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Background: Patients undergoing major surgical operations continue to experience pain with an overall reported incidence of 29.7% for moderate-to-severe pain and 10.9% for severe pain. Even in developed countries, 86% of patients experience postsurgical pain and 75% of those who reported pain described its severity as moderate-to-severe during the immediate postoperative period Major abdominal surgical operations ideally require the Acute Pain Management Service (APMS) for regular pain assessment and timely management of breakthrough pains and complications in the postoperative period. Aim of the study: To determine the effectiveness of Postoperative Analgesia used for Major Abdominal surgery and its efficacy and safety. Materials and methods: 38 Patients under General Anesthesia and 13 Patients under Regional + General Anesthesia who underwent major Laparotomy procedures were included in the study. Data regarding the type of postoperative Analgesia, Co–Analgesic used (NSAIDS, Paracetamol in oral/suppository form) during both intra and postoperative period were noted. All patients were followed on the first and second postoperative day at 4 PM. Pain severity with VAS score, side effects of Analgesia and Patient satisfaction with Pain management were recorded. Sindhu, Naheed Azhar, Nalini. Observational study to assess the effectiveness of post-operative pain management of patients undergoing major abdominal surgeries in a tertiary care hospital. IAIM, 2019; 6(5): 98-103. Page 99 Results: Use of Epidural Analgesia and Multimodal approach for Postoperative Pain relief greatly improves the patient satisfaction and early recovery of patients undergoing Major Abdominal surgeries. Conclusions: Although there is limited drug availability, regular assessments and appropriate dose adjustments and Use of Epidural and multimodal analgesic practice led to a high level of patient satisfaction
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Objective To explore the change of complications and inflammatory mediators in patients at nutritional risk after intervention with fish oil after major abdominal surgery.Methods Totally 60 patients who had received extrahepatic bile duct exploration ± left lobectomy and radical surgeries for their gastrointestinal tumors in our department from September 2010 to March 2011 were enrolled in this study.Their Nutritional Risk Screening 2002 scores were ≥3 points the day after surgery.These 60 cases patients were randomly divided into fish oil group (n =30) and the control group (n =30).Both groups were treated with total parenteral nutrition isocaloric and isonitrogenous energy emulsion intralipid of 3 Ls' bags after surgery.Aslo,they were treated with electrolyte,vitamins and trace elements equally,which were adjusted according to laboratory tests.The application of parenteral nutrition was no less than 5 days,and the other treatment was provided routinely.Surgeries were performed under general anesthesia in all patients.Urinary catheter was uniformly placed preoperative,and was removed within 24 hours after surgery.The degree of surgical trauma was scored on the operative day.Fasting venous blood samples were collected for measuring the fasting interleukin (IL)-6 and tumour necrosis factor-α (TNF-α) one day before surgery and one and six days after surgery.The relevant complications were recorded.Two patients in the fish oil group withdrew from the study on the third post-operative day.Results TheIL-6 levels were (10.65 ± 4.24),(29.45 ± 9.39),and (13.37 ± 6.99) ng/Land the TNF-α levels were (2.47 ± 1.16),(23.05 ± 11.43),and (6.05 ± 2.97) ng/L in the fish oil group one day before surgery and one and six days after surgery.In the control group,in contrast,the IL-6 levels were (11.17 ± 4.67),(25.10 ± 10.13),and (17.38 ± 7.13) ng/L and the TNF-α levels were (2.70 ± 1.63),(22.11 ± 12.54),and (8.93 ± 3.61) ng/L at the corresponding time points.Comparisons of the IL-6 and TNF-α between the fish oil group and control group showed no significant difference one day before surgery and one day after surgery (P =0.787,P =0.206,P =0.983,P =0.852).Comparison of the IL-6 between the one day and six days after surgery also had no statistical significance (P =0.101).However,the decrease of IL-6 was significantly larger in the fish oil group than in the control group from day 1 to day 6 after surgery (P =0.036).The post-operative levels of TNF-α were significantly different between these two groups (P =0.024).Complications were noted in 3 cases (2 cases of infectious complications) in the fish oil group and in 6 cases in the control group (5 cases of infectious complications) (P =0.002),in which the inffectious complications were also statistically significant (P =0.001).Conclusions Patients at nutritional risks after major abdominal surgeries have higher TNF-α and IL-6 levels.Fish oil can notably reduce the TNF-α level in these patients.In addition,fish oil decreases the surgical complications,in particular the infectious complications.
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Introducción: la combinación de ketamina con morfina disminuye tanto el dolor como el consumo de esta última durante el período postoperatorio. Sin embargo la dosis óptima y la duración de la ketamina aún están por determinar. Objetivos: evaluar el efecto de la administración de ketamina en el consumo postoperatorio de morfina, reducción del dolor, y efectos adversos de la ketamina en la cirugía abdominal mayor. Método: se realizó un estudio prospectivo, aleatorio, doble ciego, en 75 pacientes programados para cirugía abdominal mayor divididos en tres grupos: (1) Grupo PERI: recibió ketamina intraoperatoria y postoperatoria 48 horas después de la cirugía (2 ìg/kg/min después de un bolo de 0,5 mg/kg); (2) Grupo INTRA: recibió solamente ketamina en el intraoperatorio (2 ìg/kg/min después de un bolo de 0.5 mg/kg); (3) Grupo CTRL: recibió placebo. Se evaluó el consumo de morfina, la escala análoga visual y los efectos adversos en las primeras 48 horas. Resultados: el consumo acumulativo de morfina 24 horas después del proceder anestésico quirúrgico fue significativamente menor en el grupo PERI (27 mg ± 17) que en el INTRA (48 mg ± 40,5) y en CTRL (50 mg ± 22) (p < 0.005). La escala análoga visual fue significativamente menor en los grupos PERI e INTRA que en el CTRL (p < 0.002). Una mayor incidencia de náuseas se observó en el grupo CTRL comparado con el PERI (41 % vs. 8 %, (p = 0.005) ). Conclusiones: bajas dosis de ketamina mejora la analgesia postoperatoria con una disminución del consumo de morfina cuando es administrada por 48 horas en el postoperatorio con baja incidencia de efectos adversos.
Introduction: the combination of ketamine with morphine decreases both pain and the consumption of the latter drug during the postoperative period. However the optimal dose and duration of ketamine are yet to be determined. Objectives: to evaluate the effect of ketamine administration on postoperative morphine consumption, pain reduction, and adverse effects of ketamine in major abdominal surgery. Method: a prospective, randomized double-blind study was made in 75 patients scheduled for major abdominal surgery and divided into 3 groups: (1) PERI Group: received ketamine intraoperatively and postoperatively 48 hours after surgery (2 ug / kg / min after a bolus of 0.5 mg / kg); (2) INTRA Group: received only intraoperative ketamine (2 mg / kg / min after a bolus of 0.5 mg / kg), (3) CTRL Group: received placebo. Morphine consumption, visual analogical scale and the adverse effects in the first 48 years were evaluated. Results: cumulative morphine consumption 24 hours after the surgical anesthetic procedure was significantly lower in the PERI group (27 mg ± 17) than in the INTRA (48 mg ± 40.5) and CTRL (50 mg ± 22) (p <0.005). The visual analogical scale was significantly lower in PERI and INTRA groups than in CTRL (p<0.002). A higher nausea incidence was observed in the CTRL group compared to the PERI one (41 % vs. 8 %, (p = 0.005) ). Conclusions: low doses of ketamine improve postoperative analgesia with a reduction in morphine consumption when it is administrated for 48 years in the postoperative phase with low adverse effects incidence.
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Objective To explore the effect of clinical application of self-starting devices in patients after major abdominal surgery. Methods From January 2007 to June 2009, 90 patients with major abdominal surgery were randomly divided into the observation group and the control group with 45 patients in each. The observation group using self-starting devices 6 hours after surgery, the control group used the traditional approach to sit and lie. The effect of the two groups was compared. Results Significant difference existed in recovery of bowel movement, wound healing and incidence of pressure sore between the two groups. Conclusions Application of self- starting devices in patients after major abdominal surgery can promote recovery of bowel movement and wound healing and prevent incidence of pressure sore, so that patients can recover early.
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BACKGROUND: Continuous epidural analgesia with an opioid-local anesthetic combination is an effective strategy for postoperative pain relief after abdominal surgery. Levobupivacaine, the pure S (-) enantiomer of racemic bupivacaine, is similar to its native agent for anesthetic efficacy but has less cardiotoxic and neurotoxic potential than the bupivacaine. We compared the efficacy and safety of 0.1% levobupivacaine with sufentanil or 0.2% levobupivacaine with the same dose of suentanil for patient-controlled epidural analgesia after major abdominal surgery. METHODS: Forty patients scheduled for major abdominal surgery under general anesthesia were randomized to receive either 0.1% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) or 0.2% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 3 ml/h and bolus dose of 2 ml on demand. Visual analogue scale (VAS) pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation were assessed during 48 hours following the surgery. In addition, degree of motor block and mobilization, additional analgesic requirements and adverse effects were assessed. RESULTS: There were no significant differences in VAS pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation. There were no significant differences in mean volume of local anesthetic consumption, additional analgesic requirements, degree of motor block and mobilization and the incidence of adverse effects. CONCLUSIONS: 0.1% levobupivacaine with sufentanil provided comparable postoperative epidural analgesia and incidences of adverse effects to 0.2% levobupivacaine with the same dose of suentanil in patients undergoing major abdominal surgery.