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Hajilo P, Imani B, Zandi S, Mehrafshan A. Comparing the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery. Front Surg 2023; 10:1264519. [PMID: 37841816 PMCID: PMC10568066 DOI: 10.3389/fsurg.2023.1264519] [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: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
Background Due to the sensitivity of the surgical site and a higher probability of injury, the use of a scalpel and electrocautery to create an incision in the spine is discussed. In this study, we will compare the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery. Materials and methods This study was conducted in Iran as a randomized controlled trial with double-blinding (1,401). Sixty candidates for spine surgery were randomly divided into two groups of 30 using electrocautery (A) and a scalpel (B) based on available sampling. The VAS scale was used to assess postoperative pain. The duration of the incision and intraoperative blood loss were recorded. The infection and fluid secretions were determined using the Southampton scoring scale. Utilizing the Manchester scar scale, the wound healing status was evaluated. The SPSS version 16 software was used for data analysis (t-test, Mann-Whitney U, ANOVA). Results The electrocautery group had substantially lower bleeding, pain, and wound healing rates than the scalpel group (P > 0.05). However, the electrocautery group had significantly longer surgical times, more secretions, and a higher infection rate than the scalpel group (P > 0.05). In terms of demographic and clinical characteristics, there was no significant difference between the two groups (P < 0.05). Conclusion Electrocautery reduces postoperative hemorrhage and, potentially, postoperative pain in patients. However, as the duration of surgery increases, so does the duration of anesthesia, and patient safety decreases. Additionally, the risk of infection increases in the electrocautery group compared to the scalpel group, and the rate of wound healing decreases. Clinical Trial Registration https://www.irct.ir/, identifier (IRCT20230222057496N1).
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Affiliation(s)
- Parisa Hajilo
- Student Operating Room, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behzad Imani
- Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shirdel Zandi
- Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Mehrafshan
- Department of Neurosurgery, Nekuii Forghani Hospital University of Medical Sciense Qom, Qom, Iran
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Evaluation of Pain Following the Use of Scalpel Versus Electrosurgery for Skin Incisions in the Facial Regions. ACTA ACUST UNITED AC 2018; 39:107-112. [PMID: 30864361 DOI: 10.2478/prilozi-2018-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Postoperative pain presents a significant medical problem. It can create a considerable discomfort in the immediate postoperative period and thus increase patient's morbidity. Multiple mechanisms are involved in its' etiology, one of them being the method of tissue incision. The aim of this study is to compare the early postoperative pain following incision with two different methods, scalpel and electrosurgery in the facial regions. MATERIAL AND METHODS Eighty patients with both benign and malignant skin lesions in the facial regions undergoing surgery were enrolled in this study. Patients were randomized in two groups. In group A, comprising 40 patients, cold steel surgical scalpel №15 was used for the surgical procedure. Electrosurgical microneedle with 0.06mm tip radius and generator unit KLS Martin Electrosurgical Unit ME MB 2 set on cutting mode, power 12 W was used for performing the surgery in group B including the same number of patients. After the surgery patients were given analgesics on their demand. The total number of on demand analgesics requirements was calculated. The patients were also asked to note the oral analgesics they were taking after being released from the hospital. RESULTS Results of this study showed a statistically significant difference between the groups in the analgesics demand on the day of the operation (p=0.041). On the day of the operation 52.5% patients in the scalpel group and only 30% of the patents of the electrosurgery group received analgesics on demand. In all other analysed time points, the patients in the scalpel group received analgesics more often than the patients in the microneedle group, but with no statistically confirmed difference between the groups (p>0.05). Even more significant is the fact that patients treated with electrosurgery that needed analgesics, had significantly bigger excision area median 471 (rank 283-589) compared to the patients treated with the conventional method 289 (rank 177-432) (p=0.016). CONCLUSION In accordance with previous studies our results suggested a significantly reduced postoperative pain in the electrosurgery group.
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Ismail A, Abushouk AI, Elmaraezy A, Menshawy A, Menshawy E, Ismail M, Samir E, Khaled A, Zakarya H, El-Tonoby A, Ghanem E. Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis. J Surg Res 2017; 220:147-163. [PMID: 29180177 DOI: 10.1016/j.jss.2017.06.093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although cutting electrocautery can be superior to the scalpel in reducing blood loss and incisional time, several reports associated electrocautery with higher rates of wound infection, impaired healing, and worse cosmesis. We performed this systematic review and meta-analysis to compare cutting electrocautery versus scalpel for surgical incisions. MATERIALS AND METHODS We conducted a computerized literature search of five electronic databases and included all published original studies comparing cutting electrocautery and scalpel surgical incisions. Relevant data were extracted from eligible studies and pooled as odds ratios (ORs) or standardized mean difference (SMD) values in a meta-analysis model, using RevMan and Comprehensive Meta-analysis software. RESULTS Forty-one studies (36 randomized trials, four observational, and one quasirandom study) were included in the pooled analysis (6422 participants). Compared with the scalpel incision, cutting electrocautery resulted in significantly less blood loss (SMD = -1.16, 95% CI [-1.60 to -0.72]), shorter incisional (SMD = -0.63, 95% CI [-0.96 to -0.29]) and operative times (SMD = -0.59, 95% CI [-1.12 to -0.05]), and lower pain scores (SMD = -0.91, 95% CI [-1.27 to -0.55]) with no significant differences in terms of wound infection rates (OR = 0.92, 95% CI [0.74-1.15]) or overall subjective scar score (SMD = -0.49, 95% CI [-1.72 to 0.75]). CONCLUSIONS Surgical incision using electrocautery can be quicker with less blood loss and postoperative pain scores than the scalpel incision. No statistically significant difference was found between both techniques in terms of postoperative wound complications, hospital stay duration, and wound cosmetic characteristics. Therefore, we recommend routine use of cutting electrocautery for surgical incisions.
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Affiliation(s)
- Ammar Ismail
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Al-Azhar Medical Students' Association, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt
| | | | - Ahmed Elmaraezy
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Al-Azhar Medical Students' Association, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt.
| | - Amr Menshawy
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Esraa Menshawy
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Mahmoud Ismail
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Esraa Samir
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Anas Khaled
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
| | - Hagar Zakarya
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman El-Tonoby
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Esraa Ghanem
- Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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