Effects of the prolonged thoracic epidural analgesia on ventilation function and complication rate after the lung cancer surgery.

UNLABELLED: Thoracic epidural analgesia has been considered to have a good anesthetic efficacy and to decrease the postoperative complication rate, while its effect upon the ventilation function is still the topic of many clinical studies. The aim of this study was to evaluate the course of early postoperative period using thoracic epidural analgesia. MATERIAL AND METHODS: A total of 453 patients undergoing the operation due to the non-small cell carcinoma were selected and examined. Their postoperative complications and mortality rate were evaluated. In 79 patients, arterial oxygen saturation (SaO(2)), forced vital capacity, forced expiratory volume in the first second, and the efficacy of analgesia were analyzed within the first 7 days after the operation. These patients were divided into subgroups according to the type of the operation--lobectomy or pneumonectomy--and the type of analgesia--thoracic epidural analgesia or opiates administered intramuscularly (control group). RESULTS: A better statistically significant efficacy of analgesia was observed in thoracic epidural analgesia group than in the control group (visual analog pain scale score 2.5 versus 5.3, P<0.01). There was also a statistically significant lower incidence of postoperative complications (20.5% versus 38.8%, respectively). Thoracic epidural analgesia is a factor decreasing the relative risk of complications (RR=0.53, 95% CI 0.28-0.99, P=0.0233). In the lobectomy group, 24 hours after the surgery, forced vital capacity was 61+/-12% in the group receiving thoracic epidural analgesia and 45+/-13% in the control group (P=0.0152); forced expiratory volume in the first second was 56+/-17% and 41+/-11%, respectively (P=0.0308). In the pneumonectomy group, 24 hours after the surgery, forced vital capacity was 47+/-16% in the group receiving thoracic epidural analgesia, 35+/-8% in the control group (P=0.080). Forced expiratory volume in the first second was 47+/-15% and 36+/-7%, respectively (P=0.0449). CONCLUSION: We conclude that analgesia with intramuscularly administered opioids provides unsatisfactory analgesia, especially in the first days after the operation. Thoracic epidural analgesia is a safe method, which provides a better quality of life for the patient, decreases the postoperative complication rate, and improves the ventilation function after the lung operations.

The analysis of infection after polypropylene mesh repair of abdominal wall hernia.

AIM: The aim of the study was to evaluate the frequency of superficial and prosthetic mesh infection following polypropylene mesh repair of different abdominal wall hernia in individual patients and to analyze the manifestation, clinical process and outcomes in patients with prosthetic mesh infection. METHODS: This was a retrospective analysis of 375 patients with 423 implanted meshes for groin, femoral, umbilical, incisional and epigastric hernias, with a mean follow-up of 15 months (range: 3-73 months). RESULTS: The total superficial infection rate was 1.65%, and the rate of mesh infection was 0.94%. There were no statistically significant differences in prosthetic mesh infection between monofilament and multifilament meshes as well as between the different repair groups of hernias. The deep incisional surgical site infection after previous operation was established as a significant risk factor for prosthetic mesh infection in incisional hernia repair (P < 0.0001). Five cases of prosthetic mesh infection were presented and analyzed. CONCLUSIONS: There is no correlation between the superficial and prosthetic mesh infection. There may be difficulties in determining mesh infection and to choose the right tactic. The reconvalescence in all patients with mesh infection was achieved only after removal of the infected mesh.