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Wang X, Wang Y, Yu N, Xu H, Lei Z. Observational study of ropivacaine and compound betamethasone mixture for analgesia after triangular fibrocartilage complex repair under wrist arthroscopy: A single-center randomized double-blind controlled trial. J Orthop Sci 2024; 29:1208-1213. [PMID: 37863682 DOI: 10.1016/j.jos.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the clinical effect of an intra-articular and local infiltration injection of a compound analgesic mixture of ropivacaine and compound betamethasone on the repair of the triangular fibrocartilage complex under wrist arthroscopy. METHODS This prospective, double-blind, randomized study involved 20 patients with Atzei type 2 or 3 injuries of the triangular fibrocartilage complex who underwent repair under wrist arthroscopy. Patients were divided into two groups (n = 10) according to the systematic random sampling method. The test group was injected with a "cocktail" mixture for pain relief. The control group was injected with normal saline. The visual analog scale (VAS) pain score, pinch force, wrist joint mobility, wrist joint function score (PRWE score), occurrence of adverse reactions and dosage of analgesic drugs were evaluated before and after the operation in the two groups. RESULTS The resting pain of the patients in the test group was less severe than that of the control group at 12 h, 24 h and 48 h after the operation (P < 0.05), and the pinch force of the patients in the test group was significantly greater than that of the control group at 1 d, 2 d and 3 d after the operation (P < 0.01). The amount of postoperative analgesics used in the test group was significantly lower than that in the control group (P < 0.01), and the patient satisfaction rate in the test group was higher than that in the control group (P < 0.05). There were no postoperative adverse effects in either group. CONCLUSION An intra-articular and local infiltration injection of a "cocktail" analgesic mixture in the repair of triangular fibrocartilage complex under wrist arthroscopy can provide good pain control in the early postoperative period and reduce the amount of postoperative analgesic drugs administered, thus improving clinical safety. LEVEL OF EVIDENCE Level II; Randomized Controlled Trial; Treatment Study.
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Affiliation(s)
- Xinzhu Wang
- Hand Surgery 5 Ward, Central Hospital Affiliated to Shenyang Medical College. No. 5, Nanqi West Road, Tiexi District, Shenyang City, Liaoning Province, China
| | - Yansheng Wang
- Hand Surgery 5 Ward, Central Hospital Affiliated to Shenyang Medical College. No. 5, Nanqi West Road, Tiexi District, Shenyang City, Liaoning Province, China
| | - Ning Yu
- Hand Surgery 5 Ward, Central Hospital Affiliated to Shenyang Medical College. No. 5, Nanqi West Road, Tiexi District, Shenyang City, Liaoning Province, China
| | - Hui Xu
- Hand Surgery 5 Ward, Central Hospital Affiliated to Shenyang Medical College. No. 5, Nanqi West Road, Tiexi District, Shenyang City, Liaoning Province, China
| | - Zeming Lei
- Hand Surgery 5 Ward, Central Hospital Affiliated to Shenyang Medical College. No. 5, Nanqi West Road, Tiexi District, Shenyang City, Liaoning Province, China; Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University. No. 36, Sanhao Street, Heping District, Shenyang City, Liaoning Province, China.
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Mead SA, Allen MJ, Elsayed SAH, Gittel CS. Evaluating the Efficacy of a Peripheral Nerve Simulator-Guided Brachial Plexus Block in Rabbits Undergoing Orthopaedic Surgery Compared to Systemic Analgesia. Vet Sci 2024; 11:213. [PMID: 38787185 PMCID: PMC11125770 DOI: 10.3390/vetsci11050213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/24/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Locoregional anaesthetic techniques are invaluable for providing multimodal analgesia for painful surgical procedures. This prospective, randomised study describes a nerve stimulator-guided brachial plexus blockade (BPB) in rabbits undergoing orthopaedic surgery in comparison to systemic lidocaine. Premedication was provided with intramuscular (IM) medetomidine, fentanyl, and midazolam. Anaesthesia was induced (propofol IV) and maintained with isoflurane. Nine rabbits received a lidocaine BPB (2%; 0.3 mL kg-1), and eight received a lidocaine constant rate infusion (CRI) (2 mg kg-1 IV, followed by 100 µg kg-1 min-1). Rescue analgesia was provided with fentanyl IV. Carprofen was administered at the end of the surgery. Postoperative pain was determined using the Rabbit Grimace Scale (RGS) and a composite pain scale. Buprenorphine was administered according to the pain score for two hours after extubation. Rabbits were filmed during the first two hours to measure distance travelled and behaviours. Food intake and faeces output were compared. Every rabbit in CRI required intraoperative rescue analgesia compared to none in BPB. However, rabbits in both groups had similar pain scores, and there was no difference in the administration of postoperative analgesia. There were no significant differences in food intake or faeces production over 18 h, and no significant differences in distance travelled or behaviours examined during the first two hours. BPB seems superior for intraoperative analgesia. Postoperatively, both groups were comparable.
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Affiliation(s)
- Sophie A. Mead
- Queen’s Veterinary School Hospital, University of Cambridge, Cambridge CB3 0ES, UK;
- Southfields Veterinary Specialists, Basildon SS14 3AP, UK
| | - Matthew J. Allen
- Surgical Discovery Centre, University of Cambridge, Cambridge CB3 0ES, UK
| | - Sara Ahmed Hassouna Elsayed
- Faculty of Veterinary Medicine, Alexandria University, Alexandria 5424041, Egypt
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - Claudia S. Gittel
- Queen’s Veterinary School Hospital, University of Cambridge, Cambridge CB3 0ES, UK;
- Rossdales Equine Hospital, Cotton End Rd, Newmarket CB8 7NN, UK
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3
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Stearns SA, Xun H, Haddad A, Rinkinen J, Bustos VP, Lee BT. Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review. Plast Reconstr Surg 2024; 153:988e-1001e. [PMID: 37337332 DOI: 10.1097/prs.0000000000010861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients. METHODS Currently available migraine therapeutics were compiled from the UpToDate software system and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic's effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and nonpharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care. RESULTS Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate postmicrosurgical use. Novel pharmaceutical therapies such as lasmiditan and calcitonin gene-related peptide antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of nonsteroidal antiinflammatory drugs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment by means of magnesium supplementation or coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting. CONCLUSIONS Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.
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Affiliation(s)
| | - Helen Xun
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Anthony Haddad
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Jacob Rinkinen
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Valeria P Bustos
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Bernard T Lee
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
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4
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Ott S, Müller-Wirtz LM, Sertcakacilar G, Tire Y, Turan A. Non-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians-A Narrative Review. J Clin Med 2024; 13:1104. [PMID: 38398416 PMCID: PMC10889232 DOI: 10.3390/jcm13041104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Multi-modal analgesic strategies, including regional anesthesia techniques, have been shown to contribute to a reduction in the use of opioids and associated side effects in the perioperative setting. Consequently, those so-called multi-modal approaches are recommended and have become the state of the art in perioperative medicine. In the majority of intensive care units (ICUs), however, mono-modal opioid-based analgesic strategies are still the standard of care. The evidence guiding the application of regional anesthesia in the ICU is scarce because possible complications, especially associated with neuraxial regional anesthesia techniques, are often feared in critically ill patients. However, chest and abdominal wall analgesia in particular is often insufficiently treated by opioid-based analgesic regimes. This review summarizes the available evidence and gives recommendations for peripheral regional analgesia approaches as valuable complements in the repertoire of intensive care physicians' analgesic portfolios.
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Affiliation(s)
- Sascha Ott
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Deutsches Herzzentrum der Charité-Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiac Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Lukas M Müller-Wirtz
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Saarland University Faculty of Medicine, 66424 Homburg, Germany
| | - Gokhan Sertcakacilar
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey
| | - Yasin Tire
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Science, 42020 Konya, Turkey
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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5
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Healy CR, Gethin G, Pandit A, Finn DP. Chronic wound-related pain, wound healing and the therapeutic potential of cannabinoids and endocannabinoid system modulation. Biomed Pharmacother 2023; 168:115714. [PMID: 37865988 DOI: 10.1016/j.biopha.2023.115714] [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] [Received: 07/04/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Chronic wounds represent a significant burden on the individual, and the healthcare system. Individuals with chronic wounds report pain to be the most challenging aspect of living with a chronic wound, with current therapeutic options deemed insufficient. The cutaneous endocannabinoid system is an important regulator of skin homeostasis, with evidence of system dysregulation in several cutaneous disorders. Herein, we describe the cutaneous endocannabinoid system, chronic wound-related pain, and comorbidities, and review preclinical and clinical evidence investigating endocannabinoid system modulation for wound-related pain and wound healing. Based on the current literature, there is some evidence to suggest efficacy of endocannabinoid system modulation for promotion of wound healing, attenuation of cutaneous disorder-related inflammation, and for the management of chronic wound-related pain. However, there is 1) a paucity of preclinical studies using validated models, specific for the study of chronic wound-related pain and 2) a lack of randomised control trials and strong clinical evidence relating to endocannabinoid system modulation for wound-related pain. In conclusion, while there is some limited evidence of benefit of endocannabinoid system modulation in wound healing and wound-related pain management, further research is required to better realise the potential of targeting the endocannabinoid system for these therapeutic applications.
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Affiliation(s)
- Catherine R Healy
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - Georgina Gethin
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland; School of Nursing and Midwifery, University of Galway, Galway City, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway City, Ireland
| | - Abhay Pandit
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland.
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Franck H, Dempfle A, Reischig K, Baastrup J, Meinzer A, Kossakowski M, Krebs TF, Bergholz R. Mobile Dressing Trolleys Improve Satisfaction and Logistics on Pediatric Surgery Wards. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1089. [PMID: 37508586 PMCID: PMC10378491 DOI: 10.3390/children10071089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Evidence-based data on the effect of dressing trolleys on children's postoperative recovery are not available. The aim of this study was to evaluate a specific pediatric surgical dressing trolley on patient and caregiver satisfaction, as well as temporal and logistical aspects of the dressing change procedures. METHODS In a prospective observational non-randomized study, a total of 100 dressing changes were observed before (group 1) and after (group 2) the introduction of a pediatric surgical dressing trolley and the satisfaction, time and logistical factors were recorded on site. RESULTS The median preparation time, the duration of the dressing change and the total time decreased significantly from group 1 to group 2 by 1:11 min (p < 0.001); 1:56 min (p = 0.05) and 5:09 min (p = 0.001), respectively. The patient's room was left significantly less often in group 2 to retrieve missing bandages. The median satisfaction of the medical staff increased by 12% in group 2 (p < 0.001). The satisfaction of the parents increased by 2.5% in group 2 (p = 0.042), and that of the nursing staff increased by 9.25% in group 2 (p = 0.015). CONCLUSIONS Our results demonstrate the positive effects of a dressing trolley for pediatric surgical dressing changes by minimizing postoperative handling and manipulation of the child. It improves time and logistical factors as well as the satisfaction of those involved, which may lead to a faster recovery.
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Affiliation(s)
- Hannes Franck
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Katja Reischig
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Jonas Baastrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Andreas Meinzer
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Meike Kossakowski
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
| | - Thomas Franz Krebs
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Robert Bergholz
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany
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Froelich A, Jakubowska E, Wojtyłko M, Jadach B, Gackowski M, Gadziński P, Napierała O, Ravliv Y, Osmałek T. Alginate-Based Materials Loaded with Nanoparticles in Wound Healing. Pharmaceutics 2023; 15:pharmaceutics15041142. [PMID: 37111628 PMCID: PMC10143535 DOI: 10.3390/pharmaceutics15041142] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Alginate is a naturally derived polysaccharide widely applied in drug delivery, as well as regenerative medicine, tissue engineering and wound care. Due to its excellent biocompatibility, low toxicity, and the ability to absorb a high amount of exudate, it is widely used in modern wound dressings. Numerous studies indicate that alginate applied in wound care can be enhanced with the incorporation of nanoparticles, revealing additional properties beneficial in the healing process. Among the most extensively explored materials, composite dressings with alginate loaded with antimicrobial inorganic nanoparticles can be mentioned. However, other types of nanoparticles with antibiotics, growth factors, and other active ingredients are also investigated. This review article focuses on the most recent findings regarding novel alginate-based materials loaded with nanoparticles and their applicability as wound dressings, with special attention paid to the materials of potential use in the treatment of chronic wounds.
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Affiliation(s)
- Anna Froelich
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Emilia Jakubowska
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Monika Wojtyłko
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Barbara Jadach
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Michał Gackowski
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Piotr Gadziński
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Olga Napierała
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Yulia Ravliv
- Department of Pharmacy Management, Economics and Technology, I. Horbachevsky Ternopil National Medical University, 36 Ruska Street, 46000 Ternopil, Ukraine
| | - Tomasz Osmałek
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
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Reporting of anaesthesia and pain management in preclinical large animal models of articular cartilage repair - A long way to go. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100261. [DOI: 10.1016/j.ocarto.2022.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
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9
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A RETROSPECTIVE STUDY OF BITE WOUND MANAGEMENT IN RING-TAILED LEMURS ( LEMUR CATTA) HOUSED WITHIN FIVE BRITISH ZOOS. J Zoo Wildl Med 2022; 52:1263-1269. [PMID: 34998298 DOI: 10.1638/2020-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/21/2022] Open
Abstract
Captive nonhuman primates frequently experience bite wounds inflicted by conspecifics; however, few studies evaluate wound management in these animals. This study evaluates bite wound management in 35 captive ring-tailed lemurs (RTL, Lemur catta) held within five British zoological institutions between 2015 and 2019. Treatments for 152 bite incidents resulting in 211 bite wounds were summarized. Treatment efficacy and potential risk factors for bite wound complications were evaluated for correlations with outcomes. Treatments in the first 48 hours included analgesia alone (54/152; 35.5%); analgesia and antimicrobials (42/152; 27.6%); no treatment (26/152; 17.1%); analgesia, antimicrobials, and wound management under anesthesia (24/152; 15.8%); and antimicrobials alone (6/152; 3.9%). Poor outcomes were observed in RTL in association with 20.4% of wounds (43/211): signs of pain (SOP) after 48 hours were the most common (30/211; 14.2%), followed by signs of infection (SOI, 16/211; 7.6%), wound dehiscence (7/211; 3.3%), and abnormal function or behavior at day 30 (4/ 211; 1.9%). Poor outcomes were more likely with severe bite wounds and bite wounds to the hand or limb (thoracic or pelvic, excluding the hand or foot). Specifically, SOP were more likely to be observed with severe wounds and solitary wounds, and SOI were more likely to be observed with wounds not treated with early antimicrobials. When SOI occurred, most resolved with antimicrobial treatment alone. Early analgesia is recommended for RTL with bite wounds. If SOP persist, multimodal analgesia should be administered. Clinicians should consider withholding antimicrobials for RTL with bite wounds of mild and moderate severity until SOI are observed.
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Yu G, Ren H, Xiao A, Liu J, Li M, Zhang N. Wound infection in elbow fractures: Incidence and new management protocol. Int Wound J 2021; 19:1409-1417. [PMID: 34935285 PMCID: PMC9493212 DOI: 10.1111/iwj.13734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/27/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Guiyong Yu
- Department of Rehabilitation, Hengshui People's Hospital, Hengshui, China
| | - Hong Ren
- Department of Rehabilitation, Hengshui People's Hospital, Hengshui, China
| | - Aiwei Xiao
- Department of Rehabilitation, Hengshui People's Hospital, Hengshui, China
| | - Juan Liu
- Department of Rehabilitation, Hengshui People's Hospital, Hengshui, China
| | - Mei Li
- Department of Rehabilitation, Hengshui People's Hospital, Hengshui, China
| | - Ning Zhang
- Department of Orthopedic Surgery, Hengshui People's Hospital, Hengshui, China
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Gillum M, Huang S, Kuromaru Y, Dang J, Yenikomshian HA, Gillenwater TJ. Nonpharmacologic Management of Procedural Pain in Pediatric Burn Patients: A Systematic Review of Randomized Controlled Trials. J Burn Care Res 2021; 43:368-373. [PMID: 34534314 DOI: 10.1093/jbcr/irab167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pain following burn injury is associated with long-term health consequences in the pediatric population. Literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct for these patients. This study aims to summarize randomized controlled trials on nonpharmacologic procedural pain management in pediatric burn patients. A systematic review was conducted on nonpharmacologic procedural pain management techniques used in the pediatric burn population. Fifteen studies were included and involved virtual reality, distraction devices, child life therapy, directed play, digital tablet games, cartoons, hypnosis, and music therapy. Treatment was effective in 8 out of 15 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 19.7% and post procedure pain by 20.1%. This study demonstrates nonpharmacologic therapy can be an effective adjunct in pediatric procedural burn pain management, however further studies are needed to develop standardized algorithms to integrate nonpharmacologic treatments with pharmacologic therapies.
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Affiliation(s)
- Matthew Gillum
- Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Samantha Huang
- Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Yuki Kuromaru
- Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Justin Dang
- Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
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12
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Goto T, Sapio MR, Maric D, Robinson JM, Domenichiello AF, Saligan LN, Mannes AJ, Iadarola MJ. Longitudinal peripheral tissue RNA-Seq transcriptomic profiling, hyperalgesia, and wound healing in the rat plantar surgical incision model. FASEB J 2021; 35:e21852. [PMID: 34499774 PMCID: PMC9293146 DOI: 10.1096/fj.202100347r] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023]
Abstract
Postoperative pain and delayed healing in surgical wounds, which require complex management strategies have understudied complicated mechanisms. Here we investigated temporal changes in behavior, tissue structure, and transcriptomic profiles in a rat model of a surgical incision, using hyperalgesic behavioral tests, histological analyses, and next‐generation RNA sequencing, respectively. The most rapidly (1 hour) expressed genes were the chemokines, Cxcl1 and Cxcl2. Consequently, infiltrating leukocytes were abundantly observed starting at 6 and peaking at 24 hours after incising which was supported by histological analysis and appearance of the neutrophil markers, S100a8 and S100a9. At this time, hyperalgesia was at a peak and overall transcriptional activity was most highly activated. At the 1‐day timepoint, Nppb, coding for natriuretic peptide precursor B, was the most strongly upregulated gene and was localized by in situ hybridization to the epidermal keratinocytes at the margins of the incision. Nppb was basically unaffected in a peripheral inflammation model transcriptomic dataset. At the late phase of wound healing, five secreted, incision‐specific peptidases, Mmp2, Aebp1, Mmp23, Adamts7, and Adamtsl1, showed increased expression, supporting the idea of a sustained tissue remodeling process. Transcripts that are specifically upregulated at each timepoint in the incision model may be potential candidates for either biomarkers or therapeutic targets for wound pain and wound healing. This study incorporates the examination of longitudinal temporal molecular responses, corresponding anatomical localization, and hyperalgesic behavioral alterations in the surgical incision model that together provide important and novel foundational knowledge to understand mechanisms of wound pain and wound healing.
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Affiliation(s)
- Taichi Goto
- Symptoms Biology Unit, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Matthew R Sapio
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Dragan Maric
- Flow and Imaging Cytometry Core Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey M Robinson
- Translational Life Science Technology Program, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Anthony F Domenichiello
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Leorey N Saligan
- Symptoms Biology Unit, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Andrew J Mannes
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Michael J Iadarola
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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13
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Preemptive Duloxetine Relieves Postoperative Pain and Lowers Wound Temperature in Centrally Sensitized Patients Undergoing Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Med 2021; 10:jcm10132809. [PMID: 34202314 PMCID: PMC8269433 DOI: 10.3390/jcm10132809] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/08/2023] Open
Abstract
(1) Background: The purpose of this study was to determine whether preemptive duloxetine in patients with central sensitization (CS) is effective for acute postoperative pain control and wound healing following total knee arthroplasty (TKA). (2) Methods: CS was defined as a score of 40 points or higher on the Central Sensitization Inventory (CSI) survey. Thirty-nine patients with CS were randomly assigned to either the duloxetine group (n = 19) or the placebo group (n = 20). The duloxetine group took duloxetine 30 mg once a day, while the placebo group took the placebo medication once a day. A pain visual analog scale (VAS) and the Brief Pain Inventory (BPI), wound complications, the temperature of the surgical site, and adverse events were investigated. Skin temperature was measured at the center of the patella using a portable digital thermometer. (3) Results: The duloxetine group reported significantly lower pain VAS scores during follow-up periods up to 6 weeks after surgery (all p < 0.05). BPI interference also showed significantly superior results in the duloxetine group after surgery (all p < 0.05). Although there was no difference in the rate of wound complications between the two groups (p > 0.05), the duloxetine group showed significantly lower wound temperature than the placebo group during the follow-up period (all p < 0.05). (4) Conclusion: In this study, preemptive duloxetine effectively reduced pain and lowered wound temperature following TKA in CS patients.
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14
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Webb DR, Churchill SR, Hill GD, McGee CA, Shi M, King-Herbert AP, Blankenship-Paris TL. Effects of Buprenorphine, Chlorhexidine, and Low-level Laser Therapy on Wound Healing in Mice. Comp Med 2021; 71:191-202. [PMID: 33863402 DOI: 10.30802/aalas-cm-20-000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Systemic buprenorphine and topical antiseptics such as chlorhexidine are frequently used in research animals to aid in pain control and to reduce infection, respectively. These therapeutics are controversial, especially when used in wound healing studies, due to conflicting data suggesting that they delay wound healing. Low-level laser therapy (LLLT) has been used to aid in wound healing without exerting the systemic effects of therapies such as buprenorphine. We conducted 2 studies to investigate the effects of these common treatment modalities on the rate of wound healing in mice. The first study used models of punch biopsy and dermal abrasion to assess whether buprenorphine HCl or 0.12% chlorhexidine delayed wound healing. The second study investigated the effects of sustained-released buprenorphine, 0.05% chlorhexidine, and LLLT on excisional wound healing. The rate of wound healing was assessed by obtaining photographs on days 0, 2, 4, 7, and 9 for the punch biopsy model in study 1, days 0, 1, 2, 4, 6, 8, 11, and 13 for the dermal abrasion model in study 1, and days 0, 3, 6, and 10 for the mice in study 2. Image J software was used to analyze the photographed wounds to determine the wound area. When comparing the wound area on the above days to the original wound area, no significant differences in healing were observed for any of the treatment groups at any time period for either study. Given the results of these studies, we believe that systemic buprenorphine, topical chlorhexidine, and LLLT can be used without impairing or delaying wound healing in mice.
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Affiliation(s)
- Donna R Webb
- National Institute of Environmental Health Sciences, Comparative & Molecular Pathogenesis Branch, National Toxicology Program, Durham, North Carolina;,
| | | | - Georgette D Hill
- Integrated Laboratory Systems, LLC., Research Triangle Park, North Carolina
| | - Christopher A McGee
- National Institute of Environmental Health Sciences, Clinical Research Branch, Durham, North Carolina
| | - Min Shi
- National Institute of Environmental Health Sciences, Biostatistics & Computational Biology Branch, Durham, North Carolina
| | - Angela P King-Herbert
- National Institute of Environmental Health Sciences, Comparative & Molecular Pathogenesis Branch, National Toxicology Program, Durham, North Carolina
| | - Terry L Blankenship-Paris
- National Institute of Environmental Health Sciences, Comparative Medicine Branch, Durham, North Carolina
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15
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Storey K, Kimble RM, Holbert MD. The Management of Burn Pain in a Pediatric Burns-Specialist Hospital. Paediatr Drugs 2021; 23:1-10. [PMID: 33447938 DOI: 10.1007/s40272-020-00434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Appropriate pain management for children who have experienced an acute burn injury is critical to improve patient outcomes and reduce potential morbidities. With 60% of our patients being under the age of 4 years, pain management is crucial in reducing pain and anxiety in both patients and parents. It is imperative that appropriate pain relief is commenced from initial contact with healthcare workers as this will affect the success or failure of future wound procedures. Uncontrolled pain can negatively affect a patient, both short and long term. It may cause anticipatory anxiety for future medical procedures, increased pain and anxiety can decrease wound re-epithelialization which can lead to long-term consequences for growth and mobility, and increased pain can also influence the possibility of patients and families displaying signs of post-traumatic stress disorder. Pain management in the form of pharmaceuticals is imperative during burn wound treatment and should incorporate pain relief targeted at both background and procedural pain. It also requires a multimodal, individualized, and targeted approach combining both pharmaceutical and nonpharmaceutical techniques, including cold running water, multimodal distraction devices, hypnotherapy, and bubbles. We discuss the research and knowledge that our center has gained through treating pediatric patients with burns over the last 20 years.
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Affiliation(s)
- Kristen Storey
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia. .,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Maleea D Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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16
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Wound Pain and Wound Healing Biomarkers From Wound Exudate: A Scoping Review. J Wound Ostomy Continence Nurs 2020; 47:559-568. [PMID: 33201141 DOI: 10.1097/won.0000000000000703] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Effective management of wound pain is essential for optimal wound healing. Nevertheless, the outcomes of wound pain interventions are based on subjective measures, which can prove problematic in patients with cognitive impairment. Identification of biomarkers associated with wound pain and wound healing can be used to more objectively estimate wound pain and contribute to the development of precise management options to reduce wound pain and promote wound healing. This scoping review aimed to identify wound pain and wound healing biomarkers from wound exudates and to describe different wound collection methods to identify these biomarkers. METHODS We searched the literature (PROSPERO database registration number: CRD42018103843) via a scoping review. SEARCH STRATEGY The PubMed database was searched for articles that explored relationships between cutaneous wound pain, wound healing, and biomolecules. Inclusion criteria were articles that reported original data, used adult human samples, and were published in English. FINDINGS Twenty-one articles were retrieved: 17 investigated molecules from wound exudate associated with wound healing status, and 4 reported molecules associated with wound pain. The most frequently observed wound pain biomarkers were proinflammatory cytokines; the most frequently observed wound healing biomarkers were proteases including those in the matrix metalloproteinase family. Six wound exudate collection methods were identified to extract potential wound pain and wound healing biomarkers from wound exudate. IMPLICATIONS The results can guide future wound exudate research to validate these wound pain and wound healing biomarkers and to develop therapies targeting these biomarkers to reduce wound pain and promote wound healing.
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17
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Hauser H, Campbell S, Korpivaara M, Stefanovski D, Quinlan M, Siracusa C. In-hospital administration of dexmedetomidine oromucosal gel for stress reduction in dogs during veterinary visits: A randomized, double-blinded, placebo-controlled study. J Vet Behav 2020. [DOI: 10.1016/j.jveb.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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18
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The 4 Principles of Complex Abdominal Wall Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2549. [PMID: 32042542 PMCID: PMC6964925 DOI: 10.1097/gox.0000000000002549] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
Abdominal wall defects are some of the most common and challenging problems encountered by plastic surgeons. A high proportion of patients with abdominal wall defects have significant comorbidities and/or contamination, putting them at high risk for complications. In addition to advanced surgical skills and precise anatomical knowledge, the plastic surgeon needs strict discipline and medical acumen, to optimize patients before and after surgery. In this paper, we discuss the goals of abdominal wall reconstruction, and the 4 steps to successful surgery: preoperative patient selection/optimization, durable and dynamic reconstruction of the musculofascial layer, careful attention to the skin and subcutaneous tissue, and meticulous postoperative management.
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19
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Goto T, Nakagami G, Minematsu T, Shinoda M, Sanada H. Measurement of mechanical withdrawal threshold on full-thickness cutaneous wounds in rats using the von Frey test. J Wound Care 2019; 28:762-772. [PMID: 31721662 DOI: 10.12968/jowc.2019.28.11.762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A method for measuring mechanical withdrawal threshold of full-thickness cutaneous wound pain in animal models is lacking. This study aimed to confirm the validity and reactivity of the von Frey test in full-thickness cutaneous wounds in rats. METHOD A 1.5cm-diameter wound was established on the dorsal areas of male Sprague-Dawley rats and subcutaneously injected with either morphine hydrochloride (5.0mg/kg) or indomethacin (2.5mg/kg) with a 27-gauge needle on day three post-wounding. On day five post-wounding, an injection of morphine hydrochloride, indomethacin or lambda-carrageenan (1.0%) into the granulation tissue was also administered. The withdrawal threshold of mechanical stimulation of the wound edge was compared in each group before treatment with injection and at two, four, eight and 24 hours after injection. RESULTS A total of 40 rats were used in the study. Since more severe inflammation in and around the wound was induced on day three post-wounding than that of day five, the withdrawal threshold measured on day three post-wounding was significantly lower than that of day five. The decrease of the withdrawal threshold was depressed by morphine hydrochloride and indomethacin treatment on day three post-wounding. While there was no significant difference between the changes in the withdrawal threshold after indomethacin treatment on day five post-wounding, we observed an increased withdrawal threshold after morphine hydrochloride treatment and decreased withdrawal threshold after lambda-carrageenan treatment on day five post-wounding. CONCLUSION The results suggest that the von Frey test can be applied to measure the mechanical withdrawal threshold of full-thickness dorsal wounds in rats.
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Affiliation(s)
- Taichi Goto
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Leadership Initiative for an Age-Friendly Society, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masamichi Shinoda
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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20
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Sen CK, Roy S. Sociogenomic Approach to Wound Care: A New Patient-Centered Paradigm. Adv Wound Care (New Rochelle) 2019; 8:523-526. [PMID: 31637098 DOI: 10.1089/wound.2019.1101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 12/15/2022] Open
Abstract
Psychoneuroendocrinology studies provided first insight into social determinants of wound healing. Social stressors impede wound healing. In 2005, we first reported that the transcriptome of wound-site neutrophil is highly responsive to psychological stress in young men. Bioinformatics processing of transcriptome-wide data from neutrophils provided first insight into social transduction pathways relevant to wound healing. In 2010, Idaghdour et al. presented striking evidence demonstrating that genetic factors are responsible for only 5% of the variation in genomic expression. In contrast, the living environment of the individual, urban or rural, was responsible for as much as 50% of such variation. Genetic and environmental factors acted in a largely additive manner. This observation may be credited as the foundation stone of human social genomics. The environment of a patient, including social factors, influences gene expression relevant to wound healing. The nonhealing wound itself and its worsening outcome, including pain, are likely to cause stress. Conversely, positive social interactions may circumvent barriers to wound healing. Thus, interventions directed at the social environment of a wound care patient are likely to help manage wound chronicity. The genomic and related Big Data technology platforms have vastly improved during the past 5 years during which these technologies have also become widely accessible and affordable. Thus, this is the right time to revisit the choice of technologies for the study of social genomics of wound healing. Against the backdrop of our current understanding of the mechanisms of wound healing, such precision approach is likely to transform wound care and its outcomes making it patient-centered and, therefore, more effective.
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Affiliation(s)
- Chandan K. Sen
- The Indiana University Health Comprehensive Wound Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sashwati Roy
- The Indiana University Health Comprehensive Wound Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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21
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Abstract
CONTEXT Acute postoperative pain remains inadequately assessed and managed. A valid instrument that assesses acute pain in sedated postanesthesia care unit (PACU) patients is needed. OBJECTIVES Two behavioral pain assessment instruments, the NonVerbal Pain Scale Revised (NVPS-R) and Critical-care Pain Observation Tool (CPOT), were used to determine whether these instruments adequately assess acute pain in the PACU. METHODS A crossover study design was used. The study was conducted in the Medical Services Administration at the Puerto Rico Medical Center. Upon PACU arrival, patient sedation levels were evaluated using the Richmond Agitation Sedation Scale. Acute pain was assessed using the CPOT (scored, 0 to 8) and the NVPS-R (scored, 0 to 10) at timepoints 0, 15, 30, 45, 60, 90, and 120 minutes. Descriptive statistics and mixed model regression analysis were used to compare pain score assessment between instruments. RESULTS Clinically significant increases in vital signs and respiratory indicators using the NVPS-R were not seen in patients with significant pain at time 0, 15, and 120 minutes. The CPOT vocalization indicator was more frequent in patients with significant pain. CONCLUSIONS Findings suggest that NVPS-R and CPOT can assess acute pain in sedated PACU patients. In patients with significant pain, the CPOT vocalization indicator was more consistent than physiological and respiratory indicators in detecting acute pain. Thus, our data do not support the exclusive use of vital sign indicators to assess acute pain, suggesting the superiority of the CPOT for the assessment of acute pain in sedated PACU patients.
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22
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Huss MK, Felt SA, Pacharinsak C. Influence of Pain and Analgesia on Orthopedic and Wound-healing Models in Rats and Mice. Comp Med 2019; 69:535-545. [PMID: 31561753 DOI: 10.30802/aalas-cm-19-000013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The surgical stress response and resulting physiologic changes can lead to postoperative complications and negatively impact animal welfare. Although appropriate pain management is crucial to reduce the pain and stress response to surgery, analgesic choice can significantly affect bone and wound healing. This review aims to summarize data from rat and mouse studies and to provide recommendations for integrating analgesia into orthopedic and wound healing models in these species. Data from other species, such as humans, rabbits and other rodents, is included, where available. From these data, we conclude that for orthopedic surgical models, opioids, local anesthetics and dissociative agents have minimal impact on fracture healing; cyclooxygenase 2 (COX2) selective nonsteroidal antiinflammatory drugs (NSAID) may be used in the shortterm; and steroids should be avoided. For wound healing models, short-term systemic or topical opioids have negligible impact on wound healing; NSAID or local anesthetics may be used short-term; and systemic steroids should be avoided. Alternative analgesics such as tramadol, gabapentin, ketamine, and acetaminophen warrant consideration and further evaluation for both orthopedic and wound healing models. In all cases, researchers and veterinarians should work together to determine the appropriate analgesic plan to minimize pain, as well as to minimize unwanted effects on the orthopedic and wound healing models themselves.
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Affiliation(s)
- Monika K Huss
- Department of Comparative Medicine, Stanford University, Stanford, California;,
| | - Stephen A Felt
- Department of Comparative Medicine, Stanford University, Stanford, California
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23
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Viscusi E, Minkowitz H, Winkle P, Ramamoorthy S, Hu J, Singla N. HTX-011 reduced pain intensity and opioid consumption versus bupivacaine HCl in herniorrhaphy: results from the phase 3 EPOCH 2 study. Hernia 2019; 23:1071-1080. [PMID: 31429023 PMCID: PMC6938470 DOI: 10.1007/s10029-019-02023-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/04/2019] [Indexed: 12/19/2022]
Abstract
Purpose Currently available local anesthetics have not demonstrated sufficient analgesia beyond 12–24 h postoperatively. The purpose of the study was to assess the safety and efficacy of HTX-011 (bupivacaine and meloxicam in Biochronomer® polymer technology), a long-acting investigational anesthetic, in reducing both postoperative pain over 72 h and postoperative opioid use compared to bupivacaine hydrochloride (HCl). Methods A phase 3, randomized, double-blind, active-controlled multi-center study (EPOCH 2; NCT03237481) in subjects undergoing unilateral open inguinal herniorrhaphy with mesh placement was performed. Subjects randomly received a single intraoperative dose of HTX-011, immediate-release bupivacaine HCl, or saline placebo prior to closure. Results The study evaluated 418 subjects, and the primary and all key secondary efficacy endpoints were in favor of HTX-011. HTX-011 reduced mean pain intensity by 23% versus placebo (primary endpoint; p < 0.001) and by 21% versus bupivacaine HCl (p < 0.001) with significant reductions in the number of patients experiencing severe pain. Opioid consumption over 72 h was reduced by 38% versus placebo (p < 0.001) and 25% versus bupivacaine HCl (p = 0.024). Overall, 51% of HTX-011 subjects were opioid-free through 72 h (versus 22% for placebo [p < 0.001] and 40% for bupivacaine HCl [p = 0.049]). HTX-011 was generally well-tolerated with fewer opioid-related adverse events reported compared to the bupivacaine HCl and placebo and no evidence of local anesthetic systemic toxicity. Conclusions HTX-011 demonstrated significant improvement in postoperative pain control and a clinically meaningful reduction in opioid consumption when compared to the most widely used local anesthetic, bupivacaine HCl.
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Affiliation(s)
- E Viscusi
- Sidney Kimmel Medical College of Thomas Jefferson University, 111 South 11th Street, Gibbon Building, Suite 8490, Philadelphia, PA, 19107, USA.
| | | | - P Winkle
- Anaheim Clinical Trials, Anaheim, CA, USA
| | - S Ramamoorthy
- University of California at San Diego Health System, San Diego, CA, USA
| | - J Hu
- Heron Therapeutics, Inc., San Diego, CA, USA
| | - N Singla
- Lotus Clinical Research, LLC, Pasadena, CA, USA
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Abstract
BACKGROUND Patients with lung cancer often undergo surgery shortly after diagnosis. Despite undergoing extensive operation, many patients are transferred to a local hospital a few days after surgery. Transitions between different levels of care are risky due to common medication and follow-up errors. OBJECTIVE The study purpose was to explore patients' experiences of transfer between hospitals after lung cancer surgery. The study aim was to improve the quality of transitional care. METHODS In-depth interviews with 14 patients with lung cancer (6 men, 8 women) were conducted in the patients' homes. Interviews were audiotaped, transcribed, and analyzed using the hermeneutic analysis method. RESULTS Patients' experience of transfer between hospitals after lung cancer surgery is one of being in a caregiver gap characterized by feeling unprepared and uncertain, feeling unprotected and not being cared for, and suffering because of inadequate organization. Patients are vulnerable and at risk of injury before and during transfer, as well as after arrival at local hospitals. CONCLUSIONS Study findings highlight a rarely considered risk of inadequate care before, during, and after hospital transfer of vulnerable patients. Transition between hospitals after lung cancer surgery is a part of patient care for which there are no policies or care plans and a time during which the borders of responsibility between caregivers are unclear. IMPLICATIONS FOR PRACTICE It is important to develop guidelines for clearly defined responsibilities during transfer between hospitals. Healthcare providers need to plan transfers with the same rigor as they do hospital care.
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25
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Ratajska M, Chochowska M, Kulik A, Bugajski P. Myofascial release in patients during the early postoperative period after revascularisation of coronary arteries. Disabil Rehabil 2019; 42:3327-3338. [PMID: 31050562 DOI: 10.1080/09638288.2019.1593518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The evaluation of the impact of soft tissue manual therapy with a myofascial release on pulmonary function, postoperative pain, fatigue, breathing difficulties and physical fitness, in patients during the early postoperative period after coronary artery bypass grafting and off-pump coronary artery bypass grafting surgery.Materials and methods: The study included 80 subjects (59 males) with an average age of 64.13 years old. They were randomised into two groups: group I (n = 40) received a conventional form of rehabilitation and group II (n = 40) additionally, from day 3 to day 6 post-surgery, was provided the Carol Manheim form of myofascial release. Subjects were evaluated three times: before the surgery, on day 4 and 6 post-surgery. Using the visual analogue scale, the following symptoms were measured: pain intensity, breathing difficulties and level of physical endurance. Fatigue after performing physical exercises was measured using the Borg scale. Spirometry was used to measure the one-second forced expiratory volume and forced vital capacity.Results: Positive changes were observed in both groups with regard to all analysed variables. However, group II compared to group I showed a significantly greater improvement (p < 0.05; the Mann-Whitney U test) in relation to: pain intensity on day 4 (mean 5.46 vs 6.58) and on day 6 (mean 3.05 vs 5.35) after the surgery; lower breathing difficulties on day 6 post-surgery (mean 4.08 vs 5.63); limiting physical fitness on day 6 post-surgery (mean 6.35 vs 5.13). Between the condition prior to the surgery and day 6 post-surgery in group II compared to group I, there was a significantly smaller (p < 0.05; Student's t-test) decrease in one-second forced expiratory volume (mean -0.65 vs -0.9 L/s) and the volume of forced vital capacity (mean -0.63 vs -1.33 L). Between day 4 and 6 post-surgery in group II compared to group I, there was a significantly higher (p < 0.05; Student's t-test) increase in the one-second forced expiratory volume (mean 0.21 vs 0.11 L/s) and forced vital capacity (mean 0.32 vs 0.12 L).Conclusions: Implementing myofascial release techniques in the conventional form of cardiosurgical rehabilitation might enhance the improvement in pulmonary function, lessen breathing difficulties, pain intensity and fatigue, it might augment the increase in physical endurance among patients during the early postoperative period after coronary artery bypass grafting and off-pump coronary artery bypass grafting surgery.Implications for rehabilitationThe implementation of myofascial release techniques in conventional cardiac rehabilitation may improve the pulmonary function in patients during the early postoperative period, after revascularisation of coronary arteries.The adoption of myofascial release techniques in conventional cardiac rehabilitation may decrease breathing difficulties, pain intensity, fatigue and increase the physical fitness in patients during the early postoperative period, after the revascularisation of the coronary arteries.The implementation of myofascial release techniques in conventional cardiac rehabilitation may enhance patients' improvement during the early postoperative period, after the revascularisation of the coronary arteries.
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Affiliation(s)
- Maria Ratajska
- Department of Cardiovascular Surgery, Strus Hospital Poznan, Poznan, Poland
| | - Małgorzata Chochowska
- Department of Rehabilitation, Poznan University School of Physical Education, Gorzow Wielkopolski, Poland
| | - Anita Kulik
- Department of Rehabilitation, Poznan University School of Physical Education, Gorzow Wielkopolski, Poland
| | - Paweł Bugajski
- Department of Cardiovascular Surgery, Strus Hospital Poznan, Poznan, Poland.,Poznan University of Medical Sciences, Poznan, Poland
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A Cost-Minimization Analysis Evaluating the Use of Liposomal Bupivacaine in Reconstructive Plastic Surgery Procedures. Plast Reconstr Surg 2019; 143:1269-1274. [PMID: 30730499 DOI: 10.1097/prs.0000000000005435] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postsurgical pain management is critical to patient satisfaction and value. Several studies have evaluated liposomal bupivacaine in postoperative pain management protocols; however, its economic feasibility remains undefined. This study analyzes the economic impact of liposomal bupivacaine using a national claims database to assess postoperative clinical and financial outcomes in plastic and reconstructive procedures. METHODS The Vizient Clinical Data Base/Resource Manager electronic database was reviewed for plastic surgery procedures (i.e., abdominoplasty, abdominal wall reconstruction, mastectomy with immediate tissue expander placement, mastectomy with direct-to-implant reconstruction, autologous breast reconstruction, and augmentation mammaplasty) at participating hospitals from July 1, 2016, to July 1, 2017. The main outcome measures were the length of stay; 7-, 14-, and 30-day readmission rates; and direct and total costs observed. RESULTS During the study period, 958 total cases met inclusion criteria. Liposomal bupivacaine was used in 239 cases (25 percent). Compared with cases that did not use liposomal bupivacaine, liposomal bupivacaine cases had a decreased length of stay (9.2 days versus 5.8 days), decreased cost (total cost, $39,531 versus $28,021; direct cost, $23,960 versus $17,561), and lower 30-day readmission rates (4 percent versus 0 percent). The 14- and 7-day readmission rates were similar between the two groups. CONCLUSIONS The use of liposomal bupivacaine may contribute to a reduction in length of stay, hospital costs, and 30-day readmission rates for abdominal and breast reconstructive procedures, which could contribute to a favorable economic profile from a system view. Focusing on the measurement and improvement of value in the context of whole, definable, patient processes will be important as we transition to value-based payments.
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Maver T, Mohan T, Gradišnik L, Finšgar M, Stana Kleinschek K, Maver U. Polysaccharide Thin Solid Films for Analgesic Drug Delivery and Growth of Human Skin Cells. Front Chem 2019; 7:217. [PMID: 31024901 PMCID: PMC6466929 DOI: 10.3389/fchem.2019.00217] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
Chronic wounds not only lower the quality of patient's life significantly, but also present a huge financial burden for the healthcare systems around the world. Treatment of larger wounds often requires the use of more complex materials, which can ensure a successful renewal or replacement of damaged or destroyed tissues. Despite a range of advanced wound dressings that can facilitate wound healing, there are still no clinically used dressings for effective local pain management. Herein, alginate (ALG) and carboxymethyl cellulose (CMC), two of the most commonly used materials in the field of chronic wound care, and combination of ALG-CMC were used to create a model wound dressing system in the form of multi-layered thin solid films using the spin-assisted layer-by-layer (LBL) coating technique. The latter multi-layer system was used to incorporate and study the release kinetics of analgesic drugs such as diclofenac and lidocaine at physiological conditions. The wettability, morphology, physicochemical and surface properties of the coated films were evaluated using different surface sensitive analytical tools. The influence of in situ incorporated drug molecules on the surface properties (e.g., roughness) and on the proliferation of human skin cells (keratinocytes and skin fibroblasts) was further evaluated. The results obtained from this preliminary study should be considered as the basis for the development "real" wound dressing materials and for 3D bio-printing applications.
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Affiliation(s)
- Tina Maver
- Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia.,Department of Pharmacology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Tamilselvan Mohan
- Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia
| | - Lidija Gradišnik
- Faculty of Medicine, Institute of Biomedical Sciences, University of Maribor, Maribor, Slovenia
| | - Matjaž Finšgar
- Faculty of Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia
| | - Karin Stana Kleinschek
- Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia.,Institute for Chemistry and Technology of Materials, Graz University of Technology, Graz, Austria
| | - Uroš Maver
- Department of Pharmacology, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Faculty of Medicine, Institute of Biomedical Sciences, University of Maribor, Maribor, Slovenia
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Robinson-Junker A, O’Hara B, Durkes A, Gaskill B. Sleeping through anything: The effects of unpredictable disruptions on mouse sleep, healing, and affect. PLoS One 2019; 14:e0210620. [PMID: 30703113 PMCID: PMC6354982 DOI: 10.1371/journal.pone.0210620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/29/2018] [Indexed: 01/27/2023] Open
Abstract
Many aspects of the laboratory environment are not tailored to the needs of rodents, which may cause stress. Unpredictable stressors can cause ulcers, prolonged pituitary-adrenal activation, and anhedonia. Similarly, pain has been demonstrated to slow wound healing, and mice experiencing pain exhibit altered behavior. However it is unknown how husbandry, which occurs when the mice are inactive, and lack of analgesia, specifically in a punch biopsy procedure, effects animal physiology, behavior, and welfare, particularly as it relates to sleep fragmentation. We hypothesized that sleep fragmentation, induced by unpredictable husbandry and lack of pain management will slow wound healing. Two main treatments were tested in a factorial design in C57BL/6 mice of both sexes (64 mice total); 1) analgesia (carprofen and saline) and 2) sleep disruptions (random and predictable). Mice were singly housed in a non-invasive sleep monitoring apparatus on arrival (Day -4). Disruption treatments were applied from Day -3 to 2. All mice received a punch biopsy surgery (Day 0) with topical lidocaine gel and their analgesic treatment prior to recovery, and on Days 1 and 2. Nesting behavior was assessed daily and a sugar cereal consumption test, as a measure of anhedonia, was conducted on Days -1 to 2. On Day 3, mice were euthanized and wound tissue and adrenal glands were collected. We found that the disruption predictability had no effect on mouse sleep, wound healing, or adrenal cortex:medulla ratio. It's possible that the disruption period was not long enough to induce chronic stress. However, male mice who received analgesia slept more than their female counterparts; this may be related to sex differences in pain perception. Overall, it does not appear that the predictability of disturbance effects sleep fragmentation or stress responses, indicating that husbandry activities do not need to occur at set predictable times to improve welfare.
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Affiliation(s)
- Amy Robinson-Junker
- Department of Comparative Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States of America
| | - Bruce O’Hara
- Department of Biology, University of Kentucky, Lexington, Kentucky, United States of America
| | - Abigail Durkes
- Department of Comparative Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States of America
| | - Brianna Gaskill
- Department of Animal Sciences, Purdue University, West Lafayette, Indiana, United States of America
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High fish density delays wound healing in Atlantic salmon (Salmo salar). Sci Rep 2018; 8:16907. [PMID: 30443022 PMCID: PMC6237775 DOI: 10.1038/s41598-018-35002-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
In this study, we look closer at how high fish densities influence wound repair mechanisms in post-smolt Atlantic salmon. The fish were wounded with a 5 mm skin punch biopsy needle and stocked at two different densities, a high fish density (100 kg/m3) treatment and a low fish density treatment (20 kg/m3) serving as the control. The healing wounds were followed for 57 days with samples taken 1, 3, 7, 14, 36, 43 and 57 days post wounding. The transcriptomic analysis suggests that high fish density enhance inflammation and represses cell proliferation, tissue secretion and collagen synthesis in the healing wounds. The histological analysis further showed delayed epidermal and dermal repair in the high fish density treatment compared to control. The overall wound contraction was also altered by the treatment. In conclusion, high fish density enhances immune responses and delay tissue repair, which ultimately results in delayed wound healing.
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Kim MS, Koh IJ, Lee SY, In Y. Central sensitization is a risk factor for wound complications after primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:3419-3428. [PMID: 29574545 DOI: 10.1007/s00167-018-4914-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/20/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Postoperative wound complication is a significant risk factor for subsequent deep periprosthetic joint infection after total knee arthroplasty (TKA). Central sensitization is an abnormal enhancement of pain mechanism involving the central nervous system. Although psychological disorder is widely considered as a risk factor, the relationship between central sensitization and wound complication is currently unclear. Therefore, the purpose of this study was to investigate whether central sensitization was associated with high wound complication rate after primary TKA. MATERIALS AND METHODS Between January and June 2016, 161 patients undergoing unilateral TKA were prospectively divided into two groups based on central sensitization inventory score of 40 points after excluding cases with known risk factors such as physical comorbidities, health-related behaviors, and psychological disorders. Group 1 consisted of 112 patients (112 knees) whose central sensitization inventory score was < 40 points and group 2 consisted of 49 patients (49 knees) whose central sensitization inventory score was ≥ 40 points. Wound complications were defined as wound dehiscence, suture granuloma, prolonged wound oozing after postoperative day 5, significant hematoma formation, or surgical site infection recorded during the initial 90-day postoperative period. Demographic data, visual analog scale (VAS), central sensitization inventory score, and wound complications were compared between the two groups. RESULTS Wound complications developed in 3 (2.7%) knees in group 1 and 14 (28.6%) knees in group 2 (p < 0.001). Multivariate logistic regression analysis showed that the odds of postoperative wound complications were increased 15.7 times in patients with central sensitization inventory score ≥ 40 (95% CI 4.1-60.0, p < 0.001). CONCLUSION Central sensitization is a risk factor for the development of postoperative wound complication after primary TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung Yeol Lee
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, South Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, South Korea.
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Yeap YL, Wolfe J, Fridell JA, Ezell J, Powelson JA. Pain interventions for organ transplant patients undergoing incisional hernia repair: Is epidural or transversus abdominus plane block a better option? Clin Transplant 2018; 32:e13384. [PMID: 30129984 DOI: 10.1111/ctr.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative pain management in transplant recipients undergoing incisional herniorraphy is challenging. Historically limited to intravenous or oral opioids, alternatives including transversus abdominus plane (TAP) block catheters and thoracic epidural catheters have been introduced. The aim of this study was to determine whether TAP catheters and thoracic epidural analgesia significantly impacted on postoperative pain and opioid usage in transplant recipients undergoing incisional hernia repair. METHODS This single-center retrospective study included 154 patients undergoing incisional hernia repair from January 2011 to June 2015. Of these, 56 received epidurals, 51 received TAP catheters, and 47 received no intervention. RESULTS Demographic profiles were comparable among the three groups including type of previous transplant and type of hernia surgery. Thoracic epidural analgesia was associated with lower median, mean, and maximum pain scores (P < 0.001) and less opioid requirement (P < 0.001). There was no difference in pain scores and opioid usage among the TAP catheter and no intervention groups. There was no difference in time to first flatus or first bowel movement, length of hospital stay, individual opioid-related side effects, and adverse reactions among the three groups. CONCLUSION This study supports the use of thoracic epidural analgesia in patients undergoing hernia repair after transplant surgery.
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Affiliation(s)
- Yar Luan Yeap
- Anesthesiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - John Wolfe
- Anesthesiology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Jake Ezell
- Anesthesiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - John A Powelson
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Abass M, Picek S, Garzón JFG, Kühnle C, Zaghlou A, Bettschart-Wolfensberger R. Local mepivacaine before castration of horses under medetomidine isoflurane balanced anaesthesia is effective to reduce perioperative nociception and cytokine release. Equine Vet J 2018; 50:733-738. [PMID: 29660154 PMCID: PMC6175468 DOI: 10.1111/evj.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 03/30/2018] [Indexed: 02/07/2023]
Abstract
Background In horses castration with primary intention healing is usually performed under balanced inhalation anaesthesia. To optimise analgesia, the use of local anaesthesia was tested. Objectives To investigate the effect of local mepivacaine before castration with first intention healing under balanced medetomidine‐isoflurane anaesthesia and flunixin meglumine, morphine analgesia on perioperative cytokine levels and pain in horses. Study design Prospective blinded clinical study. Methods Twenty stallions were randomly assigned to control or mepivacaine groups. Flunixin meglumine was administered before sedation with medetomidine and followed by ketamine/diazepam intravenously (i.v.). Anaesthesia was maintained with isoflurane and 3.5 μg/kg per hour medetomidine. Mepivacaine horses were given mepivacaine 2% (3.5 mL SC, 1 mL/100 kg intrafunicularly, 2 mL/100 kg intratesticularly) on each side. For recovery, horses were given 2 μg/kg medetomidine i.v. and 0.1 mg/kg morphine i.m. and oral phenylbutazone (0.02 mg/kg q12h) for post‐operative analgesia. One hour before premedication and 4, 8 and 24 h post‐incision, pain was scored with three different pain scales (Equine Utrecht University Scale for Facial Assessment of Pain, Horse Grimace Scale, Equine Utrecht University Scale for Composite Pain Assessment) and plasma cytokines (interleukin‐6 and tumour necrosis factor alpha) were measured. Data were analysed using repeated measures ANOVA, linear regression and unpaired t‐test, significance level P≤0.05. Results Horses in both groups showed a significant increase in pain scores and cytokines compared to baseline. Post‐operatively the mepivacaine group exhibited significantly lower pain scores and cytokine levels. Mean heart rate during anaesthesia was significantly lower in the mepivacaine group compared to control group (28.8 ± 1 and 33.2 ± 1.7 respectively). Otherwise there were no differences between the groups. Main limitations The decision to provide additional analgesia was based on the attending surgeon's assessment rather than a standardised rescue analgesia plan based on pain scores. The study was only conducted for 24 h post‐castration and complications were not recorded. Conclusion Local mepivacaine before castration with primary wound closure improved anaesthesia quality, attenuated post‐operative increases in cytokines and reduced post‐operative pain despite balanced anaesthesia with multimodal analgesia in control horses.
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Affiliation(s)
- M Abass
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.,Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - S Picek
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - J F G Garzón
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - C Kühnle
- Equine Department, Division of Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - A Zaghlou
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - R Bettschart-Wolfensberger
- Equine Department, Division of Anaesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
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Impact of stress on aged immune system compartments: Overview from fundamental to clinical data. Exp Gerontol 2018; 105:19-26. [DOI: 10.1016/j.exger.2018.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
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Airikkala-Otter I, Gamble L, Mazeri S, Handel IG, Bronsvoort BMDC, Mellanby RJ, Meunier NV. Investigation of short-term surgical complications in a low-resource, high-volume dog sterilisation clinic in India. BMC Vet Res 2018; 14:56. [PMID: 29482640 PMCID: PMC5828070 DOI: 10.1186/s12917-018-1378-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Surgical sterilisation is currently the method of choice for controlling free-roaming dog populations. However, there are significant logistical challenges to neutering large numbers of dogs in low-resource clinics. The aim of this study was to investigate the incidence of short-term surgical complications in a low-resource sterilisation clinic which did not routinely administer post-operative antibiotics. The medical records of all sterilisation surgeries performed in 2015 at the Worldwide Veterinary Service International Training Centre in Tamil Nadu, India were reviewed (group A) to assess immediate surgical complications. All animals in this group were monitored for at least 24 h post-surgery but were not released until assessed by a veterinarian as having uncomplicated wound healing. In the second part of this study from August to December 2015, 200 free-roaming dogs undergoing sterilisation surgery, were monitored for a minimum of 4-days post-surgery to further assess postoperative complications (group B). Results Surgery related complications were seen in 5.4% (95%CI, 4.5–6.5%) of the 1998 group A dogs monitored for at least 24 h, and in 7.0% (3.9–11.5%) of the 200 group B dogs monitored for 4 days. Major complications were classed as those requiring an intervention and resulted in increased morbidity or mortality. Major complications were seen in 2.8% (2.1–3.6%) and 1.5% (3.1–4.3%) of group A and B, respectively. Minor complications requiring little or no intervention were recorded for 2.6% (1.9–3.4%) for group A and 5.5% (2.8–9.6%) for group B. There was no evidence for a difference in complication rates between the two groups in a multivariate regression model. Conclusion This study demonstrated that high volume, low-resource sterilisation of dogs can be performed with a low incidence of surgical complications and low mortality.
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Affiliation(s)
- I Airikkala-Otter
- Worldwide Veterinary Service, 4 Castle Street, Cranborne, Dorset, BH21 5PZ, UK
| | - L Gamble
- Worldwide Veterinary Service, 4 Castle Street, Cranborne, Dorset, BH21 5PZ, UK
| | - S Mazeri
- The Epidemiology, Economics and Risk Assessment (EERA) Group, The Roslin Institute and the Royal (Dick) School of Veterinary Studies (R(D)SVS), Easter Bush, Midlothian, EH25 9RG, UK
| | - I G Handel
- The Epidemiology, Economics and Risk Assessment (EERA) Group, The Roslin Institute and the Royal (Dick) School of Veterinary Studies (R(D)SVS), Easter Bush, Midlothian, EH25 9RG, UK
| | - B M de C Bronsvoort
- The Epidemiology, Economics and Risk Assessment (EERA) Group, The Roslin Institute and the Royal (Dick) School of Veterinary Studies (R(D)SVS), Easter Bush, Midlothian, EH25 9RG, UK
| | - R J Mellanby
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and the Roslin Institute, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, EH25 9RG, UK
| | - N V Meunier
- The Epidemiology, Economics and Risk Assessment (EERA) Group, The Roslin Institute and the Royal (Dick) School of Veterinary Studies (R(D)SVS), Easter Bush, Midlothian, EH25 9RG, UK.
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Morley N. Operating department practitioners care of the patient with diabetes in the perioperative period. J Perioper Pract 2018; 27:71-76. [PMID: 29328746 DOI: 10.1177/175045891702700402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 07/29/2016] [Indexed: 11/16/2022]
Abstract
Diabetes mellitus (DM) is a of group metabolic diseases which are defined by hyperglycaemia affecting multiple organs. The condition is found in people of all ages and ethnicities. Diabetes mellitus affects 180 million people worldwide and increasing numbers of patients are presenting with diabetic complications and the need for surgical intervention. This article describes the pathophysiology of DM and the management of the condition, particularly type I and type 2, in the perioperative phase of the surgical patient journey.
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Yang D, Davies A, Burge B, Watkins P, Dissanaike S. Open-to-Air Is a Viable Option for Initial Wound Care in Necrotizing Soft Tissue Infection that Allows Early Detection of Recurrence without Need for Painful Dressing Changes or Return to Operating Room. Surg Infect (Larchmt) 2017; 19:65-70. [PMID: 29211657 DOI: 10.1089/sur.2017.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The standard treatment of necrotizing soft tissue infection (NSTI) includes extensive surgical debridement. Care of these debridements is challenging because of the size of the wound and associated pain. A potential solution is to leave the wounds open-to-air in the period after the initial debridement, allowing for regular inspection at bedside while reducing pain associated with frequent dressing changes. We evaluated the feasibility of this approach from a pain control standpoint. PATIENTS AND METHODS An audit of wound care modalities used on adult patients with NSTI admitted to a regional burn center between January 2009 and May 2014 was performed. Patients with at least one operation were included. Those opting for palliative care were excluded. Wound care was divided into four categories: open-to-air (OTA), negative-pressure wound therapy (NPWT), packing, and ointment. Wound care, pain score, pain medication use, and number of operations were collected for the first seven days after initial debridement. Pain management was assessed by pain scores. Analgesic use was measured and compared using conversion to morphine milligram equivalents (MME). RESULTS Ninety-six patients were included; 67% were men with average age of 50 years, resulting in a total of 672 days of wound care evaluated: 69 days of OTA, 127 days of NPWT, 200 days of packing, and 126 days of ointment (150 days were undocumented). Average daily pain score from all wound care modalities was 2.00. Negative pressure wound therapy had the highest reported daily pain score (2.18, p = 0.034), whereas OTA had the lowest pain score (1.63, p < 0.05). Mortality was lower in the OTA cohort but was not statistically significant; there were no other differences in long-term outcome. CONCLUSION Leaving wounds OTA is a safe and viable option in the immediate post-debridement period of NSTI to reduce pain, while permitting frequent re-evaluation for quick recognition of disease progression and repeat operative debridement if necessary.
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Affiliation(s)
- Derek Yang
- 1 Department of Surgery, Texas Tech University Health Sciences Center , School of Medicine, Lubbock, Texas
| | | | | | - Phillip Watkins
- 3 The Clinical Research Institute, Texas Tech University Health Sciences Center , Lubbock, Texas
| | - Sharmila Dissanaike
- 1 Department of Surgery, Texas Tech University Health Sciences Center , School of Medicine, Lubbock, Texas
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Korat PS, Kapupara PP. Local infiltration of the surgical wound with levobupivacaine, ibuprofen, and epinephrine in postoperative pain: An experimental study. Biomed Pharmacother 2017; 96:104-111. [DOI: 10.1016/j.biopha.2017.09.131] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022] Open
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Gao Z, Cui F, Cao X, Wang D, Li X, Li T. Local infiltration of the surgical wounds with levobupivacaine, dexibuprofen, and norepinephrine to reduce postoperative pain: A randomized, vehicle–controlled, and preclinical study. Biomed Pharmacother 2017; 92:459-467. [DOI: 10.1016/j.biopha.2017.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/06/2017] [Accepted: 05/08/2017] [Indexed: 12/24/2022] Open
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Ziehm S, Rosendahl J, Barth J, Strauss BM, Mehnert A, Koranyi S. Psychological interventions for acute pain after open heart surgery. Cochrane Database Syst Rev 2017; 7:CD009984. [PMID: 28701028 PMCID: PMC6432747 DOI: 10.1002/14651858.cd009984.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND This is an update of a Cochrane review previously published in 2014. Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. OBJECTIVES To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention control in adults undergoing open heart surgery for pain, pain medication, psychological distress, mobility, and time to extubation. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PsycINFO for eligible studies up to February 2017. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We checked lists of references of relevant articles and previous reviews. We searched the ProQuest Dissertations and Theses Full Text Database, ClinicalTrials and the WHO International Clinical Trials Registry Platform to identify any unpublished material or ongoing trials. We also contacted the authors of primary studies to identify any unpublished material. In addition, we wrote to all leading heart centres in Germany, Switzerland, and Austria to check whether they were aware of any ongoing trials. SELECTION CRITERIA Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. DATA COLLECTION AND ANALYSIS Two review authors (SZ and SK) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. We assessed the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS We added six studies to this update. Overall, we included 23 studies (2669 participants).For the majority of outcomes (two-thirds), we could not perform a meta-analysis since outcomes were not measured, or data were provided by one trial only.No study reported data on the number of participants with pain intensity reduction of at least 50% from baseline. Only one study reported data on the number of participants below 30/100 mm on the Visual Analogue Scale (VAS) in pain intensity (very low-quality evidence). Psychological interventions did not reduce pain intensity in the short-term interval (g 0.39, 95% CI -0.18 to 0.96, 2 studies, 104 participants, low-quality evidence), medium-term interval (g -0.02, 95% CI -0.24 to 0.20, 4 studies, 413 participants, moderate-quality evidence) or in the long-term interval (g 0.05, 95% CI -0.20 to 0.30, 2 studies, 200 participants, moderate-quality evidence).No study reported data on median time to re-medication or on number of participants re-medicated. Only two studies provided data on postoperative analgesic use in the short-term interval, showing that psychological interventions did not reduce the use of analgesic medication (g 1.18, 95% CI -2.03 to 4.39, 2 studies, 104 participants, low-quality evidence). Studies revealed that psychological interventions reduced mental distress in the medium-term (g 0.37, 95% CI 0.13 to 0.60, 13 studies, 1388 participants, moderate-quality evidence) and likewise in the long-term interval (g 0.32, 95% CI 0.10 to 0.53, 14 studies, 1586 participants, moderate-quality evidence). Psychological interventions did not improve mobility in the medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444 participants, low-quality evidence), nor in the long-term interval (g 0.09, 95% CI -0.10 to 0.28, 4 studies, 458 participants, moderate-quality evidence). Only two studies reported data on time to extubation, indicating that psychological interventions reduced the time to extubation (g 0.56, 95% CI 0.08 to 1.03, 2 studies, 154 participants, low-quality evidence).Overall, the very low to moderate quality of the body of evidence on the efficacy of psychological interventions for acute pain after open heart surgery cannot be regarded as sufficient to draw robust conclusions.Most 'Risk of bias' assessments were low or unclear. We judged selection bias (random sequence generation) and attrition bias to be mostly low risk for included studies. However, we judged the risk of selection bias (allocation concealment), performance bias, detection bias and reporting bias to be mostly unclear. AUTHORS' CONCLUSIONS In line with the conclusions of our previous review, there is a lack of evidence to support or refute psychological interventions in order to reduce postoperative pain in participants undergoing open heart surgery. We found moderate-quality evidence that psychological interventions reduced mental distress in participants undergoing open heart surgery. Given the small numbers of studies, it is not possible to draw robust conclusions on the efficacy of psychological interventions on outcomes such as analgesic use, mobility, and time to extubation respectively on adverse events or harms of psychological interventions.
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Affiliation(s)
- Susanne Ziehm
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
| | - Jenny Rosendahl
- University Hospital of JenaInstitute of Psychosocial Medicine and PsychotherapyStoystrasse 3JenaThuringiaGermany07743
| | - Jürgen Barth
- UniversityHospital and University of ZurichInstitute for Complementary and Integrative MedicineSonneggstrasse 6ZurichSwitzerlandCH‐8091
| | - Bernhard M Strauss
- University Hospital of JenaInstitute of Psychosocial Medicine and PsychotherapyStoystrasse 3JenaThuringiaGermany07743
| | - Anja Mehnert
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
| | - Susan Koranyi
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
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Tan P, Martin M, Shank N, Myers L, Wolfe E, Lindsey J, Metzinger S. A Comparison of 4 Analgesic Regimens for Acute Postoperative Pain Control in Breast Augmentation Patients. Ann Plast Surg 2017; 78:S299-S304. [PMID: 28459704 PMCID: PMC6686898 DOI: 10.1097/sap.0000000000001132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients undergoing breast augmentation are treated with multiple combinations of medications for pain control including ketorolac, liposomal bupivacaine, bupivacaine, and intravenous and oral narcotics. There is no current consensus on the optimal combination; therefore, all are used at the discretion of the surgeon. METHODS This was a single-center, retrospective study. The total number of patients included was 132. Comparisons were made between 4 groups: bupivacaine only (B); bupivacaine and liposomal bupivacaine (BL); bupivacaine and liposomal bupivacaine plus intraoperative ketorolac (BLKi); and bupivacaine and liposomal bupivacaine plus postoperative ketorolac (BLKp). Average pain scores immediately postoperative and before discharge were recorded and correlated to percentage of patients who received narcotic in the post-anesthesia care unit (PACU). Additional end points noted were side effects including nausea and time spent in PACU postoperatively. RESULTS Those receiving intraoperative ketorolac had the lowest pain on discharge (P < 0.0001) and the lowest percentage of patients receiving narcotics (P = 0.009) out of all 4 groups. There was no significant difference between the 4 groups in terms of time spent in PACU, pain immediately after the procedure, or amount of antiemetic given. No bleeding complications were noted for those who did or did not receive ketorolac. CONCLUSIONS When given options for pain control in breast augmentation, intraoperative ketorolac should be considered, because its inclusion was significant in decreasing use of narcotics and pain upon discharge. Addition of other costly drugs such as liposomal bupivacaine may not provide additional benefit in the immediate postoperative setting for procedures with a short recovery period such as breast augmentation.
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Affiliation(s)
- Pamela Tan
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Morgan Martin
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Nina Shank
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Leann Myers
- Tulane University Department of Biostatistics and Bioinformatics, New Orleans, LA
| | - Emily Wolfe
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - John Lindsey
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Stephen Metzinger
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
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Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery. Plast Reconstr Surg 2017; 138:51S-60S. [PMID: 27556775 DOI: 10.1097/prs.0000000000002774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reconstructive plastic surgery is vital in assisting patients with reintegration into society after events such as tumor extirpation, trauma, or infection have left them with a deficit of normal tissue. Apart from performing a technically sound operation, the plastic surgeon must stack the odds in the favor of the patient by optimizing them before and after surgery. The surgeon must look beyond the wound, at the entire patient, and apply fundamental principles of patient optimization. This article reviews the evidence behind the principles of patient optimization that are commonly used in reconstructive surgery patients.
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Finlayson K, Miaskowski C, Alexander K, Liu WH, Aouizerat B, Parker C, Maresco-Pennisi D, Edwards H. Distinct Wound Healing and Quality-of-Life Outcomes in Subgroups of Patients With Venous Leg Ulcers With Different Symptom Cluster Experiences. J Pain Symptom Manage 2017; 53:871-879. [PMID: 28063868 DOI: 10.1016/j.jpainsymman.2016.12.336] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/04/2016] [Accepted: 12/07/2016] [Indexed: 11/23/2022]
Abstract
CONTEXT Adults with venous leg ulcers frequently experience multiple symptoms that may influence quality of life (QOL). OBJECTIVES The objective of this study was to identify patient subgroups based on their experience with a pain-depression-fatigue-sleep disturbance symptom cluster and to identify differences in patient characteristics and wound-healing and QOL outcomes between the subgroups. METHODS Secondary data analysis from previous longitudinal studies of 247 patients with venous leg ulcers. Latent class analysis identified subgroups of patients with distinct experiences with the symptom cluster of pain, depression, fatigue, and sleep disturbance. Hierarchical regression analysis identified relationships between the subgroups and QOL outcomes. Survival analysis identified differences between the subgroups and ulcer healing. RESULTS Latent class analysis found 67% of patients were in a mild symptom subgroup (i.e., experiencing no or mild pain, depressive symptoms, fatigue, or sleep disturbance). One-third of the samples were in a severe symptom subgroup, who reported moderate-to-severe levels of these symptoms. Compared with the mild subgroup, patients in the severe subgroup had poorer QOL scores (t = 8.06, P < 0.001). Symptom subgroup membership accounted for 19% of the variance (P < 0.001) within a hierarchical regression model that explained 42% of the variance in QOL (F(7,170) = 16.89, P < 0.001, R2 = 0.42). Cox proportional hazards regression found that at enrollment into the study, patients in the severe symptom subgroup were 1.5 times (95% confidence interval 1.02-2.08) less likely to heal in the following 24 weeks (P = 0.037). CONCLUSION Significant relationships were found between delayed ulcer healing, decreased QOL, and membership in the severe symptom subgroup. These findings suggest that comprehensive symptom assessment is needed to identify patients at higher risk for poor outcomes and enable early intervention.
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Affiliation(s)
- Kathleen Finlayson
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia.
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California, USA
| | - Kimberly Alexander
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Wei-Hong Liu
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Bradley Aouizerat
- Bluestone Center for Clinical Research, New York University, New York, New York, USA; Department of Oral and Maxillofacial Surgery, New York University, New York, New York, USA
| | - Christina Parker
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Diane Maresco-Pennisi
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
| | - Helen Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia
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Nagasaki K, Obara H, Tanaka K, Koyano K, Asamia A, Kitagawa Y. Peripheral nerve crushing to relieve chronic pain in diabetic and ischaemic foot ulcers. J Wound Care 2017; 25:470-4. [PMID: 27523659 DOI: 10.12968/jowc.2016.25.8.470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We retrospectively assessed the effectiveness of peripheral nerve crushing (Smithwick operation) in relieving intractable chronic pain associated with foot ulcers caused by diabetes mellitus (DM) or atherosclerosis. METHOD From April 2009 to April 2012, patients underwent peripheral nerve crushing in the leg affected by foot ulceration. The cause of ulceration was either DM alone, atherosclerosis alone, or both DM and atherosclerosis. Because sensation in the foot is associated with five nerves: the tibial, deep peroneal, superficial peroneal, sural, and saphenous, one or more of these nerves were crushed over a length of 1.5cm by using a 'pean' in the distal third of leg the where there are no major motor nerves. RESULTS There were 36 patients recruited with ulcers grade 3-5 according to the Wagner ulcer classification system that affected the toes, dorsum pedis, or any part of the plantar surface or the heel. The mean duration of foot ulcerations before the nerve crushing was 22.3±9.7 weeks. In all 36 patients, the nerve crushing was performed successfully without any perioperative surgical complication. Of the 36 patients, 34 (94.4%) had substantial pain relief immediately after nerve crushing. While the mean pain level before the procedure was 86.6±0.51mm on visual analogue scale (VAS), pain level dropped significantly after the operation to 18.6 ± 5.4mm at one week, 14.8±4.8mm at one month, 13.7±4.1mm at two months, 9.8±4.1mm at three months, 11.8±5.7mm at four months, 10.1±4.7mm at five months and 8.8±3.3mm at six months. The time to regeneration of the sensory nerves was 121±6.5 days (range: 80-181 days). The surgical complications were wound infection (6 patients) and temporary toe paralysis (three patients). The foot ulcers in 20 of the 36 patients (55.6%) were resolved by debridement or minor amputation. In seven patients (19.4%), a major amputation (five below and two above the knee) was required because of ischemia or infection. No patient died within 30 days of the operation, while nine patients died during the observation period because of comorbid conditions. CONCLUSION Peripheral nerve crushing could be the alternative procedure for achieving analgesia in patients with intractable chronic pain from foot ulcers caused by DM or atherosclerosis.
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Affiliation(s)
- K Nagasaki
- Department of Surgery, Saitama Municipal Hospital, Saitama, Japan
| | - H Obara
- Department of Surgery, Keio University School of Medicine
| | - K Tanaka
- Department of Surgery, Keio University School of Medicine
| | - K Koyano
- Department of Surgery, Japanese Red Cross Hamamatsu Hospital
| | - A Asamia
- Department of Surgery, Saitama Municipal Hospital, Saitama, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine
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Ambrozova N, Ulrichova J, Galandakova A. Models for the study of skin wound healing. The role of Nrf2 and NF-κB. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:1-13. [PMID: 28115750 DOI: 10.5507/bp.2016.063] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/13/2016] [Indexed: 02/03/2023] Open
Abstract
Nrf2 and NF-κB transcription factors act in wound healing via their anti-inflammatory and anti-oxidant effects or through the immune response. Studying this process is a matter of some importance given the high cost of wound treatment. A major contribution in this regard is being made by models that enable investigation of the involvement of multiple factors in wound healing and testing new curative substances. This literature review was carried out via searches in the PubMed and Web of Science databases up to 2016. It covers skin wound healing, available models for its study (part I), the role of Nrf2 and NF-κB, substances that influence them and whether they can be used as markers (part II). Was found that in vitro assays are used for their availability but a holistic view must be established in vivo. In silico approaches are facilitating assessment of a vast amount of research data. Nfr2 and NF-κB play a crucial and reciprocal role in wound healing. Nrf2 controls repair-associated inflammation and protects against excessive accumulation of ROS while Nf-κB activates the innate immune reaction, proliferation and migration of cells, modulates expression of matrix metalloproteinases, secretion and stability of cytokines and growth factors for wound healing.
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Affiliation(s)
- Nikola Ambrozova
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jitka Ulrichova
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Adela Galandakova
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Goto T, Tamai N, Nakagami G, Kitamura A, Naito A, Hirokawa M, Shimokawa C, Takahashi K, Umemoto J, Sanada H. Can Wound Exudate from Venous Leg Ulcers Measure Wound Pain Status?: A Pilot Study. PLoS One 2016; 11:e0167478. [PMID: 27936243 PMCID: PMC5147907 DOI: 10.1371/journal.pone.0167478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/15/2016] [Indexed: 11/25/2022] Open
Abstract
We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity) and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score). Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman’s correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01), intermittent pain (ρ = -0.48, P = 0.01), neuropathic pain (ρ = -0.51, P = 0.01), and total score (ρ = -0.46, P = 0.01). The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03) and continuous pain (ρ = 0.48, P = 0.03). Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients.
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Affiliation(s)
- Taichi Goto
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Leadership Initiative for an Age-Friendly Society, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
- * E-mail: (HS); (TG)
| | - Nao Tamai
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Ayumi Naito
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Fujisawa City Hospital, Fujisawa-city, Kanagawa, Japan
| | | | | | | | | | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- * E-mail: (HS); (TG)
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Abstract
Within the literature there is an accumulating body of evidence to suggest that psychological stress may have a negative impact on wound healing. This article examines the psychoneuroimmulogy theory associated with stress and acute wound healing with reference to caring for patients with surgical wounds. The evidence reviewed in this article highlights the value of understanding individual patient need for reducing stress pre and post operatively to benefit the healing process.
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Affiliation(s)
- Julie Brown
- Tissue Viability Nurse, Oxford University Hospitals NHS Foundation Trust
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McCloskey AP, Gilmore S, Zhou J, Draper ER, Porter S, Gilmore BF, Xu B, Laverty G. Self-assembling ultrashort NSAID-peptide nanosponges: multifunctional antimicrobial and anti-inflammatory materials. RSC Adv 2016. [DOI: 10.1039/c6ra20282a] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This paper outlines the design, synthesis and characterisation of innovative NSAID-peptide gelators which demonstrate antimicrobial and anti-inflammatory properties and have potential use as multifunctional materials for biomedical applications.
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Affiliation(s)
| | | | - J. Zhou
- Department of Chemistry
- Brandeis University
- Waltham
- USA
| | - E. R. Draper
- Department of Chemistry
- University of Liverpool
- Liverpool
- UK
| | - S. Porter
- School of Pharmacy
- Queen's University
- Belfast
- UK
| | | | - Bing Xu
- Department of Chemistry
- Brandeis University
- Waltham
- USA
| | - G. Laverty
- School of Pharmacy
- Queen's University
- Belfast
- UK
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Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery. Plast Reconstr Surg 2016; 137:351-360. [DOI: 10.1097/prs.0000000000001882] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tyburski MD. Pain Management and the Physiatrist. PM R 2015; 7:S223-S224. [PMID: 26568501 DOI: 10.1016/j.pmrj.2015.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mark D Tyburski
- Department of Physical Medicine and Rehabilitation, The Permanente Medical Group, 2120 Professional Drive, Suite 225, Roseville, CA 95661
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Hudson BF, Ogden J. Exploring the Impact of Intraoperative Interventions for Pain and Anxiety Management During Local Anesthetic Surgery-A Systematic Review and Meta-Analysis. J Perianesth Nurs 2015; 31:118-33. [PMID: 27037166 DOI: 10.1016/j.jopan.2014.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/19/2014] [Accepted: 11/10/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the effectiveness of audiovisual and relaxation-based intraoperative interventions for their impact on intraoperative pain and anxiety. DESIGN Systematic review and meta-analysis. METHODS The following databases were searched for articles published between 1990 and January 2014: MEDLINE, PsychINFO, CINAHL, and Web of Science. Twenty randomized trials meeting the following inclusion criteria were included; adult participants undergoing elective outpatient surgery under local anesthetic using a form of distraction-based intraoperative intervention for the management of anxiety and pain. FINDING Thirty percent of studies reviewed found that intraoperative interventions improved patient experience in comparison to treatment as usual, 20% of studies were inconclusive, and 50% of studies found that interventions during surgery provided no benefit. CONCLUSIONS Both relaxation-based and audiovisual interventions were found to be efficacious for pain and anxiety management during surgery under local anesthetic. This review indicates that relaxation-based interventions could be more effective than audiovisual interventions for managing intraoperative anxiety.
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