Biologic therapies targeting the interleukin (IL)-23/IL-17 immune axis for the treatment of moderate-to-severe plaque psoriasis: a systematic review and meta-analysis.

There are a rapidly increasing number of novel biologic therapies for psoriasis targeting interleukin-23 (IL-23) and interleukin-17 (IL-17). This systematic review and meta-analysis evaluated the efficacy and safety of induction therapy (12-16 weeks) with biologic therapies targeting the IL-23/IL-17 immune axis for the treatment of moderate-to-severe plaque psoriasis. Twenty-seven randomized controlled trials met the specified inclusion criteria. The results showed that ixekizumab q2w had the greatest efficacy in terms of achieving 90% reduction in Psoriasis Area and Severity Index when compared to placebo [risk ratio (RR): 65.01, 95% confidence intervals (CI): 13.97-302.56, P < 0.00001], etanercept (RR: 3.14, 95% CI: 2.22-4.45) and ustekinumab (RR: 1.73, 95% CI: 1.41-2.12). The IL-17 inhibitors were overall shown to have a higher efficacy than the IL-23 inhibitors during induction therapy. However, the IL-17 inhibitors had an increased risk of adverse events when compared to placebo, while there was no increased risk with any of the IL-23 inhibitors. In conclusion, induction therapy with IL-17 inhibitors is highly efficacious but carries a higher risk of adverse events than induction therapy with IL-23 inhibitors.

Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery.

INTRODUCTION: Stoma formation delays discharge after colorectal surgery. Stoma education is widely recommended, but little data are available regarding whether educational interventions are effective. The aim of this prospective study was to investigate whether an enhanced recovery after surgery (ERAS) programme with dedicated ERAS and stoma nurse specialists focusing on counselling and stoma education can reduce the length of hospital stay, re-admission, and stoma-related complications and improve health-related quality of life (HRQoL) compared to current stoma education in a traditional standard care pathway. METHODS: In a single-center study 122 adult patients eligible for laparoscopic or open colorectal resection who received a planned stoma were treated in either the ERAS program with extended stoma education (n = 61) or standard care with current stoma education (n = 61). The primary endpoint was total postoperative hospital stay. Secondary endpoints were postoperative hospital stay, major or minor morbidity, early stoma-related complications, health-related quality of life, re-admission rate, and mortality. HRQoL was measured by the generic 15D instrument. RESULTS: Total hospital stay was significantly shorter in the ERAS group with education than the standard care group (median [range], 6 days [2-21 days] vs. 9 days [5-45 days]; p < 0.001). Regarding overall major and minor morbidity, re-admission rate, HRQoL, stoma-related complications and 30-day mortality, the two treatment groups exhibited similar outcomes. CONCLUSION: Patients receiving a planned stoma can be included in an ERAS program. Pre-operative and postoperative stoma education in an enhanced recovery programme is associated with a significantly shorter hospital stay without any difference in re-admission rate or early stoma-related complications.

Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial.

AIM: The aim of this randomized clinical trial was to compare patients treated using a multimodal approach [enhanced recovery after surgery (ERAS)], with a special focus on counselling, to patients treated in a standard conventional care pathway, who underwent elective colorectal resection. METHOD: In a single-centre trial, adult patients eligible for open or laparoscopic colorectal resection were randomized to an ERAS programme or standard care. The primary end-point was postoperative total hospital stay. Identical discharge criteria were defined for both treatment groups. Secondary end-points included postoperative complications, postoperative C-reactive protein levels, postoperative hospital stay, readmission rate and mortality. All parameters were recorded before operation, on the day of surgery and daily thereafter until discharge. RESULTS: Total hospital stay was significantly shorter among patients randomized to ERAS than among the standard group [median 5 days (range 2-50 days) vs median 8 days (range 2-48 days); P = 0.001]. The two treatment groups exhibited similar outcomes regarding overall major and minor morbidity, reoperation rate, readmission rate and 30-day mortality. There were also no differences in tolerance of enteral nutrition or in the inflammatory response, as reflected by postoperative C-reactive protein levels. CONCLUSION: ERAS care was associated with a significantly shorter length of hospital stay. Without any difference in surgical or general complications, tolerance of enteral nutrition or postoperative C-reactive protein levels, peri-operative information and guidance for ensuring that patients comply with the ERAS approach appear to be important factors to reduce the length of hospital stay.

[Auxiliary cerclage-wiring in internal fixation of displaced acetabular fractures]. / Auxiliäre Cerclage zur Reposition und Retention dislozierter Acetabulumfrakturen.

BACKGROUND: Displaced fractures of the acetabulum involving the quadrilateral plate continue to be a surgical challenge. In this study, we describe our operation technique of auxiliary acetabular cerclage-wiring combined with plate osteosynthesis and present our results as well as short-term outcome. PATIENTS AND METHODS: All patients aged 18 years and older treated with auxiliary cerclage-wiring between 2007 and 2012 were included in this study. Fractures were classified according to Letournel. Cerclage wiring was used when reposition and retention of the fracture was insufficient with plates and screws alone. Short-term outcome was evaluated by the German Short Musculoskeletal Functional Assessment (SMFA-D) questionnaire. RESULTS: Data from 23 patients were collected. The follow-up period was 7 months (range 2-23 months). Of the 23 patients, 22 showed excellent fracture reduction and retention. One patient had to undergo revision surgery due to loss of reposition. Patients showed good functional outcome. CONCLUSION: Auxiliary acetabular cerclage-wiring is a safe and effective method for fracture reduction and retention especially in displaced acetabular fractures involving the quadrilateral plate.

Identification and characterization of secretagogin promoter activity.

Secretagogin is a newly identified calcium-binding protein selectively expressed in neuroendocrine tissue and pancreatic beta-cells. The function of secretagogin is unknown, but it has been suggested in beta-cells to influence calcium-influx, insulin secretion and proliferation, and has been observed downregulated in diabetes-prone BB rat islets exposed to cytokines. In the present study, we identified and characterized promoter activity of a human 1498 bp sequence upstream the transcription start site. The promoter sequence showed subtle but significant regulation by glucose within the normo-physiological range. Glucose also led to changes in expression of secretagogin protein in INS-1e cells, but not in primary cells from non-diabetes-prone Wistar Furth rats. No effects of cytokines neither on promoter activity nor protein expression were observed. The promoter region was furthermore screened by direct sequencing, and 11 polymorphisms were identified. Genotyping in a large homogenous Type 1 diabetes (T1D) family collection did not reveal association with T1D.

Relationship between scintigraphic and radiographic evaluations of spinous processes in the thoracolumbar spine in riding horses without clinical signs of back problems.

REASONS FOR PERFORMING STUDY: Radiography and scintigraphy are used to aid diagnosis of the cause of back pain, but a large variation in appearance and radiopharmaceutical uptake in fully functioning horses make diagnosis difficult. OBJECTIVES: To describe the range of and compare scintigraphic and radiographic findings in the spinous processes of horses without clinical signs of back problems. METHODS: Thirty-three apparently normal riding horses underwent scintigraphic and radiographic examinations of the spinous processes in the thoracolumbar spine. Scintigraphic images were evaluated in a continuous blue, green and red colour scale, and the level of radiopharmaceutical uptake in the spinous processes from T10-L2 was graded into none, mild, moderate or severe increased radiopharmaceutical uptake. Structural changes along the borders of the spinous processes and the width of the interspinous spaces from T10-L2 were recorded. RESULTS: Only 7 horses had no scintigraphic or radiographic findings. Nine horses had no increased radiopharmaceutical uptake, 17 had no sclerosis, 21 had no radiolucencies and 11 had normal spacing of the spinous processes (>4 mm wide). The majority of findings in 26 horses were located from T13-18 and were mild. CONCLUSIONS: The findings of a wide spectrum of scintigraphic and radiographic changes leads to the conclusion that changes within this range found in affected horses cannot be interpreted as clinically significant. POTENTIAL RELEVANCE: To determine whether scintigraphy and/or radiography can be used to separate horses with back pain from horses without clinical signs, the results from this study should be compared to the scintigraphic and radiographic findings in horses with clinical signs.

Kinematic evaluation of the back in fully functioning riding horses.

REASONS FOR PERFORMING STUDY: Clinical history and examination are important features in diagnosis of equine back dysfunction. However, interpretation is subjective and therefore may vary substantially. OBJECTIVES: To establish a clinical tool to objectively evaluate the function of the equine back, in the form of a database on the kinematics of the back at the walk and trot in fully functioning riding horses. METHODS: Thirty-three fully functioning riding horses walked and trotted on a treadmill. Morphometrics and kinematics were tested for correlations to age, height, weight and stride length, and differences between gender (geldings and mares) and use (dressage and showjumping). RESULTS: A database for range of movement and symmetry of movement for extension and flexion, lateral bending, lateral excursion and axial rotation was presented. Symmetry values were very high for all variables. Significant differences were observed in use and gender. Age was negatively correlated to extension and flexion of the thoracolumbar junction. CONCLUSIONS: Interrelationships between use, gender and age to conformation and movement were established. POTENTIAL RELEVANCE: The database provides a basis for objective reference for diagnosis, therapy and rehabilitation of clinical cases of back dysfunction.

Kinematic evaluation of the back in the sport horse with back pain.

REASONS FOR PERFORMING STUDY: Earlier studies have developed a clinical tool to evaluate objectively the function of the equine back. The ability to differentiate horses with back pain from asymptomatic, fully functioning horses using kinematic measures from this tool has not been evaluated. OBJECTIVES: To compare the kinematics of the back at walk and trot in riding horses with back dysfunction to the same parameters in asymptomatic sport horses. METHODS: The kinematics of the back in 12 horses with impaired performance and back pain were studied at walk and trot on a treadmill. Data were captured for 10 sees at 240 Hz. Range of movement (ROM) and intravertebral pattern symmetry of movement for flexion and extension (FE), lateral bending (LB) and axial rotation (AR) were derived from angular motion pattern data and the results compared to an earlier established database on asymptomatic riding horses. RESULTS: At walk, horses with back dysfunction had a ROM smaller for dorsoventral FE in the caudal thoracic region (T13 = 7.50 degrees, T17 = 7.71 degrees; P<0.05), greater for LB at T13 (8.13 degrees; P<0.001) and smaller for AR of the pelvis (10.97 degrees; P<0.05) compared to asymptomatic horses (FE-T13 = 8.28 degrees, FE-T17 = 8.49 degrees, LB-T13 = 6.34 degrees, AR-pelvis = 12.77 degrees). At trot, dysfunctional horses had a smaller (P<0.05) ROM for FE at the thoracic lumbar junction (T17 = 2.46 degrees, L1 = 2.60 degrees) compared to asymptomatic horses (FE-T17 = 3.07 degrees, FE-L1 = 3.12 degrees). CONCLUSIONS: The objective measurement technique can detect differences between back kinematics in riding horses with signs of back dysfunction and asymptomatic horses. The clinical manifestation of back pain results in diminished flexion/extension movement at or near the thoracic lumbar junction. However, before applying the method more extensively in practice it is necessary to evaluate it further, including measurements of patients whose diagnoses can be confirmed and long-term follow-ups of back patients after treatment. POTENTIAL RELEVANCE: Since the objective measurement technique can detect small movement differences in back kinematics, it should help to clinically describe and, importantly, objectively detect horses with back pain and dysfunction.

Scintigraphic evaluation of the thoracic spine in the asymptomatic riding horse.

Scintigraphic evaluation of the spinous processes of the equine spine has been done by subjective evaluation of radiotracer uptake in clinically abnormal horses. To determine the range of variation in asymptomatic riding horses, 33 normal horses were examined. Two 60 degrees oblique views of the thoracic and lumbar spine were evaluated subjectively, and a semi quantitative method based on standardized regions of interest in each spinous process in T10-L3 was also applied. A ratio between each spinous process and a reference area (Rib 15 or 16) was calculated. The effects of two different color displays and a smoothing filter were assessed. The results of the subjective evaluation was compared to the calculated ratios, and the associations between age, gender, weight, height, use and increased radiotracer uptake, and ratios were analyzed. No significant association was found between age, gender, weight, height, use and increased radiotracer uptake, or ratio. One or more areas of increased radiotracer uptake between T13 and T18 were common in the asymptomatic riding horse, which may have implications for the interpretation of clinical patients. The blue, green and red color display had a higher sensitivity for detecting increased radiotracer uptake compared to the continuous grayscale. The smoothing filter used in this study had no effect on the detection of areas with increased radiotracer uptake. The association between the results of the subjective evaluation and the semi quantitative method was apparent when analyzed in T13-17. To evaluate if the semi quantitative method can replace the subjective evaluation, studies on clinically affected horses are necessary.

Scintigraphy of the sacroiliac joint region in asymptomatic riding horses: scintigraphic appearance and evaluation of method.

The sacroiliac region in 33 clinically normal riding horses was examined with scintigraphy to determine the normal scintigraphic appearance, to evaluate a semiquantitative method used to calculate a sacroiliac joint (SI joint) ratio, and to identify factors that affect the scintigraphic appearance of the pelvis. The scintigraphic examination included dorsal views of each SI joint region and one lateral view of the urinary bladder. Two predefined areas (the SI joint and the area between the tuber sacrale and the SI joint) were evaluated subjectively by comparing the intensity in each area to the intensity in the tuber sacrale, and a semiquantitative method was applied on the images to calculate an SI joint ratio. The thickness of the muscle mass overlying each SI joint was measured by using ultrasound. A corrected ratio was calculated based on a corrected pixel count for each SI joint. Of 29 evaluated horses, 28 had normal radiotracer uptake in the SI joints and 10 horses had symmetric normal radiotracer uptake in the area between the tuber sacrale and the SI joint. The mean SI joint ratio was 0.53 on both the left and right sides, and the mean corrected SI joint ratio was 2.15 on the left side and 2.13 on the right side. Factors that affect the scintigraphic appearance of the pelvis were identified and included attenuation, radioactive urine, and muscle symmetry. The muscle thickness ranged from 8-11 cm, causing 71-82% attenuation. Radioactive urine in the urinary bladder was located ventral to the SI joint region in 16 horses, and four of these were excluded from further evaluation because of risk of misinterpretation. A visual assessment of symmetry of the horses' gluteal muscle mass was compared with the ultrasound measurements. Fourteen horses (14/33) were regarded symmetric by both techniques. Soft tissue attenuation was found to severely compromise the result and indicated that only lesions in the SI joint with severely increased radiotracer uptake can be detected with scintigraphy. Knowledge about presence of radioactive urine ventral to the SI joint region and assessment of muscle symmetry is essential for a correct subjective evaluation. Any situation with difference in muscle mass between the left and right side of the pelvis will give a false impression of increased radiotracer uptake on the side with lesser muscle mass.

Effect of conformational aspects on the movement of the equine back.

The relationship between structure and function is important in the judgement of the horse. Twenty sound riding horses walked and trotted on a treadmill. The movement of the backs of each of the horses was measured using a commercially available movement analysis system. Morphometric, spatiotemporal and kinematic information were correlated to investigate the effect of conformation on movement. Taller and heavier horses seem to have longer thoracic and lumbar backs, and are wider at the pelvis. Horses with longer strides extended and flexed their backs in the caudal saddle region to a greater extent at the walk, but not the trot. Horses with greater angle of L5 tend to extend and flex this region of the back more. At the walk and trot, a long thoracic back results in greater lumbar lateral bending. A negative relationship was found between the curvature of mid-thoracic back and the amount of lateral bending of L1 and L3 and axial rotation of the pelvis at the trot. There are clear relationships between back conformation and movement that may be important to the orthopaedic health of the horse. Further understanding of the relationships between conformation, movement and injury may provide an objective basis for the evaluation of future performance and soundness.

Physiotherapy treatment of late symptoms following surgical treatment of breast cancer.

Women who have been subjected to surgical treatment for breast cancer may develop late sequelae in the area of operation on the chest wall and/or in the ipsilateral arm or shoulder after the immediate surgical discomfort has passed. As many patients seek treatment of their own accord by physiotherapists, we considered it relevant to evaluate the effect of two different physiotherapy regimes. We also wished to determine whether there was a possible relationship between occurrence of late sequelae and physical findings, carried out by means of a simple clinical examination based on physiotherapeutic methods of examination. Fifty-nine patients, 1-4 years postoperatively, were randomized to two different physiotherapy regimens. Patients were examined by a physician before and after the treatment, and they answered a questionnaire four times in all within the course of the investigation. The questionnaire covered six main late sequelae, as well as the degree of discomfort. Our investigation shows that many women experience late symptoms after surgical treatment of breast cancer, and that is possible in these patients, to demonstrate a reduction in strength in the ipsilateral extremity, reduced movement and increased muscle tone. Physiotherapy can improve the strength, movement and muscle tone in the operated extremity and also reduce the presence and severity of the late symptoms.

Time course of subjective pain ratings, and wound and leg tenderness after hysterectomy.

BACKGROUND: Little information is available on time course of wound tenderness and relationship to subjective pain ratings following surgery. Furthermore, it is not clarified whether surgical procedures may induce hyperalgesia to mechanical stimulation outside the area of the surgical incision. We have therefore assessed postoperative pain and pressure pain thresholds (PPT) adjacent to and remote from the surgical incision in 16 patients undergoing hysterectomy. METHODS: Pressure pain threshold was assessed with pressure algometry preoperatively, 4 and 6 and 1, 4 and 8 d after surgery on the abdominal wall 0.05, 5, 10 and 15 cm perpendicular to the wound, and on the anterior surface of the left thigh and tuberositas tibia. Furthermore, pain was assessed on a visual analogue scale (VAS) at rest and during cough. RESULTS: PPT decreased significantly 0.5, 5, 10 and 15 cm from skin incision up to 96 h after surgery (P < 0.01) with a trend towards higher PPT with increasing distance from the wound. There was no significant changes in PPT on the thigh or the tuberositas tibia (P = 0.49 and P = 0.12) and no correlation between changes in PPT near the wound and in remote (areas the legs) (Rs = -0.082, P = 0.53, respectively). VAS at rest increased from 4 to 24 h and the cough values, remained elevated throughout the study (P < 0.05). An inverse relationship was observed between PPT 5 cm from the incision and VAS at rest (Rs = -0.406, P = 0.0002) and during cough (Rs = -0.398, P = 0.0002). CONCLUSION: These results indicate that wound pressure algometry correlates to postoperative pain at rest and during movement and may be an alternative way of assessing wound pain and tenderness. Increased tenderness to mechanical stimulation remote from the surgical wound could not be demonstrated.

The Nordic multicenter double-blind randomized controlled trial of prophylactic ursodeoxycholic acid in liver transplant patients.

BACKGROUND: Prophylactic treatment with ursodeoxycholic acid (UDCA) has been reported to reduce the incidence of acute rejection after liver transplantation compared with historical controls. We investigated this in a prospective, randomized, placebo-controlled multicenter study. METHODS: Fifty-four liver transplant patients were allocated to the UDCA treatment group (15 mg/kg/day), and 48 patients were allocated to the placebo group. Trial medicine was started on the first postoperative day and was given for 3 months. Follow-up was for 12 months. Treatment was stratified for adults with chronic liver disease (n=77), adults with acute liver failure (n=10), and children (n=15). RESULTS: The frequency of patients with acute rejection was 65% in the UDCA treatment group and 68% in the placebo group. The frequency of steroid-resistant rejection was similar in both groups. The probability of acute rejection, analyzed according to the intention-to-treat policy with Kaplan-Meier analysis, was similar in both treatment groups. No significant differences were found in patient survival and graft survival probabilities. For the biochemical markers of cholestasis, only gamma-glutamyltransferase was significantly improved after 2 months of UDCA treatment. CONCLUSIONS: The initial optimistic report of a beneficial effect of prophylactic treatment with UDCA on acute rejection after liver transplantation was not confirmed in this controlled study.

Pharmacokinetics and analgesic effect of ropivacaine during continuous epidural infusion for postoperative pain relief.

BACKGROUND: The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. METHODS: Through an epidural catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion was followed up to the end of infusion. Postoperative pain at rest, on coughing, and at mobilization was assessed by means of a visual analog scale 2,4,6,8,12, and 24 h after the end of surgery. Sensory (pinprick) and motor block (modified Bromage scale) were assessed at the same intervals. RESULTS: The total plasma concentrations of ropivacaine increased markedly and consistently during the 24-h epidural infusion, in contrast to stable unbound concentrations. Both total and unbound plasma concentrations at the end of infusion were proportional to the total dose, although only the latter was proportional to the infusion rate. The total and unbound plasma clearance was independent of dose. Total mean clearance decreased on average by 21% (P < 0.001) during the last 12 h of epidural infusion, i.e., from 539 +/- 191 ml/min to 418 +/- 138 ml/min, indicating time-dependent kinetics. The unbound clearance also varied between estimates after 8 h of infusion and the end of treatment, i.e., a 5.3% decrease from 10.4 +/- 5.3 l/min to 9.5 +/- 3.9 l/min (P < 0.05). The unbound fraction of ropivacaine in plasma decreased during treatment, and this was related to the increase in alpha1-acid glycoprotein concentration. Pain was generally well controlled, and median visual analog scale scores during mobilization were less than 30 mm in patients receiving ropivacaine at 20 mg/h. CONCLUSIONS: The pharmacokinetics of ropivacaine were independent of dose, but total clearance decreased with time over 24 h. The consistent increase in total plasma concentration during the postoperative epidural infusion contrasted to much less variation in the unbound plasma concentrations of ropivacaine.

[Late symptoms among patients surgically treated for breast cancer. A questionnaire in the county of Southern Jutland]. / Senfølger hos patienter opereret for brystkraeft. En spørgeskemaundersøgelse i Sønderjyllands Amt.

The 1989 protocol of the Danish Breast Cancer Cooperative Group implied a more extensive axillary dissection and reduced frequency of regional lymphnode irradiation. A questionnaire concerning late symptoms was sent to all women operated from 1989 to 1993. The rate of response among women treated with modified radical mastectomy was 82%. Of 163 patients, 79% had one or more late symptoms. Most troublesome was pain in the neck, shoulder and arm or scar-related pain. Other symptoms were lymphoedema, paraesthesia of the arm and impaired shoulder function; each symptom occurring among 29-47% of the women. Most symptoms began three to four weeks postoperatively. The frequency of late symptoms corresponded with number of lymphnodes removed, number of tumourpositive nodes and irradiation of the scar. Thirty-five women were treated with tumourectomy and they experienced similar late symptoms with a similar degree of distress. It is concluded that late symptoms among women treated for breast cancer still occur frequently.

Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy.

In a double-blind, randomized study, 32 patients scheduled for elective inguinal herniotomy under general anaesthesia received subcutaneous infiltration with 40 ml ropivacaine 2.5 mg/ml or bupivacaine. Postoperative pain intensity was assessed repeatedly for 24 hours at rest, during cough and movement on a visual analogue scale (VAS) and by means of pressure algometry. No differences between pain intensities or wound tenderness were found between the groups. The demand for analgesics was similar in the two groups. We conclude that incisional ropivacaine is as effective as bupivacaine in the management of post-herniotomy pain.

Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia.

STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development of late postoperative constant and episodic hypoxemia, which instead may be related to the magnitude of trauma and/or opioid administration.

Effect of epidural blockade and oxygen therapy on changes in subcutaneous oxygen tension after abdominal surgery.

The effect of oxygen therapy (37% by face mask) and epidural local anesthetic blockade (9 ml 0.5% bupivacaine at Th9-11 level) on wound oxygenation was evaluated in eight otherwise healthy patients undergoing elective colorectal resection. The patients were monitored continuously for subcutaneous oxygen tension, arterial oxygen saturation, heart rate, and skin temperature on the day after operation, and arterial blood for gas analysis was drawn every 15 min during the study. A fluid challenge (10 ml saline/kg body wt) did not alter any of the measured values. The epidural blockade did not change any of the measured values. Oxygen therapy before epidural blockade increased median subcutaneous oxygen tension from 60 to 71 mmHg (P < 0.02) and, after epidural blockade, from 64 to 71 mmHg (P < 0.02) Time to reach steady state in subcutaneous oxygen tension with oxygen therapy was 30 (15-55) min without epidural blockade and 15 (10-20) min with blockade (P < 0.03). In conclusion, epidural local anesthetic blockade did not increase subcutaneous oxygen tension with or without oxygen therapy after elective uncomplicated major abdominal surgery.