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1.
Front Public Health ; 10: 825408, 2022.
Article in English | MEDLINE | ID: covidwho-1776025

ABSTRACT

Objective: During total knee arthroplasty (TKA), tourniquet may negatively impact post-operative functional recovery. This study aimed at investigating the effects of tourniquet on pain and return to function. Methods: Pubmed, Embase, and Cochrane Library were comprehensively searched for randomized controlled trials (RCTs) published up to February 15th, 2020. Search terms included; total knee arthroplasty, tourniquet, and randomized controlled trial. RCTs evaluating the efficacies of tourniquet during and after operation were selected. Two reviewers independently extracted the data. Effect estimates with 95% CIs were pooled using the random-effects model. Dichotomous data were calculated as relative risks (RR) with 95% confidence intervals (CI). Mean differences (MD) with 95% CI were used to measure the impact of consecutive results. Primary outcomes were the range of motion (ROM) and visual analog scale (VAS) pain scores. Results: Thirty-three RCTs involving a total of 2,393 patients were included in this study. The mean age is 65.58 years old. Compared to no tourniquet group, the use of a tourniquet resulted in suppressed ROM on the 3rd post-operative day [MD, -4.67; (95% CI, -8.00 to -1.35)] and the 1st post-operative month [MD, -3.18; (95% CI, -5.92 to -0.44)]. Pain increased significantly when using tourniquets on the third day after surgery [MD, 0.39; (95% CI, -0.19 to 0.59)]. Moreover, tourniquets can reduce intra-operative blood loss [MD, -127.67; (95% CI, -186.83 to -68.50)], shorter operation time [MD, -3.73; (95% CI, -5.98 to -1.48)], lower transfusion rate [RR, 0.85; (95% CI, 0.73-1.00)], higher superficial wound infection rates RR, 2.43; [(5% CI, 1.04-5.67)] and higher all complication rates [RR, 1.98; (95% CI, 1.22-3.22)]. Conclusion: Moderate certainty evidence shows that the use of a tourniquet was associated with an increased risk of higher superficial wound infection rates and all complication rates. Therefore, the findings did not support the routine use of a tourniquet during TKA.


Subject(s)
Arthroplasty, Replacement, Knee , Pain, Postoperative , Tourniquets , Aged , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Humans , Pain, Postoperative/etiology , Randomized Controlled Trials as Topic , Range of Motion, Articular , Tourniquets/adverse effects
2.
Reg Anesth Pain Med ; 46(5): 398-403, 2021 05.
Article in English | MEDLINE | ID: covidwho-1503798

ABSTRACT

BACKGROUND: The femoral nerve block (FNB) may be used for analgesia in hip fracture surgery. The pericapsular nerve group (PENG) block is a novel regional technique and may provide better pain reduction while preserving motor function, but these blocks have not been directly compared. METHODS: In a single-center double-blinded randomized comparative trial, patients presenting for hip fracture surgery received analgesia with either FNB or PENG block. The primary outcome measure was pain scores (Numeric Rating Scale (NRS) 0 to 10). Secondary outcomes were postoperative quadriceps strength, opiate use, complications, length of hospital stay, and patient-reported outcomes. RESULTS: Sixty patients were randomized and equally allocated between groups. Baseline demographics were similar. Postoperatively in recovery (day 0), the PENG group experienced less pain compared with the FNB group. (In the PENG group, 63% experienced no pain, 27% mild pain, and 10% moderate to severe pain. In comparison, 30% of the FNB group reported no pain, 27% mild pain, and 36% moderate to severe pain; p=0.04). This was assessed using an 11-point Likert NRS. Quadriceps strength was better preserved in the PENG group in the recovery unit (assessed using Oxford muscle strength grading, 60% intact in the PENG group vs none intact in the FNB group; p<0.001) and on day 1 (90% intact vs 50%, respectively; p=0.004). There was no difference in other outcomes. CONCLUSIONS: Patients receiving a PENG block for intraoperative and postoperative analgesia during hip fracture surgery experience less postoperative pain in the recovery room with no difference detected by postoperative day 1. Quadriceps strength was better preserved with the PENG block. Despite the short-term analgesic benefit and improved quadriceps strength, there were no differences detected in the quality of recovery.


Subject(s)
Analgesia , Nerve Block , Femoral Nerve , Humans , Pain Management , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control
4.
Neuromodulation ; 24(8): 1439-1450, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1455641

ABSTRACT

OBJECTIVE: Transcutaneous electrical nerve stimulation (TENS) is a minimally invasive method for treating pain. In the most recent review published in 2012, TENS was associated with increased pain relief following cardiothoracic surgery when compared to standard multimodal analgesia. The purpose of this systematic review and meta-analysis is to determine if adding TENS to current pain management practices decreases pain and analgesic use and improves pulmonary function for postcardiothoracic surgery patients. MATERIALS AND METHODS: CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, PubMed, and ClinicalTrials.gov were searched using specific keywords. Covidence was used to screen, select studies, and extract data by two independent reviewers. The Cochrane Risk of Bias tool assessed risk of bias. Visual analog scale (VAS) and pulmonary function data were exported for meta-analysis using a random effects model. RESULTS: The search yielded 38 articles. Eight randomized controlled trials met inclusion criteria for the literature review. Five studies were included in the meta-analysis of pain at 24, 48, and 72 hours postoperatively. Data were analyzed using the standard mean difference (SMD). TENS had a significant impact on VAS at rest (-0.76 SMD [95% confidence interval, CI = -1.06 to -0.49], p < 0.00001) and with coughing (-1.11 SMD [95% CI = -1.64 to -0.56], p < 0.0001). FEV1 improved after 72 hours (1.00 SMD [95% CI = 0.66-1.35], p < 0.00001), as did forced vital capacity (1.16 SMD [95% CI = 0.23-2.10], p = 0.01). CONCLUSION: The addition of TENS therapy to multimodal analgesia significantly decreases pain following cardiothoracic surgery, increases the recovery of pulmonary function, and decreases the use of analgesics.


Subject(s)
Analgesia , Transcutaneous Electric Nerve Stimulation , Analgesics, Opioid/therapeutic use , Humans , Pain, Postoperative/etiology , Pain, Postoperative/therapy , Systematic Reviews as Topic
5.
Sci Rep ; 10(1): 5189, 2020 03 23.
Article in English | MEDLINE | ID: covidwho-1454803

ABSTRACT

Stapled hemorrhoidopexy has a few advantages such as less postoperative pain and faster recovery compared with conventional hemorrhoidectomy. There are two major devices used for stapled hemorrhoidopexy, PPH stapler (Ethicon EndoSurgery) and DST stapler (Covidien). This study was conducted to investigate the postoperative outcomes among patients with grade III and IV hemorrhoids who underwent hemorrhoidopexy with either of these two devices. A total of 242 consecutive patients underwent stapled hemorrhoidopexy with either PPH stapler (110 patients) or DST stapler (132 patients) at a single center in 2017. We performed a retrospective case-control study to compare the short-term postoperative outcomes and the complications between these two groups. After matching the cases in terms of age, gender, and the grade of hemorrhoids, there were 100 patients in each group (PPH versus DST). There were no significant differences in the postoperative visual analog scale (VAS) score and analgesic usage. Among complications, the incidence of anorectal stricture was significantly higher in the DST group (p = 0.02). Evaluation of the mucosal specimen showed that the total surface area, the muscle/mucosa ratio and the surface area of the muscle were also significantly higher in the DST group (p = 0.03). Further analysis of the DST group demonstrated that patients with anorectal stricture after surgery are younger than patients without anorectal stricture, and higher muscle/mucosa ratio (p = 0.03) and a higher surface area of the muscle (p = 0.03) also measured in the surgical specimen. The two devices provide similar outcomes of postoperative recovery. Patients who underwent DST stapled hemorrhoidopexy had a higher incidence rate of stricture, larger area of muscle excision, and higher muscle/mucosa ratio in the surgical specimen. Further investigation is warranted for a better understanding of the correlation between muscle excision and anorectal stricture.


Subject(s)
Hemorrhoidectomy/instrumentation , Hemorrhoids/surgery , Surgical Staplers , Acetaminophen/therapeutic use , Anal Canal/pathology , Analgesics/therapeutic use , Anus Diseases/etiology , Constriction, Pathologic/etiology , Equipment Design , Female , Hemorrhage/etiology , Humans , Intestinal Mucosa/pathology , Isoxazoles/therapeutic use , Male , Middle Aged , Organ Size , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome , Urinary Retention/etiology
6.
PLoS One ; 16(2): e0244860, 2021.
Article in English | MEDLINE | ID: covidwho-1058294

ABSTRACT

INTRODUCTION: Regional anesthesia offers an alternative to general anesthesia and may be advantageous in low resource environments. There is a paucity of data regarding the practice of regional anesthesia in low- and middle-income countries. Using access data from a free Android app with curated regional anesthesia learning modules, we aimed to estimate global interest in regional anesthesia and potential applications to clinical practice stratified by World Bank income level. METHODS: We retrospectively analyzed data collected from the free Android app "Anesthesiologist" from December 2015 to April 2020. The app performs basic anesthetic calculations and provides links to videos on performing 12 different nerve blocks. Users of the app were classified on the basis of whether or not they had accessed the links. Nerve blocks were also classified according to major use (surgical block, postoperative pain adjunct, rescue block). RESULTS: Practitioners in low- and middle-income countries accessed the app more frequently than in high-income countries as measured by clicks. Users from low- and middle-income countries focused mainly on surgical blocks: ankle, axillary, infraclavicular, interscalene, and supraclavicular blocks. In high-income countries, more users viewed postoperative pain blocks: adductor canal, popliteal, femoral, and transverse abdominis plane blocks. Utilization of the app was constant over time with a general decline with the start of the COVID-19 pandemic. CONCLUSION: The use of an in app survey and analytics can help identify gaps and opportunities for regional anesthesia techniques and practices. This is especially impactful in limited-resource areas, such as lower-income environments and can lead to targeted educational initiatives.


Subject(s)
Anesthesia, Local/economics , Health Education/economics , Income , Mobile Applications , Telemedicine , Geography , Humans , Nerve Block , Outcome Assessment, Health Care , Pain, Postoperative/etiology
7.
J Laparoendosc Adv Surg Tech A ; 31(4): 455-457, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-759898

ABSTRACT

Background: COVID-19 era has put laparoscopic surgery a risk procedure because of theoretical risk of viral transmission of COVID-19. However, safe evacuation of stagnant air during laparoscopic surgery is also necessary to safeguard health care warriors. Methods: We are reporting experience of 24 laparoscopic surgeries using a closed smoke evacuation/filtration system using a ultra low-particulate air (ULPA) filtration capability (ConMed AirSeal® System) at a single center between March 22, 2020, and May 30, 2020. All surgeries were either urgent or emergency in nature. Results: Totally, 17 males and 7 females who required urgent surgery. Most common indication for laparoscopic intervention was acute cholecystitis and complications related to acute cholecystitis. Owing to the closed smoke evacuation system, low intra-abdominal pressure was maintained during all surgeries. Of all procedures, only 0.8 time per procedure, the laparoscope taken out for cleaning. Mean time for completion of surgery was 58 minutes. Compliance of surgical staff was high due to the deemed safe smoke evacuation system. Mean of postoperative pain score was low. Mean hospital stay was 4.9 days. Conclusions: We propose to use a closed smoke evacuation/filtration system with ULPA filtration capability or similar devices in each minimally invasive surgery to reduce risks of transmission as minute as possible until we have enough knowledge about the pattern of disease transmission.


Subject(s)
COVID-19/prevention & control , Digestive System Surgical Procedures/instrumentation , Health Personnel , Laparoscopy/instrumentation , Occupational Exposure/prevention & control , Cholecystitis, Acute/complications , Cholecystitis, Acute/surgery , Digestive System Surgical Procedures/adverse effects , Emergencies , Female , Humans , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Operating Rooms , Operative Time , Pain, Postoperative/etiology , Pneumoperitoneum, Artificial , SARS-CoV-2
8.
J Gynecol Obstet Hum Reprod ; 49(7): 101813, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-276349

ABSTRACT

BACKGROUND: Laparoscopic gynaecological surgery is commonly performed under general anaesthesia with endotracheal intubation. In general surgery, locoregional anaesthesia was applied to laparoscopic procedures, increasing minimally invasive surgery advantages. AIMS: To assess and compare postoperative pain after laparoscopic adnexal procedures for benign conditions under spinal anaesthesia (SA) versus general anaesthesia (GA). Furthermore, anaesthesiologic, surgical and clinical data were evaluated in both groups. MATERIALS AND METHODS: This is a prospective cohort study performed in a tertiary level referral centre for minimally invasive gynaecological surgery (Gynaecology and Human Reproduction Physiopathology, University of Bologna). Women scheduled for adnexal laparoscopic surgery for benign conditions between February and May 2019 were assigned to receive either SA or GA with endotracheal intubation. A sample size of 13 women per group was needed to detect a 2-point difference in pain scores. MAIN FINDINGS: 13 women were enrolled in the SA arm, 15 in the GA arm. In the SA cohort, the most common intraoperative adverse event was shoulder pain, reported by 3/12 women. At 1, 8, 12, 24 and 48 h after surgery pain was significantly lower in the SA arm (p < .05). Patients submitted to SA experienced no need for opioid drugs administration, unlike those receiving GA. Patients' mobilization and return of bowel function were noted significantly earlier in the SA group (p < .05). CONCLUSIONS: SA is a feasible, safe and effective anaesthesiologic technique for laparoscopic gynaecological procedures for benign conditions, allowing a better control of postoperative pain. Women undergoing SA achieve earlier mobilization and bowel canalization. During the Covid-19 pandemics, SA could be useful in reducing the need for invasive procedures on respiratory tract.


Subject(s)
Adnexal Diseases/surgery , Anesthesia, General/methods , Anesthesia, Spinal/methods , Gynecologic Surgical Procedures/methods , Laparoscopy/methods , Pain, Postoperative/diagnosis , Adnexa Uteri/surgery , Adult , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Intubation, Intratracheal , Laparoscopy/adverse effects , Middle Aged , Pain, Postoperative/etiology , Prospective Studies , Sample Size
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