: −4.03 to −0.86, p = 0.003; I2 = 52%) in the vitamin group than that in the placebo group within postoperative 1–2 h. At postoperative 24 h, a lower pain score (SMD = −0.65, 95% CI: −1.11 to −0.19, p = 0.005; I2 = 81%) and lower morphine consumption (WMD = −6.74 mg, 95% CI: −9.63 to −3.84, p < 0.00001; I2 = 85%) were also noted in the vitamin group. Subgroup analyses demonstrated significant reductions in pain severity and morphine requirement immediately (1–2 h) and 24 h after surgery for patients receiving intravenous vitamin C but not in the oral subgroup. These findings showed significant reductions in pain score and opioid requirement up to postoperative 24 h, respectively, suggesting the effectiveness of perioperative vitamin C use. Further large-scale trials are warranted to elucidate its optimal intravenous dosage and effectiveness against chronic pain in the postoperative pain control setting.

Short-Term Clinical Outcomes after Using Novel Deeper Intubation Technique (DIT) of Ileus Tube for Acute Bowel Obstruction Patients

Background. The ileus tube has been widely used for the treatment of acute small bowel obstruction. However, it is difficult to get the tube sufficiently adjacent to the obstruction site due to various reasons. Methods. We developed a novel intubation technique, named Deeper Intubation Technique (DIT), by using the Zebra Urological Guidewire and digital gastrointestinal fluoroscopy, where we deepened the catheter intubation, and further compared the effects of DIT with the Traditional Intubation Technique (TIT) on the short-term clinical outcomes of 183 patients. Results. The average intubation depth of DIT apparently exceeds that of TIT (213.89±31.11 vs. 134.67±18.22 cm, P<0.001). Compared with patients in the TIT group, patients in the DIT group got a lower pain score (P<0.001), shorter recovery time for anal exhaust defecation (2.87±1.50 vs. 3.37±1.52 d, P=0.040), higher recovery rate in anal exhaust defecation (24 h, 16.8% vs. 5.7%, P=0.021; 48 h, 46.3% vs. 27.3%, P=0.009), better symptomatic remission rate and imaging relief rate (P<0.05), and increased drainage volume (1006.88±583.45 vs. 821.02±358.73 ml, P=0.009). Importantly, the emergency surgery rate in the DIT group was lower than that in the TIT group (3.2% vs. 13.6%, P=0.014). In addition, the DIT procedure was effective for patients with adhesive obstruction but not for cancerous and stercoral bowel obstruction. Conclusion. Compared to TIT, DIT produced better short-term clinical outcomes, indicating that DIT is a safe and feasible technique for the treatment of adhesive intestinal obstruction.

Comparing the Effect of Dexamethasone, Normal Saline, and Metoclopramide on Prevention of Postoperative Nausea, Vomiting and Pain in Patient Undergoing Laparoscopic Cholecystectomy or Open Appendectomy: A Randomized Clinical Trial

BACKGROUND: Post-operative nausea and vomiting (PONV) and pain are a common complications of adult patients undergoing anesthesia, but the incidence of these complications in patients go through laparoscopic cholecystectomy or open appendectomy is unknown. AIM: We conduct this study for comparing the effect of dexamethasone administration with normal saline and with metoclopramide for reducing these undesirable effects. DESIGN: This was a three-armed, parallel-group, double-blind, and randomized controlled clinical trial. METHODS: Seventy-two patients of both genders underwent elective surgeries (laparoscopic cholecystectomy or open appendectomy), randomly assigned to three groups: A dexamethasone-treated (8 mg) group (Group 1) (n = 24), normal saline-treated (100 ml) group (Group 2) (n = 24), and metoclopramide-treated (10 mg) group (Group 3) (n = 24). All nausea, vomiting, and pain episodes were recorded during 24 h after anesthesia in three time periods: 0–4, 4–12, and 12–24 h post-anesthesia. Results: Nausea and vomiting grading scale shows no significant difference when compare dexamethasone (Group 1) with normal saline (Group 2), significant difference when compare dexamethasone (Group 1) with metoclopramide (Group 3), and also significant difference when compare normal saline (Group 2) with metoclopramide (Group 3). Group 1 showed a lower pain score (p < 0.01 and p < 0.0001) compared with pain score recorded by patients of Groups 2 and 3, respectively. Besides that, Group 2 also showed a lower pain score (p < 0.0001) compared with pain score recorded by Group 3 patients. CONCLUSION: Dexamethasone has unimportant effect when compare with normal saline, more effectiveness than metoclopramide in reducing PONV. However, dexamethasone more effective in reducing pain when comparing with normal saline and metoclopramide for patients they underwent laparoscopic cholecystectomy or open appendectomy surgery under general anesthesia.

Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study

Background We analyzed the influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal surgery (RIRS) in a prospective, randomized controlled study. Methods Seventy patients who underwent RIRS from September 2015 to February 2017 were randomly allocated to general anesthesia (GA) or spinal anesthesia (SA) groups. Renal function was assessed using estimated glomerular filtration rate, and separate renal function was evaluated using nuclear medicine tests. Maneuverability and accessibility were evaluated after every surgery. All procedures were performed by a single experienced surgeon (SY Cho). Results Stone-free rate was higher in the GA (92.3%, 36 of 39) than the SA (71.0%, 22 of 31) (P = 0.019) group. Pain score was higher in the GA than in the SA group on the first postoperative morning (P = 0.025), but pain scores of the two groups were similar before discharge (P = 0.560). There were no differences in the changes of serum creatinine level (P = 0.792) and changes of estimated glomerular filtration rate (P = 0.807). Differences of separate renal function between operative and contralateral site increased significantly in patients under GA than under SA at postoperative 3 months (P = 0.014). Maneuverability and accessibility were better in SA with sedation than GA (P < 0.001). Conclusions RIRS under SA showed advantages in renal function change using renogram at postoperative 3 months and in lower pain score on the first postoperative morning. Performance of operator under SA was worse than that under GA and significantly improved with sedation. RIRS under SA showed advantages in lower pain score at postoperative first day. Trial registration Clinicaltrials.gov ID is NCT03957109, and registration date is 17th May 2019. This study was retrospectively registered.

Comparative study of laparoscopic hernia repair versus open hernia repair

Background: Hernia is the abnormal exit of an organ or fatty tissue, such as the bowel, through the weak wall of the cavity in which it normally resides. Repair of inguinal hernia is common surgical procedures. This study aims to compare between laparoscopic and open hernia repair. Method: Study is non randomized comparative study. Study includes 76 patients who had undergone surgery for hernioplasty. Among them 38 undergone laparoscopic hernioplasty and 38 undergone open hernioplasty from June 2016 to August 2018. Results: Mean hospital stay was 2.95 days in group 1 and 4.03 in group 2 .VAS was found to be 2.45 in group 1 and 5.71 in group 2 which is significantly low in group 1 patients with p<0.001. Duration of surgery is more in group 1 with mean duration of 94.08 minutes comparing to group 2 with mean duration of 43.55 minutes (with p<0.001). Conclusion: Laparoscopic hernia repair offers advantages over open repair in terms of less hospital stay and lower pain score for patient not contraindicated for general anesthesia and complicated hernia.

Single-incision laparoscopic surgery versus conventional laparoscopic appendectomy

Background: Single Incision Laparoscopic Surgery (SILS) is a new technique of minimally invasive surgery using a single incision to minimize all ports to one site, hence a single scar that can be strategically placed in the umbilicus for a perceived scar less abdomen.Methods: We report this study evaluating the possible advantages of SILS versus conventional laparoscopic appendectomy through a randomized controlled trial. The study population includes patients diagnosed as acute appendicitis. A total of 50 patients underwent appendectomy, patients were randomly assigned to either SILS appendectomy or conventional appendectomy in 1:1 ratio. Primary end points were operative time, complication rate, postoperative pain, post-operative hospital stay and patient satisfaction.Results: The pain scores measured at 48 hours were significantly lower in SILS group than conventional Lap appendectomy group. Patients had significant satisfaction score and lower pain score in SILS group than Lap appendectomy group measured at 6 weeks after appendectomy. However, the post-operative stay was similar in both the groups. There was no conversion to open appendectomy in both the groups. Patient satisfaction score in SILA was found to be higher than CLA. Operating times were similar and post-operative stay was apparently lower.Conclusions: SIL appendectomy is as safe and effective as conventional lap appendectomy.

Oxidative Stress as a Physiological Pain Response in Full-Term Newborns

This research paper aims to investigate if oxidative stress biomarkers increase after a painful procedure in term newborns and if nonpharmacological approaches, or sex, influence pain degree, and the subsequent OS. 83 healthy term newborns were enrolled to receive 10% oral glucose or sensorial saturation (SS) for analgesia during heel prick (HP). The ABC scale was used to score the pain. Advanced oxidation protein products (AOPP) and total hydroperoxides (TH) as biomarkers of OS were measured at the beginning (early-sample) and at the end (late-sample) of HP. The early-sample/late-sample ratio for AOPP and TH was used to evaluate the increase in OS biomarkers after HP. Higher levels of both AOPP and TH ratio were observed in high degree pain (4–6) compared with low degree pain score (0–3) (AOPP:p=0.049; TH:p=0.001). Newborns receiving SS showed a significantly lower pain score (p=0.000) and AOPP ratio levels (p=0.021) than those without. Males showed higher TH levels at the end of HP (p=0.005) compared to females. The current study demonstrates that a relationship between pain degree and OS exists in healthy full-term newborns. The amount of OS is gender related, being higher in males. SS reduces pain score together with pain-related OS in the newborns.