Inkk Trial - Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.

Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief.@*OBJECTIVE@#This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room.@*OUTCOMES AND MEASURES@#Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy.@*RESULTS@#The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.@*CONCLUSION@#Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.

A COMPARATIVE STUDY BETWEEN CAUDAL ROPIVACAINE AND ROPIVACAINE PLUS DEXAMETHASONE FOR INFRAUMBILICAL SURGERY IN PEDIATRIC PATIENTS

Background: Caudal block is one of the most popular regional block in children with high success rate for infra-umbilical surgeries. Among local anaesthetics ropivacaine provides a greater margin of safety, less motor blockade, less neurological and cardiac toxicity and similar duration of analgesia compared to bupivacaine. Addition of dexamethasone as an additive to local anesthesia decreases the postoperative rescue analgesia consumption.This study was designed to compare the effectiveness of intra-operative and postoperative analgesia on adding dexamethasone to 0.15% ropivacaine with 0.15%ropvacaine given alone. A prospective double blinded Materials: randomised controlled study was conducted consisting of 60 patients undergoing infra-umbilical surgeries under general anesthesia with Caudal block. Patients were randomised into two groups. Group A received 0.15% Inj.ropivacaine 1.5ml/kg with 1ml normal saline and Group B received 0.15% Inj.Ropivacaine 1.5ml/kg with 0.1mg/kg Inj.dexamethasone in caudal block Mean FLACC pain score was comparable and statistically not signi?cant (P=0.083) in both groups upto 30min Results: postoperatively. At 60min mean pain score in group A was 0.30 ± 0.54 and in group B was 0 (P=0.005) which was statistically signi?cant. In group A 40%(12) patients required rescue analgesia whereas in group B only 10%(3) patients required analgesia(P= 0.007) Patients remained hemodynamically stable throughout the procedure. After 60min Conclusion: postoperatively FLACC score was signi?cantly higher in group A as compared to group B. It concludes that addition of dexamethasone signi?cantly reduced postoperative pain and need for rescue analgesia without any side effects.

Pattern of analgesic use for post-operative pain relief among adult surgical patients in a tertiary care hospital

Background: Post-operative pain is an acute pain which if not adequately managed may lead to morbidity and complications. It can be controlled effectively by analgesics. It is essential to choose an analgesic with good efficacy and safety profile to avoid drug-related complications. Aims and Objectives: This study aims (i) to study the pattern of analgesic use for postoperative pain; (ii) to study the efficacy of the analgesic prescribed for post-operative pain; and (iii) to study the safety of the analgesics used for post-operative pain. Materials and Methods: A prospective observational study was conducted for 3 months period. The pattern of analgesic use for post-operative pain was studied in 110 patients. The influence of sociodemographic factors, surgery related factors on pain assessment score, and patient satisfaction score was assessed. The safety profile of analgesics used was studied. Results: Post-operative was seen equally in both the genders and mean age of patients was 41 years. Diclofenac was the most common analgesic prescribed and intramuscular route was most commonly used. About 64% of patients were satisfied with their treatment and 94.55% of patients did not encounter any adverse effects. However, there was no association between various factors and pain assessment score and patient satisfaction score. Conclusion: Post-operative pain can be effectively managed by non-opioid analgesics like diclofenac which provide cost-effective treatment. Analgesic for post-operative pain should be chosen judiciously by considering patient-related and surgery-related factors for better post-operative pain management and to prevent post-operative complications.

Effect of Yashtimadhu Ghrita Gudapurana on Post Operative Pain Management in Patients of Haemorrhoids and Fissure-in-ano with Special Reference to Shastranipataja Vedana: A Randomized Controlled Trial.

Modern medical Science has offered many surgical procedures like open and closed haemorrhoidectomy, anal dilatation, Sphincterotomy etc for haemorrhoides and fissure in ano. These operative procedures are associated with unavoidable sequel of symptoms like Pain, Discharge and Inflammation etc. Role of analgesia is vital in the treatment of post-operative pain. The mode of analgesia depends on degree or level of pain which is a subjective criteria. Analgesics routinely used are NSAIDs, opioids and corticosteroids. Side effects includes like Gastritis, Gastrointestinal bleeding etc. Hence, Analgesia has to be supplemented with antacids or H2 Receptor Agonists. Here, quest for knowledge for an alternative treatment to analgesics starts. According to Sushrutacharya, these diseases like Arsha and Parikartika are termed as Chhedya, i.e., treatable by surgery and he has indicated Yashtimadhu Ghrita in Shastranipataja Vedana. Methodology- In present study, total 100 postoperative patients of haemorrhoids and fissure in ano, randomly allocated into two groups (50 in each group). In Group A (n = 50), Yashtimadhu Ghrita Gudapurana was done every day after sitz bath for 5 days. In Group B (n = 50), local application of lignocaine jelly every day after sitz bath for 5 days. Result- Yashtimadhu Ghrita as a local application is clinically as effective as lignocaine jelly in the management of post operative pain in patients of hemorrhoids and fissures in ano. Conclusion- it was concluded that Yashtimadhu Ghrita is helpful in the management of pain in the post operative patient of haemorrhoids and fissure in ano

Femoral Stem Subsidence and its Associated Factors after Cementless Bipolar Hemiarthroplasty in Geriatric Patients

@#Introduction: Early femoral stem subsidence has been a concern as a predictor of the beginning of implant loosening, especially on cementless hip arthroplasty implants. This study aimed to determine the factors that affect femoral stem subsidence and outcome following hemiarthroplasty in the geriatric population. Materials and Methods: This is a retrospective study of 179 patients who underwent cementless bipolar hemiarthroplasty during the 2011-2019 period at an orthopaedic and traumatology hospital. Data on the patient's demography, pre-operative American Society Anaesthesiologist (ASA) score, body mass index (BMI), canal flare index (CFI), Dorr classification, and stem alignment were obtained. The primary outcomes were post-operative femoral stem subsidence, post-operative pain, and functional outcome using Harris Hip Score (HHS). Statistical analysis was conducted to identify risk factors associated with the primary outcome. Results: The mean femoral stem subsidence was 2.16 ±3.4 mm. The mean post-operative Visual Analog Score (VAS) on follow-up was 1.38 ± 1. Mean HHS on follow-up was 85.28±10.3. American Society Anaesthesiologist score 3 (p = 0.011, OR = 2.77) and varus alignment (p=0.039, OR = 6.963) were related to worse stem subsidence. Otherwise, neutral alignment (p = 0.045 and OR = 0.405) gave protection against femoral stem subsidence. The female gender (p = 0.014, OR 2.53) was associated with postoperative pain onset. Neutral alignment had significant relationship with functional outcomes (p = 0.01; OR 0.33). Conclusion: A higher ASA score and varus stem alignment were related to a higher risk of femoral stem subsidence. Meanwhile, neutral stem alignment had a protective effect on the femoral stem subsidence and outcome.

Post-operative Paediatric Pain Assessment and Management at a Tertiary Health Facility, Southern Nigeria: Surgeons’ Perspectives and Practice

Introduction:Whereas advances in perioperative care of children continue to be made with increasing evidence-based practice for postoperative analgesia, inadequate relief of postoperative pain resulting in significant morbidity and mortality is still being reported.Objective:To appraise surgeons' perspectives and practice of paediatric post-operative pain assessment and management at a tertiary health facility in southern Nigeria.Methods: In this cross-sectional survey carried out between September and December 2019, asemi-structured and self-administered questionnaire was distributed to surgeons/trainees in departments/units where paediatric patients undergo both major and minor surgeries. Their perspectives and practice of postoperative pain assessment and management were analysed using SPSS version 20.0.Results:Seventy-nine respondents completed the survey, including 19(24%) consultants, 32(40.5%) senior registrars, and 22(27.9%) junior registrars. Two-third of respondents (n=51, 64.6%) had more than 10 years working experience post-graduation. Involving parents/caregiverso assess postoperative pain was the most common strategy used by respondents (n=69, 87.3%), and most of them (n=67, 84.8%) do not make use of any pain assessment tools. Non-pharmacologic strategies for postoperative pain management were applied/prescribed sometimes (n=20, 25%) or rarely (n=20, 25%). Paracetamol and NSAIDs were the commonest non-opioid analgesics used while pentazocine was the commonly used opioid. Many respondents (n=66, 83.5%) had never prescribed morphine for postoperative analgesia in children. Seventeen percent of respondents do not prescribe postoperative analgesia to newborns.Conclusion:Findings of this study show that the practice in our institution falls short of the recommended multimodal approach to paediatric postoperative pain care.Development of standard protocols and training of providers of postoperative care are recommended.

Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Hemorrhoids are one of the most common conditions that lead to surgery, and until now surgical hemorrhoidectomy has been the major effective treatment. Post-operative pain from hemorrhoidectomy has been experienced by thousands of patients and remains a major inconvenience of the operation.@*OBJECTIVE@#This study evaluates the clinical efficacy of the pestle needle therapy, an acupoint stimulation method, for relief of post-hemorrhoidectomy pain.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS@#This was a single-center, patient-assessor-blinded and randomized controlled trial with 154 patients receiving Milligan hemorrhoidectomy surgery. Eligible patients were randomly assigned to either a treatment group or a control group at a ratio of 1:1. The treatment group received the pestle needle therapy, with manual stimulation at Yaoshu (DU2), Mingmen (DU4), Changqiang (DU1), Chengshan (BL57), Erbai (EX-UE2) and the perianal points (1, 3, 5, 7, 9, and 11o'clock around the lesion); while the control group received a sham treatment with very light pressure. Three sessions of treatment were performed at 30 min, 4 h and 12 h after the surgery, and each lasted for 15 min.@*MAIN OUTCOME MEASURES@#The primary outcome was post-operative pain measured with the visual analogue scale (VAS) at 12 h after surgery. The secondary outcomes included the VAS scores measured at 0.5, 2, 4, 6, 8, 24 and 48 h after surgery, the analgesic dose, the time and the VAS score of the patients' first defecation after surgery, as well as the Hamilton Rating Scale for Anxiety (HAMA) evaluated before discharge.@*RESULTS@#The mean pain score of the treatment group was significantly lower than that of the control group (3.10 ± 1.27 vs 4.82 ± 1.29; P < 0.001) at 12 h after surgery. Compared with the control group, patients in the treatment group needed a smaller dose of analgesic within the first 24 hours after surgery (P = 0.002); and their HAMA scores before discharge were lower (4.07 ± 2.40 vs 5.10 ± 2.45, P = 0.009). Compared to the treatment group, patients in the control group had a greater time to the first defecation after surgery ([52.34 ± 15.72] h vs [27.08 ± 13.68] h; P < 0.001), but there was no difference in their VAS scores at the first defecation (P = 0.092).@*CONCLUSION@#The pestle needle therapy was effective for relieving pain, reducing anxiety and improving bowel function after hemorrhoidectomy, and it is worthy of clinical application.

A Comparative Study between the Efficacy of Pre-incisional and Post-incisional Wound Infiltration of Bupivacaine for the Relief of Post-operative Pain

Introduction: Pain, the “fifth vital sign” is an unpleasant sensation localized to a part of the body. Post-operative pain has beenwidely studied, as it causes adverse psychological and physiological effects. Many anesthetic agents and techniques have beendeveloped to minimize the post-operative pain. This study compares the effectiveness of two such techniques: Pre-incisionaland post-incisional infiltration using bupivacaine as the anesthetic agent.Materials and Methods: This prospective, randomized, non-crossover type, double-blind interventional study was conductedon 60 patients of either gender, aged 15–50 years, belonging to the American Society of Anesthesiologists Grades I and IIundergoing lower abdominal surgeries. They were randomly divided into two groups: Pre-incisional and post-incisional infiltrationgroups and were monitored for up to 24 h postoperatively for the duration of analgesia and intensity of pain.Results: The duration of post-operative analgesia was better in the pre-incisional infiltration group (540 min) compared to thepost-incisional infiltration group (360 min). Similarly, the overall mean pulse rate, mean systolic blood pressure (SBP), and meanrespiratory rate were lower in the pre-incisional infiltration group, indicating better post-operative pain relief.Conclusion: Although both pre-incisional and post-incisional infiltration of bupivacaine are safe, pre-incisional infiltrationprovides better relief of post-operative pain.

Comparative Study of Post-Operative Pain in Open (Lichtenstein) Repair Versus Laparoscopic Repair for Unilateral Inguinal Hernia.

Introduction: Inguinal hernia repair is the most commonprocedure that general surgeons undertake all over the world.The increasing popularity of laparoscopic inguinal herniarepair is, in part, due to the clinical potentials with lesspost operative pain and a shorter duration of convalescencecompared with an open hernia repair technique. The studyfocuses to compare the operative time, postoperative painalong with requirements of analgesics.Material and methods: The present study was conducted on60 patients admitted with diagnosis of inguinal hernia overthe period of one and half years (Jan 2014-June 2015) in theDepartment of General Surgery, MMIMSR, MULLANA(DISTT AMBALA), Haryana, India. These patients weredivided at random by lottery system in two groups of 30patients each i.e. Group A and Group B. Group A was treatedby Tension Free Hernia Repair by Lichtenstein technique.Group B was treated by Laparoscopic technique of herniarepair.Results: VAS score in the Lichtenstein inguinal hernia repairgroup ranged from 1 to 8 for which the mean was 3.80 ±1.86during the 1st 12 hours whereas VAS score in the laparoscopicrepair group ranged from 1 to 7 whose mean was 2.87±1.78.Analgesic tablet was given to the patients of both the grouppost-operative day 2 onwards as per requirement after 24hours of operation. The mean analgesic tablet consumed was5.27±1.72 in Lichtenstein open mesh repair and 3.53±1.93 inlaparoscopic repair which was statistically significant.Conclusion: Laparoscopic procedure showed clear advantagessuch as less postoperative and chronic pain, lower incidenceof use of pain medication.

The comparison of the efficacy of intra-peritoneal instillation along with local infiltration with bupivacaine versus placebo for post-operative analgesia after laparoscopic tubal ligation

Background: Intra-peritoneal instillation of local anesthetics has been shown to minimize post-operative pain after laparoscopic surgeries. The present study was undertaken with the following aim to compare the efficacy of intra-peritoneal instillation and local infiltration with bupivacaine versus placebo for post-operative analgesia after laparoscopic tubal ligation. To correlate the advantages and side effects of the drugs during the procedure. To establish a protocol for the use of bupivacaine instillation and infiltration for post-operative analgesia after laparoscopic tubal ligation.Methods: A prospective study was carried out in a tertiary care hospital attached to a teaching medical institute. Institutional ethics committee approval was obtained for this randomized control study (double blind) including 50 women who will be divided in two groups. Group A will be administered intra-peritoneal bupivacaine along with local infiltration. Group B will be administered normal saline. Post-operative pain will be monitored by a blind observer and rescue analgesia will be administered at visual analogue score of 3.Results: Both the groups were comparable with respect to age and BMI. The mean duration of analgesia in Group A with bupivacaine was 315.60±79.9 min (Median 300 min).  The mean duration of analgesia in Group B with normal saline was 138.20±46.97 min (Median 150 min, p value <0.001).Conclusions: The study depicts a significant pain relief after use of bupivacaine. Bupivacaine instillation in the peritoneal cavity along with local infiltration of the drug gives prolongs pain relief as compared to normal saline.

A Pre Induction Administration of One Gram Oral or Intravenous Acetaminophen in Control of Post-Operative Pain: A Comparative Study

Introduction: Post operative pain after surgery is a cause ofsignificant morbidity and patient dissatisfaction. In this studywe try to compare efficacy between 1 gram acetaminophenoral dose with 1 gram acetaminophen intravenous dose incontrolling post operative pain.Material and methods: This study is a prospective,randomized and comparative study conducted at NRI instituteof medical sciences, Visakhapatnam between Oct 2016 toOctober 2017. 90 patients belonging to ASA status I and IIof both genders, age group- 18 to 60 years and undergoingsurgeries under general anaesthesia lasting less than 2 hourswere enrolled for the study. 2 groups out of which Group Areceived 1gm oral paracetamol and Group B received 1gmintravenous paracetamol. The grous were compared postoperatively for pain scores at 30, 60, 90, 120, 150 minute aftersurgery using visual analogua scale(VAS)Results: The mean VAS scores were 2.78, 4.07, 5.81, 6.36, 6.5for Group A and 2.18, 3.5, 4.76, 6.04, 6.43 for Group B. Thuspain scores were consistently lesser in Group B than GroupA. Pain scores were significantly lower in Group B during thetime period 30 mins and 90 mins (p values 0.039 and 0.002respectively). The time of first rescue analgesia (i.e, Fentanyl)was compared in both the groups. Mean for time of demandfor analgesia was 88.67 mins and 102 mins in Group A andGroup B respectively. P value was 0.05 thus a significantlyearlier requirement of rescue analgesia in Group A.Conclusion: The rescue analgesic requirement wassignificantly lesser in intravenous acetaminophen group.Hence 1gm intravenous paracetamol is superior to oralformulation in controlling post operative pain

A prospective evaluation of efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% after cataract surgery

Background: Different medications are used to reduce pain and inflammation after cataract surgery. Hence this study was taken up to compare the efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% in reducing anterior chamber inflammation and pain after cataract surgery.Methods: Total of 100 patients who underwent uneventful cataract surgery with posterior chamber intra ocular lens (IOL) implantation were randomly allocated to receive bromfenac 0.09% and flurbiprofen 0.03% topically from first post-operative day onwards for 6 weeks. Assessment of anterior chamber inflammation and pain was done by slit lamp and visual analogue scale respectively on each follow up days. Analysis was done by unpaired t test and Fischer’s exact test.Results: The response to treatment was earlier in bromfenac group for all the inflammatory changes (significant difference was found on day 7, p<0.05) except for corneal edema where both the groups showed similar response. On 7th day after surgery, 72% patients in flurbiprofen group and 12% in bromfenac group had pain (score1), while on the 14th day none in the bromfenac group complained of pain whereas 4% in flurbiprofen group still had pain. Both the drugs were safe and no clinically serious adverse effects were observed in either of the groups.Conclusions: This study showed both the medications, topical bromfenac 0.09% and topical flurbiprofen 0.03% effective and safe in reducing pain and anterior chamber inflammation after cataract surgery but the response was earlier with bromfenac 0.09%.

Combination of clonidine-bupivacaine in caudal epidural anesthesia for hypospadias surgery in children: prospective, randomized, blind study / Associação clonidina-bupivacaína na anestesia peridural caudal para cirurgia de hipospádia em crianças: estudo prospectivo, randomizado, encoberto

Abstract Background and objectives: The combination of clonidine with local anesthetic administered for epidural anesthesia via caudal route seems to improve the quality of postoperative analgesia, but with conflicting results. This study compared the postoperative analgesia of three different doses of clonidine combined with bupivacaine in caudal epidural anesthesia in children undergoing hypospadias repair. Methods: Eighty children aged 1-10 years, candidates for surgical repair of hypospadias, were randomly divided into four groups of 20 patients to receive general anesthesia combined with caudal epidural anesthesia with bupivacaine 0.165% alone or in combination with 1, 2 or 3 µg.kg- 1 of clonidine. The primary outcome was morphine consumption in the first 24 h postoperatively. Mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, time to awakening, pain severity (FLACC scale), level of sedation (RAMSAY), duration of analgesia, and occurrence of adverse effects were also compared. Results: Intraoperatively, there was no difference between groups regarding mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, and time to awakening. Postoperative morphine consumption and pain severity were similar between groups, but the group receiving clonidine (3 µg.kg-1) had lower heart rate and higher sedation level than the group receiving bupivacaine alone. Conclusions: The combination of clonidine at doses of 1, 2 or 3 µg.kg-1 with bupivacaine 0.16% via caudal epidural route did not alter the consumption of morphine in the early postoperative period of children undergoing hypospadias repair.

Resumo Justificativa e objetivos: A associação de clonidina ao anestésico local administrado por via peridural caudal parece melhorar a qualidade da analgesia pós-operatória, mas com resultados conflitantes. Este estudo comparou a analgesia pós-operatória de três diferentes doses de clonidina associada à bupivacaína na anestesia peridural caudal em crianças submetidas à correção de hipospádia. Método: Oitenta crianças entre um e dez anos, candidatas à correção cirúrgica de hipospádia, foram divididas, aleatoriamente, em quatro grupos de 20 pacientes para receber anestesia geral associada à anestesia peridural caudal com bupivacaína 0,166% isolada ou associada a 1, 2 ou 3 µg.Kg-1 de clonidina. Como desfecho principal avaliou-se o consumo de morfina nas primeiras 24 horas de pós-operatório. Compararam-se também pressão arterial média, frequência cardíaca, concentração expirada de sevoflurano, tempo de despertar da anestesia, intensidade da dor pela escala FLACC, nível de sedação (Ramsay), tempo de duração da analgesia e ocorrência de efeitos adversos. Resultados: No transoperatório, não houve diferença entre os grupos quanto à pressão arterial média, frequência cardíaca, concentração expirada de sevoflurano e ao tempo de despertar. No pós-operatório, o consumo de morfina e a intensidade da dor foram similares entre os grupos, mas o grupo que recebeu 3 µg.Kg-1 de clonidina apresentou menor frequência cardíaca e maior sedação do que o grupo que recebeu somente bupivacaína. Conclusões: A associação de clonidina nas doses de 1, 2 ou 3 µg.Kg-1 à bupivacaína 0,166% por via peridural caudal não alterou o consumo de morfina no pós-operatório imediato de crianças submetidas à correção de hipospádia.

Post-Operative Pain and Convalescence in Comparison of Laparoscopic Ventral Hernia Repair Vs Open Ventral Hernia Repair

Background: Ventral hernia is defined as a fascial defectlocated to the abdominal wall. The laparoscopic repair ofIncisional and ventral hernia is fast becoming the standard ofcare.Objectives: To compare and evaluate the post-operative painand convalescence between two groups.Methods: Study was conducted on 30 cases of ventral herniaadmitted in Rajindra Hospital, Patiala. They were divided intotwo comparison groups (15 cases each). Group A: Openventral hernia repair; Group B: Laparoscopic ventral herniarepair.Results and Conclusions: Laparoscopic repair should be thepreferred method of repair of ventral hernia as it is associatedwith a shorter hospital stay, decreased post-operative pain,better cosmetic results decreased complication rate likerecurrence, and seroma formation, decreased mesh infectionrate, early ambulation period, better patient satisfaction andearly return to activities.

Patient Satisfaction And Cost Analysis Of Analgesia Management For Post-Operative Procedures In Htaa: Pca Vs. Conventional Method

@#Acute pain service (APS) offer several techniques to the post-operative patient in controlling and relieving the pain such as intravenous infusion, patient-controlled analgesia, epidural infusion, subcutaneous or intramuscular injection and intrathecal administration. The effectiveness of and satisfaction towards APS is not clearly defined. Therefore, the aim of this study is to conduct the cost analysis and comparison between these techniques and patient satisfaction. The study design for cost analysis was retrospective study. The means of the data were calculated based on Integration Store of Hospital Tengku Ampuan Afzan records. In addition, the evaluation of patient’s satisfaction was conducted by using a cross-sectional study design. The mean of the data was calculated and analysed by using Chi-square test. The total cost required to prepare PCA for post-operative patient was the highest with RM 8810.98. Meanwhile, the cost for subcutaneous morphine injection, epidural infusion and peripheral block injection were RM 2.11, RM 5323.95 and RM 4.95 respectively. However, when taking into the aspect of patient’s satisfaction, PCA has the highest level of excellent performance with 54.6% compare to EDA (33%) and BLOCK (12.4%) with the p-value is less than 0.05. In conclusion, every drug has its own side effects. As the healthcare provider, it is a need to ensure drugs that were given to the patients are at the very minimum risk of having the side effects. Based on the findings of this study, it could be said that both drugs have lower percentage of people experienced the side effect after treated with the drugs. Therefore, the future study should be more focusing on the side effect of the drugs used. In terms of cost spent for the methods, the PCA regimen is more likely expensive compared to the conventional methods. However, based on survey among the patients, PCA-treated patients expressed higher satisfaction compared to the conventional regimen of pain management.

A Comparative Study to Compare the incidence of Post-Operative Pain in Patients Undergoing Haemorrhoidectomy with Lateral Sphincterotomy Vs. Haemorrhoidectomy without Lateral Sphincterotomy

Background: Haemorrhoids are common pathology of anal canal. Over the last few years, because of new surgical techniques, increased attention has been laid on Surgical Management of hemorrhoids, still open Haemorrhoidectomy remains the mainstay of treatment. Postoperative pain is one of the most common complications of open Haemorrhoidectomy. In our study we decided to compare the incidence of postoperative pain in open Haemorrhoidectomy with or without lateral sphincterotomy. Methods: To compare the incidence of post-operative pain in patient of open Haemorrhoidectomy with lateral sphincterotomy versus open Haemorrhoidectomy without lateral sphincterotomy. Results: In our study group A in which open Haemorrhoidectomy along with lateral sphincterotomy was done had statistically significant less postoperative pain at 6 hours and 24 hours postoperatively and on postoperative day 7 at the time of follow up with Chi square test (P<0.0001). Conclusion: Addition of lateral sphincterotomy decreased post-operative pain and also reduced the need for post-operative analgesia in a significant number of patients. Hence through this study, we concluded that in conventional open Haemorrhoidectomy, addition of lateral sphincterotomy is an effective, convenient, and simple way to reduce post-operative pain.

A Comparative Study of Acute and Chronic Pain between Single Port and Triple Port Video-assisted Thoracic Surgery for Lung Cancer / 中国肺癌杂志

BACKGROUND@#Through the comparative analysis of the acute and chronic pain postoperative between the single port and triple port video-assisted thoracic surgery to seek the better method which can reduce the incidence of acute and chronic pain in patients with lung cancer.@*METHODS@#Data of 232 patients who underwent single port -VATS (n=131) or triple port VATS (n=101) for non-small cell lung cancer (NSCLC) on January 1, 2016 to June 30, 2017 in our hospital were analyzed. The clinical and operative data were assessed, numeric rating scale (NRS) was used to evaluate the mean pain score on the 1th, 2th, 3th, 7th, 14th days, 3th months and 6th months postoperative.@*RESULTS@#Both groups were similar in clinical characteristics, there were no perioperative death in two groups. In the 1th, 2th, 7th, 14th days and 3th, 6th months postoperative, the NRS score of the single port group was superior, and the difference was significant compared with the triple port (P0.05). Univariate and multivariate analysis of the occurrence on the chronic pain showed that the operation time, surgical procedure and the 14th NRS score were risk factors for chronic pain (P<0.05).@*CONCLUSIONS@#The single port thoracoscopic surgery has an advantage in the incidence of acute and chronic pain in patients with non-small cell lung cancer. Shorter operative time can reduce the occurrence of chronic pain. The 14th day NRS score is a risk factor for chronic pain postoperative.

Comparative evaluation of post-operative pain after pulpectomy with K-files, Kedo-S files and MTwo files in deciduous molars -a randomized clinical trial / Avaliação comparativa da dor pós-operatória após pulpectomia com limas k, Kedo-S e MTwo em molares decíduos - um ensaio clínico randomizado

Objective: Despite the tortuous course of primary root canal system, a paradigm shift occurred from conventional hand files to rotary system, which lead to faster, cost-effective, uniform and predictable fillings. One of the many advantages being, reduction in post-operative pain with the use of rotary system. Many rotary file systems were introduced, with the recent one, the Kedo-S. So the present study aimed to compare and evaluate the post ­ operative pain after pulpectomy using K-files, MTwo files and Kedo-S files in deciduous molars. Material and Methods: 75 teeth were randomly divided into three groups (group A ­ K-files, group B - Kedo-S files and group C - MTwo files) for pulpectomy of primary molars. Post ­ operative pain was assessed every 6,12,24,48 and 72 hours using facial pain scale. Results: 44% of volunteers in K-file group had moderate pain followed by Kedo-S group (8%) and then MTwo files (4%). Conclusion: The least post-operative pain was found in Mtwo group followed by Kedo-S group and K-file group. (AU)

Objetivo: Apesar do curso tortuoso do sistema de canais radiculares de dentes molares decíduos, uma mudança de paradigma ocorreu das limas manuais convencionais para o sistema rotatporio, o que leva a obturações mais rápidas, econômicas, uniformes e previsíveis. Uma das muitas vantagens é a redução da dor pós-operatória com o uso do sistema rotatório. Muitos sistemas de limas rotátórias foram introduzidas, como o recente Kedo-S. Assim, o presente estudo objetivou comparar e avaliar a dor pós-operatória após pulpectomia utilizando limas K, MTwo e Kedo - S em molares decíduos. Material e Métodos: Setenta e cinco dentes foram divididos aleatoriamente em três grupos (grupo A - limas K, grupo B - limas Kedo-S e grupo C - limas MTwo) para pulpectomia de molares decíduos. A dor pós - operatória foi avaliada a cada 6,12,24,48 e 72 horas, utilizando a escala de dor facial. Resultados: 44% dos voluntários do grupo K apresentaram dor moderada, seguidos pelo grupo Kedo-S, com 8%, e MTwo, com 4%. Conclusão: A menor dor pósoperatória foi encontrada no grupo Mtwo, seguido pelo grupo Kedo-S e pelo grupo K-file. (AU)

Persistent Pain after Breast Cancer Surgery and Rehabilitation(review) / 中国康复理论与实践

Persistent pain after breast cancer surgery (PPBCS) is a common complication in patients suffering breast cancer sur-gery.There are varied factors related to PPBCS,such as surgical injuries,pre-and post-operative pain,age,psychosocial factors, genetic factors, and nerve sensitization, etc. Medicine, surgery and rehabilitation could be helpful for PPBCS. Rehabilitation can mobilize the enthusiasm of patients to participate in the treatment,and improve their physical and psy-chological function,with less side-effect,that could be applied widely.