Local perianal nerve block versus spinal block for closed hemorrhoidectomy: a ramdomized controlled trial.

OBJECTIVE: To compare analgesic effectiveness, postoperative pain, complications, and patients' satisfaction between two randomly allocated groups--one group that had local perianal nerve block and another group that had spinal block following closed hemorrhoidectomy. MATERIAL AND METHOD: Sixty-seven patients underwent elective hemorrhoidectomy. Of these, 33 were randomly allocated to receive spinal anesthesia (SA) while 34 received perianal local analgesia (LA) with bupivacaine. Pain measurement at 6 and 24 hours following hemorrhoidectomy, the quantity of postoperative analgesic medication administered, patient's satisfaction and complications were recorded. RESULTS: Among the patients who had SA, there were 5 patients (15.2%) who developed hypotension during surgery. There was no reported case of hypotension among those who had LA. There was no significant difference in degree of median postoperative pain at 6 hours (LA: 38 vs. SA: 50 with VAS; p = 0.09) and at 24 hours (LA: 31 vs. SA: 35 with VAS; p = 0.35) between the two groups. Patients had a high satisfaction on both anesthetic methods. Patients in the SA group required more parenteral analgesics (p = 0.03) and had a higher incidence of urinary retention than those in the LA group (SA: 30.3% vs. LA: 8.8%, p = 0.03). CONCLUSION: Local perianal nerve block for hemorrhoidectomy is feasible and safe and superior to spinal block due to a lower incidence of post-op urinary retention and less requirement of parenteral analgesics post-op.

Factors affecting the utilization of pap smear screening program among nurses in the department of medicine, Siriraj Hospital.

Objective: To determine factors affecting the utilization of Pap smear screening program among nurses in the Department of Medicine, Siriraj Hospital. The surveyed factors included knowledge of cervical cancer, attitude toward Pap smear screening, and the negative attitude toward Pap smear procedures. Methods: This study was a cross-sectional survey. A questionnaire was distributed to 400 nurses in the Department of Medicine. Results: The response rate was 98.3% (393/400). 113 nurses were eligible to have Pap smear (aged > 35 years). Only 34.5% of them had regular Pap smear screening. Knowledge and attitudes between regular and non-regular groups were not different (p-value = 0.90 and 0.97, respectively). Most of nurses had good attitude toward Pap smear. In non-regular Pap smear group, most of nurses refused to have Pap smear screening due to the perception of Pap smear procedures. Conclusion: There were no relationship between knowledge or attitude and the decision to utilize Pap smear screening program. Approximately 50% of nurses had good knowledge of cervical cancer. Most of the nurses had good attitudes toward Pap smear regardless of the utilization of Pap smear screening. However, the nurses who did not use the screening program tended to have negative attitude toward Pap smear procedures.