Evaluation of the surgical factor in postoperative pain control

Postoperative pain control has been studied extensively, including many perioperative pain control procedures. Unfortunately, the impact of the surgical technique was not objectively studied. The aim of this study is to evaluate if the type of surgical dissection needed for extensive abdominal wall dissection actually has an effect in the reduction of postoperative pain or not. Forty adult patients, 19 males and 21 females, were randomly divided into two groups with each group containing 20 patients having different varieties of anterior abdominal wall ventral hernia. Patients in group I had their hernias and abdominal wall flaps dissected by only sharp dissection using scalpel. Patients in group II had their hernias and abdominal wall flaps dissected using mainly blunt dissection assisted by sharp dissection where blunt dissection could not do the job. All the patients had general anesthesia. No preemptive analgesia was used. Nalbufen was used as the only postoperative pain killer and the total amount used of it was treated as the indicator for the intensity of postoperative pain. The results of the present study showed that the total amount of Nalbufen used for the control of postoperative pain is significantly less in group I throughout the postoperative follow-up period. This study concludes that use of sharp dissection in cases of extensive abdominal wall dissection is statistically better than other methods of dissection in terms of postoperative pain control

Retro-peritoneal versus trans-peritoneal approaches in elective abdominal aortic surgery in Suez Canal University Hospital

In the era of rapidly changing surgical techniques toward safety and more cost effectiveness, retroperitoneal approach for aortic surgery is gaining popularity. This study aimed at evaluating the antero-lateral retroperitoneal approach in elective aortic surgical procedures versus the standard trans-peritoneal approach in the setting of the Suez Canal University Hospital. Since 2001 the retroperitoneal approach for aortic surgery had been introduced in the Suez Canal University Hospital. The current retrospective study was conducted in the period between 1995 and 2005. All patients had elective aortic surgery either by retro or trans-peritoneal approaches were in the study. Preoperative parameters, intra and postoperative variables, morbidity and mortality were compared in between both groups. Ninety two patients were included in two study groups. Demographic and preoperative parameters were nearly matched. The only statistically significant differences between both groups were found in some of the intra and postoperative variables. No statistically significant differences were found regarding either fatal or non-fatal complications. Both trans-peritoneal and retroperitoneal approaches are comparable to each other according to surgical expertise of the operating surgical team. With increasing experience with the retroperitoneal approach, it would be a preferable option to be chosen for performing aortic procedures