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Lai CJ, Shih PY, Cheng YJ, Lin CK, Cheng SJ, Peng HH, Chang WT, Chien KL. Incidence and risk factors of postoperative pulmonary complications after oral cancer surgery with free flap reconstruction: A single center study. J Formos Med Assoc 2024; 123:347-356. [PMID: 37739911 DOI: 10.1016/j.jfma.2023.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/13/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) increase the risk of morbidity and mortality in patients who underwent oral cancer surgery with free flap reconstruction. The association between PPC and preoperative risk factors has been investigated; however, reports on intraoperative factors are limited. Therefore, we investigated PPC incidence and its associated preoperative and intraoperative risk factors in these patients. METHODS We retrospectively analyzed medical records of patients who underwent free flap reconstruction between 2009 and 2019. PPC was defined as presence of atelectasis, pneumonia, and respiratory failure based on radiological confirmation and clinical symptoms during hospitalization. Mortality, hospital stay, preoperative factors (including age and tumor stages), American Society of Anesthesiologists (ASA) classification, and intraoperative factors (including intraoperative fluids and medications) were recorded. RESULTS PPC incidence among the 993 patients included in this study was 25.8% (256 patients). Six patients with PPCs died; death was not observed among patients without PPCs (p < 0.001). Patients with PPCs had longer hospitalization than those without PPCs (30.3 vs 23.3 days; p < 0.001). Tumor stage (stage I: reference; stage II [OR]: 3.3, p = 0.019; stage III: 4.4, p = 0.002; stage IV: 4.8, p = 0.002), age (OR: 1.0; p < 0.001), and ASA grade >2 (OR: 1.4; p = 0.020) were independent risk factors of PPC; using labetalol was a borderline significant factor (OR: 1.4; p = 0.050). CONCLUSION The PPC incidence was 25.8% in patients undergoing oral cancer surgery with free flap reconstruction. Tumor stage, age, and ASA >2 were risk factors of developing PPC.
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Affiliation(s)
- Chih-Jun Lai
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Yuan Shih
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ching-Kai Lin
- Department of Internal Thoracic Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Shih-Jung Cheng
- Department of Oral and Maxillofacial Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Hui Peng
- Department of Oral and Maxillofacial Surgery, Hsin-Chu Branch of National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Ting Chang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Population Health Research Center, National Taiwan University, Taiwan.
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Alvi AS, Nasir JA, Nizam MA, Hamdani MM, Bhangar NA, Sibtain SA, Lalani AS, Warlé MC. Quadratus lumborum block and transversus abdominis plane block in laparoscopic nephrectomy: a meta-analysis. Pain Manag 2023; 13:555-567. [PMID: 37718911 DOI: 10.2217/pmt-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Aim: To study the efficacy of quadratus lumborum block (QLB) and transversus abdominis plane (TAP) in laparoscopic nephrectomy patients. Materials & methods: We conducted a meta-analysis of randomized controlled trials for QLB and/or TAP technique compared with each other or a control. Results: Direct analysis of 24 h post-op pain score at rest for each compared with control showed significant reduction, QLB (mean differences [MD] [95% CI]: -1.12 [-1.87,-0.36]; p = 0.004) and TAP (MD [95% CI]: -0.36 [-0.59, -0.12]; p = 0.003). With movement both were respectively lower than control QLB (MD [95% CI]: -1.12 [-1.51, -0.72]; p = <0.0001) and TAP (MD [95% CI]: -0.50 [-0.95, -0.05]; p = 0.03). Moreover, QLB demonstrated less risk 24 h of post-op nausea vomiting (PONV) versus control (PONV; risk ratios [RR] [95% CI]: 0.64 [0.45,0.90]; p = 0.01). Conclusion: TAP and QLB reduce pain scores compared with control, whereas only QLB reduces PONV compared with control.
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Affiliation(s)
- Abdul S Alvi
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Jamal A Nasir
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Muhammad A Nizam
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Muhammad M Hamdani
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Nabeel A Bhangar
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Syed A Sibtain
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Ali S Lalani
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
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Luebbert E, Rosenblatt MA. Postoperative Rebound Pain: Our Current Understanding About the Role of Regional Anesthesia and Multimodal Approaches in Prevention and Treatment. Curr Pain Headache Rep 2023; 27:449-454. [PMID: 37389683 DOI: 10.1007/s11916-023-01136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE OF REVIEW Rebound pain (RP) is a common occurrence after peripheral nerve block placement, especially when blocks are used for orthopedic surgery. This literature review focuses on the incidence and risk factors for RP as well as preventative and treatment strategies. RECENT FINDINGS The addition of adjuvants to a block, when appropriate, and starting patients on oral analgesics prior to sensory resolution are reasonable approaches. Using continuous nerve block techniques can provide extended analgesia through the immediate postoperative phase when pain is the most intense. Peripheral nerve blocks (PNBs) are associated with RP, a frequent phenomenon that must be recognized and addressed to prevent short-term pain and patient dissatisfaction, as well as long-term complications and avoidable hospital resource utilization. Knowledge about the advantages and limitations of PNBs allows the anesthesiologists to anticipate, intervene, and hopefully mitigate or avoid the phenomenon of RP.
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Affiliation(s)
- Elizabeth Luebbert
- Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai Morningside and West Hospitals, New York, NY, USA
| | - Meg A Rosenblatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai Morningside and West Hospitals, New York, NY, USA.
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Boran ÖF, Urfalioglu A, Arslan M, Yazar FM, Bilal B, Orak Y, Katı B, Bozan AA. The effect of transversus abdominis plane block application on postoperative analgesia quality and patient satisfaction after varicocele surgery: a randomized clinical trial. ASIAN BIOMED 2023; 17:136-143. [PMID: 37818162 PMCID: PMC10561680 DOI: 10.2478/abm-2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Background Postoperative pain management is an important aspect of anesthesia care and multimodal analgesic techniques are generally recommended. Objective To compare the effect of spinal anesthesia + transversus abdominis plane (TAP) block application on postoperative analgesia quality and patient satisfaction with spinal anesthesia + intrathecal morphine (ITM) application. Methods A total of 70 patients were randomly separated into 2 groups as spinal anesthesia + TAP block (TAP block group, n = 34) and spinal anesthesia + ITM group (ITM group, n = 36). The groups were compared in respect of age, body mass index values, and visual analog scale (VAS) values at 0 h, 2 h, 6 h, 12 h, and 18 h, and patient satisfaction was scored by Quality Improvement in Postoperative Pain Management at 24 h. Results The mean age of the patients was 32.52 ± 6.50 years in the TAP block group and 30.11 ± 5.62 years in the ITM group, with no statistically significant difference determined. There was no statistically significant difference in terms of VAS values at 0 h, 2 h, 6 h, 12 h, and 18 h. When the factors affecting postoperative patient satisfaction were evaluated, feeling fatigue after the surgery (r = -0.811, P = 0.001) and postoperative complications such as nausea, vomiting, and itching (r = -0.831, P = 0.001) were found to have a negative effect on patient satisfaction. Conclusion Due to low complication rates, TAP block is an effective application for postoperative analgesia management in varicocele operations that increases patient satisfaction postoperatively.
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Affiliation(s)
- Ömer Faruk Boran
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, Kahramanmaraş46000, Turkey
| | - Aykut Urfalioglu
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, Kahramanmaraş46000, Turkey
| | - Mahmut Arslan
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, Kahramanmaraş46000, Turkey
| | - Fatih Mehmet Yazar
- Department of General Surgery, Sütçü Imam University School of Medicine, Kahramanmaraş46000, Turkey
| | - Bora Bilal
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, Kahramanmaraş46000, Turkey
| | - Yavuz Orak
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, Kahramanmaraş46000, Turkey
| | - Bülent Katı
- Department of Urology, Harran University School of Medicine, Şanlıurfa, Kahramanmaraş63000, Turkey
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Birrer DL, Kuemmerli C, Obwegeser A, Liebi M, von Felten S, Pettersson K, Horisberger K. INSPIRA: study protocol for a randomized-controlled trial about the effect of spirometry-assisted preoperative inspiratory muscle training on postoperative complications in abdominal surgery. Trials 2022; 23:473. [PMID: 35672861 PMCID: PMC9172146 DOI: 10.1186/s13063-022-06254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Rehabilitation strategies after abdominal surgery enhance recovery and improve outcome. A cornerstone of rehabilitation is respiratory physiotherapy with inspiratory muscle training to enhance pulmonary function. Pre-habilitation is the process of enhancing functional capacity before surgery in order to compensate for the stress of surgery and postoperative recovery. There is growing interest in deploying pre-habilitation interventions prior to surgery. The aim of this study is to assess the impact of preoperative inspiratory muscle training on postoperative overall morbidity. The question is, whether inspiratory muscle training prior to elective abdominal surgery reduces the number of postoperative complications and their severity grade. Methods We describe a prospective randomized-controlled single-centre trial in a tertiary referral centre. The primary outcome is the Comprehensive Complication Index (CCI) at 90 days after surgery. The CCI expresses morbidity on a continuous numeric scale from 0 (no complication) to 100 (death) by weighing all postoperative complications according to the Clavien-Dindo classification for their respective severity. In the intervention group, patients will be instructed by physiotherapists to perform inspiratory muscle training containing of 30 breaths twice a day for at least 2 weeks before surgery using Power®Breathe KHP2. Depending on the surgical schedule, training can be extended up to 6 weeks. In the control group, no preoperative inspiratory muscle training will be performed. After the operation, both groups receive the same physiotherapeutic support. Discussion Existing data about preoperative inspiratory muscle training on postoperative complications are ambiguous and study protocols are often lacking a clear design and a clearly defined endpoint. Most studies consist of multi-stage concepts, comprehensively supervised and long-term interventions, whose implementation in clinical practice is hardly possible. There is a clear need for randomized-controlled studies with a simple protocol that can be easily transferred into clinical practice. This study examines the effortless adjustment of the common respiratory physiotherapy from currently postoperative to preoperative. The external measurement by the device eliminates the diary listing of patients’ performances and allows the exercise adherence and thus the effect to be objectively recorded. Trial registration ClinicalTrials.govNCT04558151. Registered on September 15, 2020.
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Affiliation(s)
- D L Birrer
- Department of Transplantation and Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - C Kuemmerli
- Department of Surgery, Clarunis-University Centre for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - A Obwegeser
- Department of Physiotherapy and Occupational Therapy, University Hospital of Zurich, Zurich, Switzerland
| | - M Liebi
- Department of Physiotherapy and Occupational Therapy, University Hospital of Zurich, Zurich, Switzerland
| | - S von Felten
- Department of Biostatistics, Epidemiology and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - K Pettersson
- Department of Transplantation and Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - K Horisberger
- Department of Transplantation and Surgery, University Hospital of Zurich, Zurich, Switzerland.,Department of Surgery and Transplantation, University Hospital Mainz, Mainz, Germany
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Wang X, Guo K, Zhao Y, Li T, Yang Y, Xu L, Liu S. Lung-Protective Effects of Lidocaine Infusion on Patients with Intermediate/ High Risk of Postoperative Pulmonary Complications: A Double-Blind Randomized Controlled Trial. Drug Des Devel Ther 2022; 16:1041-1053. [PMID: 35422611 PMCID: PMC9004726 DOI: 10.2147/dddt.s358609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/26/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The non-local anesthetic effects of lidocaine have been widely reported, but there are still few studies on lung protection. We aimed to test the hypothesis that intravenous infusion of lidocaine exerts lung-protective effects in patients at intermediate/high risk of postoperative pulmonary complications (PPCs) on major abdominal surgery. Patients and Methods Patients ≥18 years, ASA II or III, with intermediate/high risk for PPCs, were included. Patients were randomly assigned into group lidocaine (received a bolus of lidocaine 1.5 mg kg−1 before the induction of anesthesia, then followed by a continuous infusion of 2.0 mg kg−1 h−1 intraoperatively until the end of surgery) or group control (received 0.9% saline in place of lidocaine at the same time points). The incidence of PPCs within 7 postoperative days was measured, defined as a collapsed composite outcome of atelectasis, respiratory infection, pleural effusion, pneumonia, respiratory failure or acute respiratory distress syndrome (ARDS) developed within 7 postoperative days, or hospital discharge, whichever came sooner. Results Of 200 subjects screened, 195 patients were finally analyzed. Overall, 35.9% (70/195) patients sustained PPCs, which occurred fewer in group lidocaine 25.8% (25/97), compared with group control 45.9% (45/98) (relative risk: 0.56, 95% CI: 0.38 to 0.84; absolute risk reduction: −20.1%; P = 0.003). Considering single PPCs episode, the most common PPC in both groups was atelectasis. The atelectasis incidence was 11.3% (11/97) in group lidocaine, much lower than that in group control 29.6% (29/98) (relative risk: 0.38, 95% CI: 0.20 to 0.72; absolute risk reduction: −18.3%, P = 0.002). However, the incidences of any other PPCs episodes were similar between the two groups. Conclusion Intraoperative intravenous infusion lidocaine could decrease the incidence of PPCs in patients at intermediate/high risk of postoperative pulmonary complications undergoing major abdominal surgery.
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Affiliation(s)
- Xinghe Wang
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Kedi Guo
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Ye Zhao
- Department of Anesthesiology, Changzhou Maternal and Child Health Care Hospital, Changzhou, People’s Republic of China
| | - Tong Li
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Yuping Yang
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Lingfei Xu
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Su Liu
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People’s Republic of China
- Correspondence: Su Liu, Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, Jiangsu, 221000, People’s Republic of China, Tel +86 18118309692, Email
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Xu Y, Ye M, Hong Y, Kang Y, Li Y, Xiao X, Zhou L, Jiang C. Efficacy of Perioperative Continuous Intravenous Lidocaine Infusion for 72 Hours on Postoperative Pain and Recovery in Patients Undergoing Hepatectomy: Study Protocol for a Prospective Randomized Controlled Trial. J Pain Res 2021; 14:3665-3674. [PMID: 34880671 PMCID: PMC8646227 DOI: 10.2147/jpr.s341550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/19/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose Many patients develop severe and persistent pain after hepatectomy delaying postoperative rehabilitation. Studies have suggested that intravenous lidocaine infusion relieved postoperative pain and improved overall postoperative outcomes. However, its efficacy on hepatectomy is still masked, due to the postoperative metabolic change of lidocaine by the liver. We hypothesized that intravenous lidocaine infusion in the perioperative period would lead to postoperative pain reduction and improve the overall patient experience. Study Design and Methods In this prospective double-blind, randomized controlled design trial, 260 adults scheduled for hepatectomy will be allocated to the lidocaine and the placebo groups. The lidocaine group will be administered lidocaine intravenously during intraoperative period and 72 postoperative hours; the placebo group will be administered normal saline at the same volume, infusion rate, and timing. The primary outcome is the incidence of moderate-severe pain (numeric rating scale ≥4) during movement at 24 hours after surgery. The secondary outcomes include the incidence of moderate-severe pain at 24 hours after surgery at rest, the incidence of moderate-severe pain at 48 and 72 hours after surgery at rest and during movement, the cumulative morphine consumption at 24, 48 and 72 hours postoperatively, bowel function recovery, the incidence of postoperative nausea and vomiting, the incidence of postoperative pulmonary complications, the length of hospital stay, levels of inflammatory factors and patient satisfaction scores. Discussion This is the first prospective trial to shed light on the efficacy of intraoperative period and 72 postoperative hours intravenous lidocaine on postoperative pain and recovery after hepatectomy. The findings will provide a new strategy of perioperative pain management for hepatectomy.
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Affiliation(s)
- Yan Xu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Mao Ye
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Ying Hong
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Yi Kang
- Department of Anesthesiology and Translational Neuroscience Center, Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yue Li
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Xiao Xiao
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Li Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Chunling Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
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Nithiuthai J, Siriussawakul A, Junkai R, Horugsa N, Jarungjitaree S, Triyasunant N. Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital. Perioper Med (Lond) 2021; 10:43. [PMID: 34876228 PMCID: PMC8653534 DOI: 10.1186/s13741-021-00214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023] Open
Abstract
Background The incidence of postoperative pulmonary complications (PPCs) is increasing in line with the rise in the number of surgical procedures performed on geriatric patients. In this study, we determined the incidence and risk factors of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais. Methods A retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk factors, evaluations were made of the relationships between the PPCs and various preoperative, intraoperative, and postoperative factors, including ARISCAT scores. Results In all, 1100 elderly postoperative patients were analyzed. Their mean age was 73.6 years, and 48.5% were male. Nearly half of their operations were laparoscopic cholecystectomies. The incidence of PPCs was 7.7%, with the most common being pleural effusion, atelectasis, and pneumonia. The factors associated with PPCs were preoperative oxygen saturation less than 96% (OR = 2.6, 1.2–5.5), albumin level below 3.5 g/dL (OR = 1.7, 1.0–2.8), duration of surgery exceeding 3 h (OR = 2.0, 1.0–4.2), and emergency surgery (OR = 2.8, 1.4–5.8). There was a relationship between ARISCAT score and PPC incidence, with a correlation coefficient of 0.226 (P < 0.001). The area under the curve was 0.72 (95% CI, 0.665–0.774; P < 0.001). Conclusions PPCs are common in elderly patients. They are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of Thai patients into PPC risk groups. The ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries.
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Affiliation(s)
- Jitsupa Nithiuthai
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arunotai Siriussawakul
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rangsinee Junkai
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nutthakorn Horugsa
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunit Jarungjitaree
- Siriraj Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Namtip Triyasunant
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Opioid Use Disorder is Associated With Complications and Increased Length of Stay After Major Abdominal Surgery. Ann Surg 2021; 274:992-1000. [PMID: 31800489 DOI: 10.1097/sla.0000000000003697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the impact of opioid use disorder (OUD) on perioperative outcomes after major upper abdominal surgeries. SUMMARY OF BACKGROUND DATA OUD, defined as dependence/abuse, is a national health epidemic. Its impact on outcomes after major abdominal surgery has not been well characterized. METHODS Patients who underwent elective esophagectomy, total/partial gastrectomy, major hepatectomy, and pancreatectomy were identified using the National Inpatient Sample (2003-2015). Propensity score matching by baseline characteristics was performed for patients with and without OUD. Outcomes measured were in-hospital complications, mortality, length of stay (LOS), and discharge disposition. RESULTS Of 376,467 patients, 1096 (0.3%) had OUD. Patients with OUD were younger (mean 53 vs 61 years, P < 0.001) and more often male (55.1% vs 53.2%, P < 0.001), black (15.0% vs 7.6%, P < 0.001), Medicaid beneficiaries (22.0% vs 6.4%, P < 0.001), and in the lowest income quartile (32.6% vs 21.3%, P < 0.001). They also had a higher rate of alcohol (17.2% vs 2.8%, P < 0.001) and nonopioid drug (2.2% vs 0.2%, P = 0.023) dependence/abuse. After matching (N = 1077 OUD, N = 2164 no OUD), OUD was associated with a higher complication rate (52.9% vs 37.3%, P < 0.001), including increased pain [odds ratio (OR) 3.5, P < 0.001], delirium (OR 3.0, P = 0.004), and pulmonary complications (OR 2.0, P = 0.006). Additionally, OUD was associated with increased LOS (mean 12.4 vs 10.6 days, P = 0.015) and nonroutine discharge (OR 1.6, P < 0.001). In-hospital mortality did not differ (OR 2.4, P = 0.10). CONCLUSION Patients with OUD more frequently experienced complications and increased LOS. Close postoperative monitoring may mitigate adverse outcomes.
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Effect of abdominal binder after laparoscopic cholecystectomy on enhanced recovery: a randomized controlled trialcontrolled trial. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:91-97. [PMID: 35600784 PMCID: PMC8966000 DOI: 10.7602/jmis.2021.24.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/03/2022]
Abstract
Purpose The purpose of this randomized controlled trial was to compare the effects of abdominal binder after laparoscopic cholecystectomy. Methods From August to December 2020, 66 patients who were set to undergo cholecystectomy were selected for a prospective trial at Kangbuk Samsung Hospital, Seoul, Republic of Korea, and their clinical characteristics and postoperative surgical outcomes were evaluated. Among 66 patients, 33 patients belong to the abdominal binder group and the other 33 patients belong to the control group. Results The average hospital stay was 2.46 ± 1.29 days, and was not significantly different between the two groups. The average postoperative pain score (visual analogue scale, 0–10) 12, 24, and 48 hours after surgery were not significantly different. However, the degree of comfort score was significantly higher for the control group patients (2.56 vs. 3.33, p < 0.001). Time to the first ambulation, walking ability, return of bowel function, time to full diet resumption, and the numbers of analgesics and antiemetics administered were not significantly different between the two groups. Conclusion No postoperative recovery benefit and no reduction in hospital stay was found in patients who used an abdominal binder while undergoing laparoscopic cholecystectomy. Statistically, between the group that used the binder and the one that did not, no significant differences in surgical outcome nor postoperative outcome were observed. The only exception was that the degree of comfort score was significantly higher in the control group. Therefore, in terms of patient benefit and convenience, wearing an abdominal binder after laparoscopic cholecystectomy is not recommended.
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Severe rebound pain after peripheral nerve block for ambulatory extremity surgery is an underappreciated problem. Comment on Br J Anaesth 2021; 126: 862-71. Br J Anaesth 2021; 126:e204-e205. [PMID: 33773754 DOI: 10.1016/j.bja.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
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GÜRBÜZ T, TANRIDAN OKÇU N. Charecteristics of postcesarean section pain. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.719225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Gonzales A, Mari M, Alloubani A, Abusiam K, Momani T, Akhu-Zaheya L. The impact of a standard pain assessment protocol on pain levels and consumption of analgesia among postoperative orthopaedic patients. Int J Orthop Trauma Nurs 2020; 43:100841. [PMID: 33558198 DOI: 10.1016/j.ijotn.2020.100841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 11/02/2020] [Accepted: 12/02/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pain is a leading concern in post-surgical orthopaedic settings; andeffective pain assessment tools are important aspects of pain management. OBJECTIVE This study assessed the effect of using standard pain assessment protocols (SPAP) on pain levels, pain management, and analgesia consumption among patients in the first 24 h following orthopaedic surgery. METHODS In total, 101 patients were recruited and assigned to the comparison group (n = 50) and experimental group (n = 51). SPAP was used in the experimental group while the comparison group received routine care. Pain levels at rest and during movement and analgesic consumption were compared between the two groups. FINDINGS There were significant differences in pain levels between the comparison and experimental groups. The experimental group consumed significantly less pain medication at 8-11 h of opioid medications and 12-15 h of non-opioid medications (P < .001). The use of non-pharmacological modalities was significantly higher in the experimental group compared to the comparison group (P < .001). CONCLUSIONS Regular pain assessment and management using SPAP can promote pain management and reduce pain levels as well as reduce analgesia administration and promote the use of non-pharmacologic approaches. These outcomes can result in fewer side effects for patients. IMPLICATIONS The findings suggest that using SPAP can result in improved outcomes as well as the use of non-pharmacologic approaches to pain management. This approach can result in better outcomes and increased communication between the nurse and the patient.
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Affiliation(s)
| | - Mohammad Mari
- Westways Staffing Services Inc, California, United States
| | - Aladeen Alloubani
- Senior Nurse Manager/ Research & EBP, King Hussein Cancer Center, Amman, Jordan.
| | - Khetam Abusiam
- Nursing Department, Al-ghad International Colleges for Medical Sciences, Saudi Arabia
| | - Thaer Momani
- College of Nursing and Health Sciences, University of Massachusetts Boston, USA
| | - Laila Akhu-Zaheya
- Faculty of Nursing, Jordan University of Science and Technology, Jordan
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Jiang N, Hao B, Huang R, Rao F, Wu P, Li Z, Song C, Liu Z, Guo T. The Clinical Effects of Abdominal Binder on Abdominal Surgery: A Meta-analysis. Surg Innov 2020; 28:94-102. [PMID: 33236689 DOI: 10.1177/1553350620974825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. We conducted a meta-analysis to quantitatively evaluate the effects of abdominal binder in abdominal surgeries. Methods. Through literature retrieval in globally recognized databases (MEDLINE, EMBASE, and Cochrane Central), trials investigating the application of abdominal binder in abdominal surgeries were systematically reviewed. The main outcomes, namely, 6-minute walk test (6MWT), visual analog scale (VAS) pain score, and symptom distress scale (SDS) score, were pooled to make an overall estimation. I2 index was calculated to identify heterogeneity, and sensitivity analysis was performed to validate the stability of main results and explore the source of heterogeneity. A funnel plot and Egger's test were applied to assess publication bias. Results. Ten randomized controlled trials consisting of 968 subjects were ultimately included for the pooled estimation. Abdominal binder significantly increased the distance of 6MWT with standard mean difference (SMD) of .555 (P < .001) and decreased the scores of VAS and SDS with SMD of -.979 (P < .001) and -.716 (P < .001), respectively. Despite of the significant heterogeneity indicated by I2 index statistic, the results of sensitivity analysis revealed the reliability of the main conclusions. While we identified no obvious publication bias regarding 6MWT (Egger's test P = .321), it seemed that significant publication biases existed with respect to the estimation of VAS (P < .001) and SDS (P = .006). Conclusion. The current meta-analysis verified that abdominal binder efficiently promoted recovery after abdominal surgeries in terms of facilitating mobilization, alleviating pain, and reducing postoperative distress. More rigorously designed clinical trials with large sample size are expected to further elaborate its clinical value.
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Affiliation(s)
- Nanhui Jiang
- Department of Intensive Care Unit, Wuhan University Zhongnan Hospital, China
| | - Bihai Hao
- School of Nursing, Huanggang Polytechnic College, China
| | - Rong Huang
- Department of Intensive Care Unit, Wuhan University Zhongnan Hospital, China
| | - Fengying Rao
- School of Nursing, Huanggang Polytechnic College, China
| | - Ping Wu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, China
| | - Zhen Li
- Department of Hepatobiliary and Pancreatic Surgery, Wuhan University Zhongnan Hospital, China
| | - Chunxue Song
- School of Nursing, Huanggang Polytechnic College, China
| | - Zhisu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Wuhan University Zhongnan Hospital, China
| | - Tao Guo
- School of Basic Medical Sciences, 372527Weifang Medical University, China
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Effectiveness of Intramuscular Electrical Stimulation on Postsurgical Nociceptive Pain for Patients Undergoing Open Pancreaticoduodenectomy: A Randomized Clinical Trial. J Am Coll Surg 2020; 231:339-350. [PMID: 32623088 DOI: 10.1016/j.jamcollsurg.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND After pylorus-preserving pancreaticoduodenectomy (PPPD), incision and suture of the abdominal muscles cause inflammatory changes and elicit somatic pain that deteriorates the quality of life. There have been no previous reports on needle electrical twitch obtaining intramuscular stimulation (NETOIMS) in abdominal open operation; this study aimed to apply NETOIMS for postoperative somatic pain in patients undergoing PPPD as a new treatment modality for pain control. METHODS Between June 2018 and January 2019, 44 patients who underwent PPPD were randomly assigned to a control group and the NETOIMS group. The NETOIMS group received NETOIMS in the transverse abdominis muscle under ultrasound guidance right after operation under general anesthesia. The pain score (visual analog scale), peak cough flow (PCF), and gait speed were repetitively measured from 1 day before operation to 2 weeks after discharge as scheduled. Data were analyzed by the linear mixed model and repeated-measures analysis of variance. RESULTS Of the 44 patients recruited, data from 38 patients were finally analyzed. The pain scores were significantly lower in the NETOIMS group after PPPD (p = 0.01). Although the PCF at each measuring time point did not show inter-group difference (p = 0.20), improvement of PCF from the second day after operation to discharge was greater (p = 0.02) and gait speed improved significantly faster (p < 0.01) in the NETOIMS group than in the control group. CONCLUSIONS NETOIMS helps in rapid reduction of postoperative somatic pain developed after PPPD and in improvement of PCF and gait speed.
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Gupta S, Mohta A, Gottumukkala V. Opioid-free anesthesia-caution for a one-size-fits-all approach. Perioper Med (Lond) 2020; 9:16. [PMID: 32566148 PMCID: PMC7301466 DOI: 10.1186/s13741-020-00147-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/04/2020] [Indexed: 12/11/2022] Open
Abstract
Post-operative pain management should ideally be optimized to ensure patient’s mobilization and ability to partake in effective pulmonary exercises for patient’s early recovery. Opioids have traditionally been the main mode for analgesia strategy in the perioperative period. However, the recent focus on opioid crisis in the USA has generated a robust discussion on rational use of opioids in the perioperative period and also raised the concept of “opioid-free anesthesia” in certain circles. Opioid-related adverse drug events (ORADE) and questionable role of opioids in cancer progression have further deterred some anesthesiologists from the routine perioperative use of opioids including their use for breakthrough pain. However, judicious use of opioid in conjunction with the use of non-opioid analgesics and regional anesthetic techniques may allow for optimal analgesia while reducing the risks associated with the use of opioids. Importantly, the opioid epidemic and opioid-related deaths seem more related to the prescription practices of physicians and post-discharge misuse of opioids. Focus on patient and clinician education, identification of high-risk patients, and instituting effective drug disposal and take-back policies may prove useful in reducing opioid misuse.
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Affiliation(s)
- Sushan Gupta
- Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Avani Mohta
- Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
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Single injection Quadratus Lumborum block for postoperative analgesia in adult surgical population: A systematic review and meta-analysis. J Clin Anesth 2020; 62:109715. [DOI: 10.1016/j.jclinane.2020.109715] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/26/2019] [Accepted: 01/11/2020] [Indexed: 12/25/2022]
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18
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Postoperative Complications and Health-related Quality of Life 10 Years After Esophageal Cancer Surgery. Ann Surg 2020; 271:311-316. [PMID: 29995688 DOI: 10.1097/sla.0000000000002972] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of postoperative complications on health-related quality of life (HRQOL) up to 10 years after surgery for esophageal cancer. BACKGROUND The impact of postoperative complications on HRQOL past 5 years is unknown. METHODS Some 616 patients undergoing open esophageal cancer surgery between April 2, 2001 and December 31, 2005 in Sweden were enrolled in this population-based, nationwide, and prospective cohort study. Exposure was the occurrence of predefined postoperative complications, and the outcome was HRQOL evaluated by validated European Organization for Research and Treatment of Cancer questionnaires at 6 months, 3, 5, and 10 years after surgery. Linear mixed models, adjusted for longitudinal HRQOL in the general population and confounders, provided mean score differences (MDs) with 95% confidence intervals (CIs) for each HRQOL item and scale in patients with or without postoperative complications. RESULTS At 10 years, 104 (17%) patients were alive and 92 (88%) answered the HRQOL questionnaires. Of these, 37 (40%) had at least 1 predefined postoperative complication. Twelve of the 25 scales and items were significantly worse in patients with postoperative complications 10 years after surgery, for example, physical function (MD -15, 95% CI -24 to -7), fatigue (MD 16, 95% CI 5-26), pain (MD 18, 95% CI 7-30), dyspnea (MD 15, 95% CI 2-27), insomnia (MD 20, 95% CI 8-32), and eating problems (MD 14, 95% CI 3-24) compared to patients without complications. CONCLUSIONS Postoperative complications are associated with considerably impaired HRQOL up to 10 years after esophageal cancer surgery.
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Bicket MC, Grant MC, Scott MJ, Terman GW, Wick EC, Wu CL. AAAPT Diagnostic Criteria for Acute Abdominal and Peritoneal Pain After Surgery. THE JOURNAL OF PAIN 2020; 21:1125-1137. [PMID: 32006701 DOI: 10.1016/j.jpain.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/18/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
Abdominal and peritoneal pain after surgery is common and burdensome, yet the lack of standardized diagnostic criteria for this type of acute pain impedes basic, translational, and clinical investigations. The collaborative effort among the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, American Pain Society, and American Academy of Pain Medicine Pain Taxonomy (AAAPT) provides a systematic framework to classify acute painful conditions. Using this framework, a multidisciplinary working group reviewed the literature and developed core diagnostic criteria for acute abdominal and peritoneal pain after surgery. In this report, we apply the proposed AAAPT framework to 4 prototypical surgical procedures resulting in abdominal and peritoneal pain as examples: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection. These diagnostic criteria address the 3 most common surgical procedures performed in the United States, capture diverse surgical approaches, and may also be applied to other surgical procedures resulting in abdominal and peritoneal pain. Additional investigation regarding the validity and reliability of this framework will facilitate its adoption in research that advances our comprehension of mechanisms, deliver better treatments, and help prevent the transition of acute to chronic pain after surgery in the abdominal and peritoneal region. PERSPECTIVE: Using AAAPT, we present key diagnostic criteria for acute abdominal and peritoneal pain after surgery. We provide a systematic classification using 5 dimensions for abdominal and peritoneal pain that occurs after surgery, in addition to 4 specific surgical procedures: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection.
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Affiliation(s)
- Mark C Bicket
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Scott
- Department of Anesthesiology, Virginia Commonwealth University; Richmond, Virginia
| | - Gregory W Terman
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Elizabeth C Wick
- Department of Surgery; The University of California San Francisco, San Francisco, California
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care & Pain Management; Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
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Relationship Between Postoperative Pain and Overall 30-Day Complications in a Broad Surgical Population: An Observational Study. Ann Surg 2020; 269:856-865. [PMID: 29135493 DOI: 10.1097/sla.0000000000002583] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to establish the relationship between postoperative pain and 30-day postoperative complications. BACKGROUND Only scarce data are available on the association between postoperative pain and a broad range of postoperative complications in a large heterogeneous surgical population. METHODS Having postoperative pain was assessed in 2 ways: the movement-evoked pain score on the Numerical Rating Scale (NRS-MEP) and the patients' opinion whether the pain was acceptable or not. Outcome was the presence of a complication within 30 days after surgery. We used binary logistic regression for the total population and homogeneous subgroups to control for case complexity. Results for homogeneous subgroups were summarized in a meta-analysis using inverse variance weighting. RESULTS In 1014 patients, 55% experienced moderate-to-severe pain on the first postoperative day. The overall complication rate was 34%. The proportion of patients experiencing postoperative complications increased from 0.25 [95% confidence interval (CI) = 0.21-0.31] for NRS-MEP = 0 to 0.45 (95% CI = 0.36-0.55) for NRS-MEP = 10. Patients who found their pain unacceptable had more complications (adjusted odds ratio = 2.17 (95% CI = 1.51-3.10; P < 0.001)). Summary effect sizes obtained with homogeneous groups were similar to those obtained from the total population who underwent very different types of surgery. CONCLUSIONS Higher actual postoperative pain scores and unacceptable pain, even on the first postoperative day, are associated with more postoperative complications. Our findings provide important support for the centrality of personalized analgesia in modern perioperative care.
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Oh SK, Lee IO, Lim BG, Jeong H, Kim YS, Ji SG, Park JS. Comparison of the Analgesic Effect of Sufentanil versus Fentanyl in Intravenous Patient-Controlled Analgesia after Total Laparoscopic Hysterectomy: A Randomized, Double-blind, Prospective Study. Int J Med Sci 2019; 16:1439-1446. [PMID: 31673234 PMCID: PMC6818204 DOI: 10.7150/ijms.34656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/12/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Fentanyl is one of the most widely used opioids for intravenous patient-controlled analgesia (IV-PCA). Sufentanil, a fentanyl analog, is suitable for postoperative pain control because it has no active metabolites and shows a higher therapeutic index and lower frequency of respiratory suppression than fentanyl. This study aimed to compare the two opioids for postoperative pain relief on the basis of analgesic efficacy, adverse effects, and patient satisfaction. Methods: Sixty-four patients undergoing total laparoscopic hysterectomy were randomly allocated into a fentanyl group (n = 31) or a sufentanil group (n = 33). The patients received 50-μg fentanyl or 10-μg sufentanil before induction of anesthesia and 5 minutes after uterine incision during surgery in the fentanyl and sufentanil group, respectively. After arriving at the post-anesthesia care unit (PACU), verbal pain score (VPS) and sedation score were assessed. IV-PCA (fentanyl 1250 μg or sufentanil 250 μg with ondansetron 8 mg; total volume, 60 ml) was connected and continued for 48 h postoperatively. Postoperative pain was evaluated by using the numeric rating scale (NRS; at rest/during cough) at 6, 12, 24, 36, and 48 hours after surgery. The cumulative PCA consumption, patient satisfaction scores, and adverse effects were measured. Results: In the PACU, VPS was significantly higher and rescue fentanyl consumption was higher in the fentanyl group than in the sufentanil group, while the sedation score and adverse effects were comparable between the groups. No significant differences were observed in the NRS scores for pain (at rest/during cough) in the ward over 48 hours postoperatively, but the cumulative PCA consumption was significantly higher in the fentanyl group (47.4 ± 9.9 ml vs. 36.2 ± 14.6 ml, P = 0.01). There were no significant intergroup differences in patient satisfaction score and the incidence of adverse effects in the ward, except for a higher incidence of dry mouth in the fentanyl group. Conclusions: In comparison with fentanyl, sufentanil showed comparable analgesic efficacy and safety with less analgesic consumption (under a potency ratio of 1:5) in IV-PCA after total laparoscopic hysterectomy. Therefore, we suggest that sufentanil can be a useful alternative to fentanyl for IV-PCA.
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Affiliation(s)
- Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Il Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyerim Jeong
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sul Gi Ji
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Sun Park
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Lior T, Shukla R, Wright GM. Excision of Giant Schwannoma in a Nonagenarian-operative techniques for enhanced recovery after thoracotomy in the high-risk patient. J Surg Case Rep 2019; 2019:rjz110. [PMID: 31007891 PMCID: PMC6465953 DOI: 10.1093/jscr/rjz110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
Thoracotomy is acknowledged as one of the most painful procedures in surgical practice, with the potential to result in significant acute and chronic sequelae, which become especially relevant in high-risk patient populations. Certain pathologies necessitate this surgical approach, and in those circumstances we must aim to mitigate postoperative complications by employing surgical techniques that decrease the risk of nerve injury, rib fracture, and unnecessary soft tissue trauma. We describe an approach to thoracotomy that incorporates evidence-based strategies to lessen the risk of these potential complications, which resulted in rapid postoperative recovery in a nonagenarian.
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Affiliation(s)
- Tali Lior
- Department of Surgery, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Rajeev Shukla
- Department of Cardiothoracic Surgery, St Vincent's Private Hospital, Fitzroy, Victoria, Australia
| | - Gavin M Wright
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria 3065, Australia
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Effect of Classic Foot Massage on Vital Signs, Pain, and Nausea/Vomiting Symptoms After Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2019; 28:359-365. [PMID: 30312194 DOI: 10.1097/sle.0000000000000586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This semiexperimental study on the effects of foot massage recruited 88 patients who underwent laparoscopic cholecystectomy at the general surgery clinics of our hospital in Turkey (June 2017 to May 2018). Patients were assigned to either the intervention group (n=44, 10 min of classic foot massage) or the control group (n=44, no intervention). Pretest assessment, intervention, and posttest assessment were conducted within 1 to 6 hours postoperatively. Outcome measures included vital signs, pain, and nausea/vomiting symptoms. The intervention was associated with a significant decrease in pain scores and incidence of nausea. Despite being associated with an increase in body temperature, the intervention was also associated with a decrease in systolic blood pressure without increasing diastolic blood pressure or respiratory rate, suggesting a positive effect on blood circulation. Classic foot massage may serve as an affordable and useful way to help improve pain, nausea, and blood circulation after laparoscopic cholecystectomy.
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Aydemir Ö, Aslan FE, Karabacak Ü, Akdaş Ö. The Effect of Exaggerated Lithotomy Position on Shoulder Pain after Laparoscopic Cholecystectomy. Pain Manag Nurs 2018; 19:663-670. [PMID: 29934129 DOI: 10.1016/j.pmn.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/05/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The exaggerated lithotomy position with the expertise of nurses can be successful solution for the patients who have the postoperative shoulder pain after laparoscopic cholecystectomy. AIMS This study aimed to determine the effect of applying an exaggerated lithotomy positions to patients who had laparoscopic cholecystectomy to relieve shoulder pain. The study was conducted on nonrandomized groups and made as a semiexperimental study with a pretest/post-test control group design. Design, Settings, and Subjects/Participants: The study was conducted on 102 patients who had elective laparoscopic cholecystectomy and agreed to participate in this study after they met the inclusion-exclusion criteria in the general surgery clinic of a training and research hospital in Istanbul between December 12, 2012, and June 30, 2013. METHODS The pain levels (10 minutes before and after positioning) and peripheral oxygen saturation (SPO2) levels (1 minute, 5 minutes, and 10 minutes before and after positioning-total 6 times) of the patients were measured using a visual analog scale and pulse oximetry, respectively. The pain levels and the analgesic (pethidine hydrochloride and diclofenac sodium) usage of the patients in both the experimental and the control group were compared. RESULTS The exaggerated lithotomy position appreciably lowered the shoulder pain of the patients in the experimental group (t = 12.663; p = .000 < .001). It also increased peripheral saturation levels of the patients more rapidly compared with those in the control group receiving analgesics (t = 17.693; p = .000 < .005). In addition, it decreased the need to use additional analgesics and opioids (t = 2.14; p = .037). CONCLUSIONS In this study the exaggerated lithotomy position was found to be fast and effective for relieving shoulder pain after laparoscopic cholecystectomy, decreased the need to use additional analgesics and opioids, and, in conjunction with pain control, also contributed to improvements in respiratory functions.
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Affiliation(s)
- Özgül Aydemir
- Istanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
| | | | - Ükke Karabacak
- School of Nursing, Acıbadem University, Istanbul, Turkey
| | - Özlem Akdaş
- Palliative Care Service, Department of Anesthesiology and Reanimation, Uşak Public Hospital, Uşak, Turkey
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Jønsson LR, Ingelsrud LH, Tengberg LT, Bandholm T, Foss NB, Kristensen MT. Physical performance following acute high-risk abdominal surgery: a prospective cohort study. Can J Surg 2017. [PMID: 29368676 DOI: 10.1503/cjs.012616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). METHODS Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization. RESULTS Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. CONCLUSION Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.
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Affiliation(s)
- Line Rokkedal Jønsson
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Lina Holm Ingelsrud
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Line Toft Tengberg
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Thomas Bandholm
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Nicolai Bang Foss
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Morten Tange Kristensen
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
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Badawy A, Seo S, Toda R, Fuji H, Fukumitsu K, Ishii T, Taura K, Kaido T, Uemoto S. A Propensity Score-Based Analysis of Laparoscopic Liver Resection for Liver Malignancies in Elderly Patients. J INVEST SURG 2017; 32:75-82. [PMID: 29039987 DOI: 10.1080/08941939.2017.1373170] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Laparoscopic liver resection is safe, feasible and associated with less blood loss, shorter hospital stays and fewer postoperative complications in the working age patients with malignant liver tumors. However, it is still unclear if the elderly patients with malignant liver tumors would also benefit from that approach as the younger patients. So, the aim of the study was to compare the clinical outcomes of laparoscopic versus open liver resection for malignant liver tumors in elderly patients. MATERIALS AND METHODS Between March 2009 and July 2016, all elderly patients (≥70 years old) who underwent laparoscopic (n = 40) and open (n = 202) liver resection for malignant liver tumors were included. A one to one propensity score matching analysis was performed, based on 6 covariates, to decrease the selection bias. RESULTS There was no significant difference between the laparoscopic and open liver resection groups regarding the patient characteristics and tumor features. The operative time was comparable between both groups (Laparoscopic group 259 min vs Open group 308 min, p = .86), while patients who underwent laparoscopic liver resection had lower intraoperative blood loss (30 ml vs 517 ml, p < .0001), shorter hospital stays (10 days vs 23 days, p < .0001), and less overall morbidity (15% vs 38%, p = .04). The one-, three-, and five-year survival for patients with hepatocellular carcinoma was comparable between both groups (Laparoscopic group 96%, 74%, 47%, vs Open group 94%, 71%, 48%, p = .82), whereas The one-, three-, and five-year recurrence-free survival for patients with hepatocellular carcinoma was significantly higher in the laparoscopic group (88%, 60%, 60% vs 54%, 25%, 19%, p = .019). CONCLUSIONS Laparoscopic approach for minor liver resection in elderly patients is safe and feasible with less blood loss, a shorter hospital stay, less postoperative complications and a better oncological outcome.
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Affiliation(s)
- Amr Badawy
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan.,b General Surgery department , Alexandria University , Alexandria , Egypt
| | - Satoru Seo
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Rei Toda
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Hiroaki Fuji
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Ken Fukumitsu
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Takamichi Ishii
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Kojiro Taura
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Toshimi Kaido
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Shinji Uemoto
- a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan
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27
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Kauppila JH, Xie S, Johar A, Markar SR, Lagergren P. Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer. Br J Surg 2017. [PMID: 28632926 DOI: 10.1002/bjs.10577] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to compare health-related quality of life (HRQoL) outcomes between minimally invasive and open oesophagectomy for cancer at different postoperative time points. METHODS A search of PubMed (MEDLINE), Web of Science, Embase, Scopus, CINAHL and the Cochrane Library was performed for studies that compared open with minimally invasive oesophagectomy. A random-effects meta-analysis was conducted for studies that measured HRQoL scores using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-OES18 questionnaires. Mean differences (MDs) greater than 10 in scores were considered clinically relevant. Pooled effects of MDs with 95 per cent confidence intervals were estimated to assess statistical significance. RESULTS Nine studies were included in the qualitative analysis, involving 1157 patients who had minimally invasive surgery and 907 patients who underwent open surgery. Minimally invasive surgery resulted in better scores for global quality of life (MD 11·61, 95 per cent c.i. 3·84 to 19·39), physical function (MD 11·88, 3·92 to 19·84), fatigue (MD -13·18, -17·59 to -8·76) and pain (MD -15·85, -20·45 to -11·24) compared with open surgery at 3 months after surgery. At 6 and 12 months, no significant differences remained. CONCLUSION Patients report better global quality of life, physical function, fatigue and pain 3 months after minimally invasive surgery compared with open surgery. No such differences remain at longer follow-up of 6 and 12 months.
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Affiliation(s)
- J H Kauppila
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Cancer and Translational Medicine Research Unit, Medical Research Centre Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - S Xie
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - A Johar
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - S R Markar
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - P Lagergren
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Kim SY, Weinberg L, Christophi C, Nikfarjam M. The outcomes of pancreaticoduodenectomy in patients aged 80 or older: a systematic review and meta-analysis. HPB (Oxford) 2017; 19:475-482. [PMID: 28292633 DOI: 10.1016/j.hpb.2017.01.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/08/2017] [Accepted: 01/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is an increasing needed to consider pancreaticoduodenectomy (PD) for the treatment of pancreatic and periampullary malignancy in patients aged 80 and over, given the increasing aging population. METHODS A systematic literature search was undertaken to identify selected studies that compared the outcomes of patients aged 80 years or over to those younger undergoing PD. RESULTS In total 18 studies were included for evaluation. Octogenarian or older populations had significantly higher 30-day post-operative mortality rate (OR: 2.22, 95% CI = 1.48-3.31, p < 0.001) and length of hospital stay (OR: 2.23, 95% CI = 1.36-3.10, p < 0.001). The overall post-operative complication rate was higher in the older group compared to the younger population (OR: 1.51, 95% CI = 1.25-1.83, p < 0.001). Elderly patients were more likely to develop pneumonia (OR: 1.72, 95% CI = 1.39-2.13, p < 0.001) and experience delayed gastric emptying (DGE) (OR: 1.77, 95% CI = 1.35-2.31, p < 0.001). The incidence of post-operative pancreatic fistula and bile leak were not significantly different between the groups. Rehabilitation and home nursing care services was also more frequently required by the older patient group at the time of hospital discharge. CONCLUSION Patients aged 80 years and older have approximately double the risk of 30-day post-operative mortality and 50% increased rate of complications following PD. Careful patient selection is required when offering surgery in this age group.
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Affiliation(s)
- Sandy Y Kim
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher Christophi
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Mehrdad Nikfarjam
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.
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Combination Treatment of Perioperative Rehabilitation and Psychoeducation Undergoing Thoracic Surgery. Case Rep Med 2017; 2017:4743952. [PMID: 28280511 PMCID: PMC5322450 DOI: 10.1155/2017/4743952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/19/2017] [Indexed: 11/30/2022] Open
Abstract
Postoperative pulmonary complications are a risk associated with thoracic surgery. However, there have been few reports on cases at high risk of postoperative complications. Cancer patients often have negative automatic thoughts about illness, and these negative automatic thoughts are associated with reduced health behavior and physical activity. This case series demonstrates the successful combination treatment of perioperative rehabilitation and psychoeducation for negative automatic thoughts in two cancer patients who underwent thoracic surgery. One patient underwent pneumonectomy with laryngeal recurrent nerve paralysis; the other patient, who had a history of recurrent hepatic encephalopathy and dialysis, underwent S6 segmentectomy. Both patients had negative automatic thoughts about cancer-related stress and postoperative pain. The physical therapists conducted a perioperative rehabilitation program in which the patients were educated to replace their maladaptive thoughts with more adaptive thoughts. After rehabilitation, the patients had improved adaptive thoughts, increased physical activity, and favorable recovery without pulmonary complications. This indicates that the combination treatment of perioperative rehabilitation and psychoeducation was useful in two thoracic cancer surgery patients. The psychoeducational approach should be expanded to perioperative rehabilitation of patients with cancer.
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30
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Shepherd DM, Jahnke H, White WL, Little AS. Randomized, double-blinded, placebo-controlled trial comparing two multimodal opioid-minimizing pain management regimens following transsphenoidal surgery. J Neurosurg 2017; 128:444-451. [PMID: 28298041 DOI: 10.3171/2016.10.jns161355] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Pain control is an important clinical consideration and quality-of-care metric. No studies have examined postoperative pain control following transsphenoidal surgery for pituitary lesions. The study goals were to 1) report postoperative pain scores following transsphenoidal surgery, 2) determine if multimodal opioid-minimizing pain regimens yielded satisfactory postoperative pain control, and 3) determine if intravenous (IV) ibuprofen improved postoperative pain scores and reduced opioid use compared with placebo. METHODS This study was a single-center, randomized, double-blinded, placebo-controlled intervention trial involving adult patients with planned transsphenoidal surgery for pituitary tumors randomized into 2 groups. Group 1 patients were treated with scheduled IV ibuprofen, scheduled oral acetaminophen, and rescue opioids. Group 2 patients were treated with IV placebo, scheduled oral acetaminophen, and rescue opioids. The primary end point was patient pain scores (visual analog scale [VAS], rated 0-10) for 48 hours after surgery. The secondary end point was opioid use as estimated by oral morphine equivalents (OMEs). RESULTS Of 136 patients screened, 62 were enrolled (28 in Group 1, 34 in Group 2). The study was terminated early because the primary and secondary end points were reached. Baseline characteristics between groups were well matched except for age (Group 1, 59.3 ± 14.4 years; Group 2, 49.8 ± 16.2 years; p = 0.02). Mean VAS pain scores were significantly different, with a 43% reduction in Group 1 (1.7 ± 2.2) compared with Group 2 (3.0 ± 2.8; p < 0.0001). Opioid use was significantly different, with a 58% reduction in Group 1 (26.3 ± 28.7 mg OME) compared with Group 2 (62.5 ± 63.8 mg OME; p < 0.0001). CONCLUSIONS Multimodal opioid-minimizing pain-management protocols resulted in acceptable pain control following transsphenoidal surgery. IV ibuprofen resulted in significantly improved pain scores and significantly decreased opioid use compared with placebo. Postoperative multimodal pain management, including a nonsteroidal antiinflammatory medication, should be considered after surgery to improve patient comfort and to limit opioid use. Clinical trial registration no.: NCT02351700 (clinicaltrials.gov) ■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized, controlled trial; evidence: Class III.
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Moss CR, Caldwell JC, Afilaka B, Iskandarani K, Chinchilli VM, McQuillan P, Cooper AB, Gusani N, Bezinover D. Hepatic resection is associated with reduced postoperative opioid requirement. J Anaesthesiol Clin Pharmacol 2016; 32:307-13. [PMID: 27625476 PMCID: PMC5009834 DOI: 10.4103/0970-9185.188827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Aims: Postoperative pain can significantly affect surgical outcomes. As opioid metabolism is liver-dependent, any reduction in hepatic volume can lead to increased opioid concentrations in the blood. The hypothesis of this retrospective study was that patients undergoing open hepatic resection would require less opioid for pain management than those undergoing open pancreaticoduodenectomy. Material and Methods: Data from 79 adult patients who underwent open liver resection and eighty patients who underwent open pancreaticoduodenectomy at our medical center between January 01, 2010 and June 30, 2013 were analyzed. All patients received both general and neuraxial anesthesia. Postoperatively, patients were managed with a combination of epidural and patient-controlled analgesia. Pain scores and amount of opioids administered (morphine equivalents) were compared. A multivariate lineal regression was performed to determine predictors of opioid requirement. Results: No significant differences in pain scores were found at any time point between groups. Significantly more opioid was administered to patients having pancreaticoduodenectomy than those having a hepatic resection at time points: Intraoperative (P = 0.006), first 48 h postoperatively (P = 0.001), and the entire length of stay (LOS) (P = 0.002). Statistical significance was confirmed after controlling for age, sex, body mass index, and American Society of Anesthesiologists physical status classification (adjusted P = 0.006). Total hospital LOS was significantly longer after pancreaticoduodenectomy (P = 0.03). A multivariate lineal regression demonstrated a lower opioid consumption in the hepatic resection group (P = 0.03), but there was no difference in opioid use based on the type of hepatic resection. Conclusion: Patients undergoing open hepatic resection had a significantly lower opioid requirement in comparison with patients undergoing open pancreaticoduodenectomy. A multicenter prospective evaluation should be performed to confirm these findings.
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Affiliation(s)
- Caitlyn Rose Moss
- Department of Anesthesiology, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Julia Christine Caldwell
- Department of Anesthesiology, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Babatunde Afilaka
- Department of Anesthesiology, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Khaled Iskandarani
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Vernon Michael Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Patrick McQuillan
- Department of Anesthesiology, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Amanda Beth Cooper
- Department of Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Niraj Gusani
- Department of Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Dmitri Bezinover
- Department of Anesthesiology, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Czyżewski P, Hryciuk D, Dąbek A, Szczepkowski M. Assessment of Abdominal Belts Impact on the Lungs Ventilation and Their Application in Early Physiotherapy after Major Abdominal Surgery - Prospective Trial. POLISH JOURNAL OF SURGERY 2016; 88:202-8. [PMID: 27648621 DOI: 10.1515/pjs-2016-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Indexed: 11/15/2022]
Abstract
UNLABELLED Early physiotherapy is an important part of the comprehensive treatment of patients after major abdominal surgery (MAS). Accelerated mobilization should be safe and requires the use of appropriate techniques. Most of the physiotherapists and surgeons recommends using abdominal belts. Opponents claim that belts have an adverse effect on lungs ventilation. The aim of the study was to determine the effect of abdominal belt on lung ventilation efficiency in the early period after MAS. MATERIAL AND METHODS The study involved 20 patients after MAS. Including 9 women and 11 men, aged between 40 to 90 years (x̅ 66.7). In the scheduled 7 patients and urgent 13. All of them were in the early period after surgery. Dynamic spirometry was performed twice in the postoperative period. For the first time wearing a belt, and then without the belt in the same group. Evaluated the forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF). For the analysis uses the Wilcoxon matched-pairs test and Spearman's rank correlations. P values <0.05 were considered significant. RESULTS The value of the ventilation indicators measured wearing abdominal belt were slightly lower than the values evaluated without the belt. The results are shown in percent predicted for age and gender, FEV wearing belt 52%, without belt 53%; FEV1 59% vs 61%; PEF 46% vs 51%. There were no statistically significant differences Conclusions. There were no significant negative influence of abdominal belt on lungs ventilation in early period after MAS. There was no correlations between age, body mass index and changes in ventilation indicators.
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Vadivelu N, Kai AM, Kodumudi V, Berger JM. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting. J Pain Res 2016; 9:425-35. [PMID: 27382329 PMCID: PMC4918895 DOI: 10.2147/jpr.s86579] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.
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Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Alice M Kai
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Vijay Kodumudi
- Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, USA
| | - Jack M Berger
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Titsworth WL, Abram J, Guin P, Herman MA, West J, Davis NW, Bushwitz J, Hurley RW, Seubert CN. A prospective time-series quality improvement trial of a standardized analgesia protocol to reduce postoperative pain among neurosurgery patients. J Neurosurg 2016; 125:1523-1532. [PMID: 26967774 DOI: 10.3171/2015.10.jns15698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The inclusion of the pain management domain in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey now ties patients' perceptions of pain and analgesia to financial reimbursement for inpatient stays. Therefore, the authors wanted to determine if a quality improvement initiative centered on a standardized analgesia protocol could significantly reduce postoperative pain among neurosurgery patients. METHODS The authors implemented a 10-month, prospective, interrupted time-series trial of a quality improvement initiative. The intervention consisted of a multimodal, interdepartmental, standardized analgesia protocol with process improvements from preadmission to discharge. All neurosurgical-floor patients participated in the quality improvement intervention, with data collected on a systematically randomly sampled subset of 96 patients for detailed analysis. Patient-reported numeric rating scale pain on the first postoperative day (POD) served as the primary outcome. RESULTS Implementation of the analgesia protocol resulted in improved preoperative and postoperative documentation of pain (p < 0.001) and improved use of multimodal analgesia, including use of NSAIDs (p < 0.009) and gabapentin (p < 0.027). This intervention also correlated with a 32% reduction in reported pain on the 1st POD for all neurosurgical patients (mean pain scale scores 4.31 vs 2.94; p = 0.000) and a 43% reduction among spinal surgery patients (mean pain scale scores 5.45 vs 3.10; p = 0.036). After controlling for covariates, implementation of the protocol was a significant predictor of lowered postoperative pain (p = 0.05) on the 1st POD. This reduction in pain correlated with protocol compliance (p = 0.028), and a significant decrease in the monthly number of naloxone doses suggests improved safety (mean dose ± SD 1.5 ± 1.0 vs 0.33 ± 0.5; p = 0.04). Furthermore, a significant and persistent reduction in the pain management component of the HCAHPS scores suggests a durability of results extending beyond the life of the study (72.1% vs 82.0%; p = 0.033). CONCLUSIONS The implementation of a standardized analgesia protocol can significantly reduce postoperative pain among neurosurgical patients while increasing safety. Given the current climate of patient-centered outcomes, this study has broad implications for the continuum of care model proposed in the Affordable Care Act. Clinical trial registration no.: NCT01693588 ( clincaltrials.gov ).
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Affiliation(s)
- W Lee Titsworth
- Departments of 1 Neurosurgery.,Harvard School of Public Health, Harvard University, Boston, Massachusetts; and
| | | | | | | | | | | | | | - Robert W Hurley
- Anesthesiology.,Psychiatry.,Neurology, and.,Orthopedic Surgery and Rehabilitation, University of Florida, Gainesville, Florida
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Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, Montes A, Pergolizzi J. Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 2015; 31:2131-43. [PMID: 26359332 DOI: 10.1185/03007995.2015.1092122] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain. At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of healthcare may be unwilling or unable to finance. Nevertheless, change is under way and the political will exists for it to continue.
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Affiliation(s)
- Winfried Meissner
- a a Leiter der Sektion Schmerz, Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum der FSU Jena , Germany
| | - Flaminia Coluzzi
- b b Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Dominique Fletcher
- c c Service Anesthésie Réanimation, Hôpital Raymond Poincare , Garches , France
| | - Frank Huygen
- d d University Hospital , Rotterdam , The Netherlands
| | | | - Edmund Neugebauer
- f f Faculty of Health , School of Medicine, Witten/Herdecke University , Cologne , Germany
| | | | - Joseph Pergolizzi
- h h Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
- i i Naples Anesthesia and Pain Associates , Naples , FL , USA
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The Impact of Assessment and Reassessment Documentation on the Trajectory of Postoperative Pain Severity: A Pilot Study. Pain Manag Nurs 2014; 15:652-63. [DOI: 10.1016/j.pmn.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 12/13/2022]
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Thornlow DK, Oddone E, Anderson R. Cascade Iatrogenesis: A Case-Control Study to Detect Postoperative Respiratory Failure in Hospitalized Older Adults. Res Gerontol Nurs 2014; 7:66-77. [DOI: 10.3928/19404921-20131126-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 11/04/2013] [Indexed: 11/20/2022]
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38
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Silva Y, Li S, Rickard M. Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial. Physiotherapy 2013. [DOI: 10.1016/j.physio.2012.09.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Siddiqui MRS, Sajid MS, Uncles DR, Cheek L, Baig MK. A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth 2011; 23:7-14. [DOI: 10.1016/j.jclinane.2010.05.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 05/13/2010] [Accepted: 05/22/2010] [Indexed: 11/27/2022]
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40
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Yang Y, Chen J, Zhu D, Chen G, Li Z, Li M, Wei S, Qiu X, Zhao H, Liu Y, Zhou Q. [Prevention and treatment of atelectasis after thoracotomy for lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:234-7. [PMID: 20673522 PMCID: PMC6000539 DOI: 10.3779/j.issn.1009-3419.2010.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/07/2010] [Indexed: 12/03/2022]
Abstract
背景与目的 肺不张是开胸术后的常见并发症,严重时会危及患者生命。本文旨在分析和探讨肺癌患者行开胸术后发生肺不张的原因和围手术期的预防和处理措施,以便降低肺不张的发生率,并提高其治愈率,以进一步降低围手术期死亡率。 方法 回顾性统计和分析我科因肺癌行开胸手术的374例患者中发生肺不张的资料和处理措施。 结果 374例肺癌患者行开胸手术后发生肺不张的有14例,经积极有效地治疗后肺不张的肺叶均复张。 结论 肺癌开胸术后肺不张发生率不高,有效的术前准备、良好的围术期处理和术后治疗可以降低开胸术后肺不张的发生率,提高治愈率。
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Affiliation(s)
- Yongbo Yang
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjian 300052, China
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Cheifetz O, Lucy SD, Overend TJ, Crowe J. The effect of abdominal support on functional outcomes in patients following major abdominal surgery: a randomized controlled trial. Physiother Can 2010; 62:242-53. [PMID: 21629603 DOI: 10.3138/physio.62.3.242] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS. METHODS Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery. RESULTS Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (∼75-78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group. CONCLUSION Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.
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Affiliation(s)
- Oren Cheifetz
- Oren Cheifetz, PT, MSc: Clinical Specialist-Physiotherapy, Hamilton Health Sciences, Hamilton, Ontario
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Prior conditions influencing nurses' decisions to adopt evidence-based postoperative pain assessment practices. Pain Manag Nurs 2009; 11:245-58. [PMID: 21095599 DOI: 10.1016/j.pmn.2009.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 04/27/2009] [Accepted: 05/18/2009] [Indexed: 11/20/2022]
Abstract
Over the past 30 years, postoperative pain relief has been shown to be inadequate. To provide optimal postoperative pain relief, it is imperative for nurses to use evidence-based postoperative pain assessment practices. This correlational descriptive study was conducted to identify factors, termed prior conditions, that influenced nurses' decisions to adopt three evidence-based postoperative pain assessment practices. A convenience sample of nurses who cared for adult postoperative patients in two Midwestern hospitals were surveyed, and 443 (46.9%) nurses responded. The previous practice and innovativeness of nurses were supportive of adoption of the three practices. Nurses felt that patients received adequate pain relief, which is unsupportive of adoption of the three practices because there is no impetus to change. Nurses who perceived the prior conditions as being supportive of adoption of pain management practices used multiple sources to identify solutions to clinical practice problems, and those who read professional nursing journals were more likely to have adopted the three practices and were more innovative. The number of sources used to identify solutions to clinical practice problems, previous practices, and innovativeness were predictive of nurses' adoption of the three evidence-based postoperative pain assessment practices. Nurses need to be encouraged to use multiple sources, including professional nursing journals, to identify solutions to clinical practice problems. Innovative nurses may be considered to be opinion leaders and need to be identified to promote the adoption of evidence-based postoperative pain assessment practices. Further exploration of the large unexplained variance in adoption of evidence-based postoperative pain assessment practices is needed.
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Li L, Herr K, Chen P. Postoperative Pain Assessment With Three Intensity Scales in Chinese Elders. J Nurs Scholarsh 2009; 41:241-9. [DOI: 10.1111/j.1547-5069.2009.01280.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cascade iatrogenesis: factors leading to the development of adverse events in hospitalized older adults. Int J Nurs Stud 2009; 46:1528-35. [PMID: 19643409 DOI: 10.1016/j.ijnurstu.2009.06.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 06/23/2009] [Accepted: 06/26/2009] [Indexed: 01/23/2023]
Abstract
Older adults are at particular risk for injuries associated with hospitalization and the rate of adverse events increases significantly with age. The purpose of this paper is to review factors associated with the development of adverse events in hospitalized older adults, especially those factors that contribute to cascade iatrogenesis. Cascade iatrogenesis is the serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event [Rothschild, J.M., Bates, D.W., Leape, L.L., 2000. Preventable medical injuries in older patients. Archieves of Internal Medicine 160 (October), 2717-2728]. Research has examined how patient characteristics may lead to cascade iatrogenesis, but existing conceptual models and research have not considered the role of nursing care. Using the outcome postoperative respiratory failure as an example, we expand on existing knowledge about factors associated with older adults' risk for developing this complication by presenting a conceptual model of events that may trigger the initial cascade and the nursing care variables that may prevent or mitigate these risks. We believe that this model will help guide research in this area and enable clinicians to identify systemic failures and develop targeted interventions to prevent their occurrence.
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Liu MC, Chen CC. Postoperative Care After Geriatric Ambulatory Surgery: Several Specific Considerations. INT J GERONTOL 2008. [DOI: 10.1016/s1873-9598(08)70045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gralla O, Buchser M, Haas F, Anders E, Kramer J, Lein M, Knoll N, Roigas J. „Fast-track“ bei laparoskopisch radikaler Prostatektomie. Urologe A 2008; 47:712-7. [DOI: 10.1007/s00120-008-1688-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Dronkers J, Veldman A, Hoberg E, van der Waal C, van Meeteren N. Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehabil 2008; 22:134-42. [DOI: 10.1177/0269215507081574] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the feasibility and effects of preoperative inspiratory muscle training on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective abdominal aortic aneurysm surgery.Design: Single-blind randomized controlled pilot study.Setting: Gelderse Vallei Hospital Ede, the Netherlands.Subjects: Twenty high-risk patients undergoing elective abdominal aortic aneurysm surgery were randomly assigned to receive preoperative inspiratory muscle training or usual care.Main measures: Effectiveness outcome variables were atelectasis, inspiratory muscle strength and vital capacity, and feasibility outcome variables were adverse effects and patient satisfaction with inspiratory muscle training.Results: Despite randomization, patients in the intervention group were significantly older than the patients in the control group (70 ± 6 years versus 59 ± 6 years, respectively; P = 0.001). Eight patients in the control group and three in the intervention group developed atelectasis (P = 0.07). The median duration of atelectasis was 0 days in the intervention group and 1.5 days in the control group (P = 0.07). No adverse effects of preoperative inspiratory muscle training were observed and patients considered that inspiratory muscle training was a good preparation for surgery. Mean postoperative inspiratory pressure was 10% higher in the intervention group.Conclusion: Preoperative inspiratory muscle training is well tolerated and appreciated and seems to reduce the incidence of atelectasis in patients scheduled for elective abdominal aortic aneurysm surgery.
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Affiliation(s)
- Jaap Dronkers
- Department of Physiotherapy, Gelderse Vallei Hospital, Ede,
| | - André Veldman
- Department of Physiotherapy, Gelderse Vallei Hospital, Ede
| | - Ellen Hoberg
- Department of Physiotherapy, Gelderse Vallei Hospital, Ede
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Pasetto LM, Lise M, Monfardini S. Preoperative assessment of elderly cancer patients. Crit Rev Oncol Hematol 2007; 64:10-8. [PMID: 17826628 DOI: 10.1016/j.critrevonc.2007.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 08/02/2007] [Indexed: 10/22/2022] Open
Abstract
The incidence of most types of cancers is age-dependent and progressive ageing is rapidly increasing the number of elderly people who need treatment for cancer. It is an ethical dilemma how aggressive one should be when it comes to treating cancer in the older population. Presumed fear of increased postoperative morbidity and mortality often results in delivery of sub-optimal cancer surgery. A careful evaluation of the general and organ-related conditions of the patients is absolutely necessary for planning the right treatment. Nevertheless, preoperative removal of risk factors and postoperative rehabilitation are as important as the use of the best techniques of anaesthesia and surgery to achieve good postoperative outcomes in these patients. In this review article we take into consideration physiology of the aged and tools available to assess surgical risks in elderly patients, in the aim of increasing awareness on optimising surgical management of elderly patients with cancer. MEDLINE and EMBASE.com (search terms: "elderly", "preoperative", "surgery"), bibliographies of articles retrieved and the authors' reference files have been used as data sources. Independent extraction has been performed by the authors using predefined criteria, including study quality indicators.
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Affiliation(s)
- Lara Maria Pasetto
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy.
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Angst MS, Drover DR. Pharmacology of drugs formulated with DepoFoam: a sustained release drug delivery system for parenteral administration using multivesicular liposome technology. Clin Pharmacokinet 2007; 45:1153-76. [PMID: 17112293 DOI: 10.2165/00003088-200645120-00002] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Lamellar liposome technology has been used for several decades to produce sustained-release drug formulations for parenteral administration. Multivesicular liposomes are structurally distinct from lamellar liposomes and consist of an aggregation of hundreds of water-filled polyhedral compartments separated by bi-layered lipid septa. The unique architecture of multivesicular liposomes allows encapsulating drug with greater efficiency, provides robust structural stability and ensures reliable, steady and prolonged drug release. The favourable characteristics of multivesicular liposomes have resulted in many drug formulations exploiting this technology, which is proprietary and referred to as DepoFoam. Currently, two formulations using multivesicular liposome technology are approved by the US FDA for clinical use, and many more formulations are at an experimental developmental stage. The first clinically available formulation contains the antineoplastic agent cytarabine (DepoCyt) for its intrathecal injection in the treatment of malignant lymphomatous meningitis. Intrathecal injection of DepoCyt reliably results in the sustained release of cytarabine and produces cytotoxic concentrations in cerebrospinal fluid (CSF) that are maintained for at least 2 weeks. Early efficacy data suggest that DepoCyt is fairly well tolerated, and its use allows reduced dosing frequency from twice a week to once every other week and may improve the outcome compared with frequent intrathecal injections of unencapsulated cytarabine. The second available formulation contains morphine (DepoDur) for its single epidural injection in the treatment of postoperative pain. While animal studies confirm that epidural injection of DepoDur results in the sustained release of morphine into CSF, the CSF pharmacokinetics have not been determined in humans. Clinical studies suggest that the use of DepoDur decreases the amount of systemically administered analgesics needed for adequate postoperative pain control. It may also provide superior pain control during the first 1-2 postoperative days compared with epidural administration of unencapsulated morphine or intravenous administration of an opioid. However, at this timepoint the overall clinical utility of DepoDur has yet to be defined and some safety concerns remain because of the unknown CSF pharmacokinetics of DepoDur in humans. The versatility of multivesicular liposome technology is reflected by the many agents including small inorganic and organic molecules and macromolecules including proteins that have successfully been encapsulated. Data concerning many experimental formulations containing antineoplastic, antibacterial and antiviral agents underscore the sustained, steady and reliable release of these compounds from multivesicular liposomes after injection by the intrathecal, subcutaneous, intramuscular, intraperitoneal and intraocular routes. Contingent on the specific formulation and manufacturing process, agents were released over a period of hours to weeks as reflected by a 2- to 400-fold increase in elimination half life. Published data further suggest that the encapsulation process preserves bioactivity of agents as delicate as proteins and supports the view that examined multivesicular liposomes were non-toxic at studied doses. The task ahead will be to examine whether the beneficial structural and pharmacokinetic properties of multivesicular liposome formulations will translate into improved clinical outcomes, either because of decreased drug toxicity or increased drug efficacy.
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Affiliation(s)
- Martin S Angst
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5117, USA.
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Abstract
Postoperative pulmonary complications are potentially preventable adverse events that are a major source of postoperative morbidity and mortality. Although these events occur more frequently than cardiac complications, less is known about how to predict their occurrence. This review of the literature identifies significant risk factors for postoperative pulmonary complications. Nurses can be instrumental in preventing postoperative pulmonary complications by identifying patients at risk for their development.
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