Abdominal Gynecologic Surgery Research Articles

Meta-analysis of electrical stimulation promoting recovery of gastrointestinal function after gynecological abdominal surgery

BACKGROUND The effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery was not clear. AIM To systematically evaluate the effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery. METHODS The Cochrane Library, Web of Science, PubMed, ProQuest, and the Chinese biomedical literature databases Wanfang, Weipu, and CNKI were used to search for relevant studies on controlled trials of electrical stimulation in gynecological abdominal surgery patients from self-established databases to May 2024. The RevMan software (version 5.3) was used to analyze the included literature and explore the heterogeneity of each study. RESULTS Seven controlled trials, involving 520 patients, were included. The results of meta-analysis showed that electrical stimulation could shorten the recovery time of intestinal sound after gynecological abdominal surgery [odds ratio (OR): -5.11, 95%CI: -5.84 to -4.38, P < 0.00001] and improve the time of first anal exhaust (OR: -1.19, 95%CI: -1.38 to -0.99, P < 0.00001), improved the time of first anal defecation (OR: -0.98, 95%CI: -1.19 to -0.78, P < 0.00001), The difference is significant. According to the funnel plot, if the scatter is symmetrical, it indicates that the funnel plot is unbiased. CONCLUSION Electrical stimulation can shorten this reduces the length of time it takes for the patient to recover from bowel sounds and also affects the time to first anal voiding and defecation to some extent, thereby promoting gastrointestinal function recovery after gynecological abdominal surgery. The quality of the studies included in this review was poor, which may have affected the final results. It is necessary to conduct a randomized controlled study with higher quality and more samples to further confirm the promoting effect of electrical stimulation on gastrointestinal function recovery to guide clinical treatment.

Comparison of analgesic efficacy of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries.

Objective: To compare the mean time for analgesic requirement of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Combined Military Hospital, Kharian. Period: 1st July 2022 to 1st January 2023. Methods: A total of 60 patients with 30 patients in each group undergoing elective c section were included in the study. Patients were counselled about VAS scoring system before procedure. Time (in minutes) for first rescue analgesia and requirement in 24 hours was noted. Results: Mean time required for first analgesia was 143.966±8.15 minutes in group A as compare to 86.400±7.08 minutes in group B (p=0.000). Conclusion: Our study has concluded that TAP block is a promising technique in alleviating postoperative pain in patients undergoing lower abdominal gynecological surgeries.

Effect of sugammadex with neostigmine on postoperative bowel function and on recovery of neuromuscular functions: A randomized controlled trial.

Early recovery of neuromuscular and bowel function after abdominal surgery are important clinical indicators of postoperative recovery. This study aimed to investigate the effects of sugammadex, and neostigmine added to sugammadex, on postoperative bowel function and recovery from neuromuscular blocking agents. Ninety gynecological surgery patients, aged 18 to 65 years, with American Society of Anesthesiologists of 1 to 2 were randomly assigned to 3 groups: sugammadex 2 mg/kg (Group S), sugammadex 1 m/kg with neostigmine 20 µg/kg + atropine 10 µg/kg (Group S1N), and sugammadex 1.5 mg/kg with neostigmine 20 µg/kg + atropine 10 µg/kg (Group S2N), for reversal at the end of surgery during moderate block (train-of-four [TOF] count 1-2). Propofol, remifentanil, rocuronium, and sevoflurane were used for general anesthesia, and neuromuscular function was assessed using kinemyography. The primary outcomes assessed the effects of sugammadex alone and in combination with neostigmine on the time to first flatus. The secondary outcomes included time to first defecation and recovery time; defined as the administration of reversal agent to TOF ratio 90%. Data from 90 female patients who underwent abdominal gynecological surgery were analyzed. No significant differences were found between the groups in term of the time to first flatus, defecation, or postoperative nausea and vomiting after surgery. However, significant differences were observed in the time to reach a TOF ratio 90% (P < .001) and extubation time (P = .003). The addition of neostigmine to sugammadex did not affect bowel function recovery. However, combining 20 μg/kg neostigmine with 1.5 mg/kg sugammadex or 2 mg/kg sugammadex alone antagonized moderate-depth nondepolarizing neuromuscular blockade with similar efficacy.

Effectiveness of Postoperative Analgesia with Rectal Placement of Diclofenac Sodium in Patients Undergoing Gynecological and Obstetrical Surgeries under General Anesthesia

Objective: To determine the frequency of need for postoperative intravenous analgesia after rectal diclofenac suppository in patients undergoing lower abdominal gynecological or obstetrical surgery under general anesthesiaStudy Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Operation Theater and Postoperative Ward of Sheikh Zayed Hospital, Lahore, Pakistan from January 2021 to July 2021.Methods: A total of 245 women undergoing gynecological and obstetrical surgeries under general anesthesia were enrolled in the study using non-probability consecutive sampling. All the participants were recruited after obtaining informed consent and meeting the inclusion criteria. All subjects had a single 100mg diclofenac suppository inserted rectally after undergoing general anesthesia, and their Visual Analog Scale (VAS) scores for postoperative analgesia were recorded immediately after surgery and again at 1, 6, and 24 hours.Results: The mean age of the patients was 37 years, with a standard deviation of 6.2. The mean VAS (Visual Analog Scale) scores at 1, 6, 12, and 24 hours were 3 (±1.24), 5 (±1.46), 7 (±1.93), and 6 (±2.14), respectively. The need for rescue analgesia was reported in 15.9% of cases at 1 hour, 37.1% at 6 hours, 82% at 12 hours, and 68.2% at 24 hours.Conclusion: The administration of diclofenac via rectal placement led to a notable decrease in Visual Analog Scale scores and a lower incidence of needing additional pain relief within the first 6 hours after surgery.&#x0D; How to cite this: Saeed R, Mahboob A, Ali SM, Latif A, Ammar T, Kakepotto IA. Requirement of Postoperative Analgesia after Per Rectal Placement of Diclofenac Sodium in Patients Undergoing Gynecological and Obstetrical Surgeries under General Anesthesia. Life and Science. 2024; 5(1): 120-125. doi: http://doi.org/10.37185/LnS.1.1.515

S-Ketamine Improves Slow Wave Sleep and the Associated Changes in Serum Protein Among Gynecological Abdominal Surgery Patients: A Randomized Controlled Trial

S-Ketamine Improves Slow Wave Sleep and the Associated Changes in Serum Protein Among Gynecological Abdominal Surgery Patients: A Randomized Controlled Trial

Influence of Regional Analgesia on Self-Reported Quality of Sleep After Gynecological Abdominal Surgery: A Secondary Analysis of a Randomized Trial

ObjectivesTo determine whether intrathecal morphine (ITM) analgesia in abdominal surgery for presumed gynecological malignancy was associated with better self-reported sleep quality postoperatively compared with epidural analgesia (EDA), and to evaluate risk factors for bad sleep quality. MethodsA secondary analysis of a randomized open controlled trial, comparing ITM and EDA as postoperative analgesia in 80 women undergoing laparotomy under general anaesthesia in an enhanced recovery after surgery framework. A total of 38 women allocated to ITM and 39 to EDA completed the study. The Swedish Postoperative Symptoms Questionnaire assessed symptoms and sleep quality during the first postoperative week. Multiple logistic regression models evaluated risk factors. The results are presented as adjusted odds ratios with 95% CIs. ResultsThe sleep quality night-by-night did not differ significantly between the women who had ITM or EDA. Risk factors for bad sleep quality for night 1 were age (0.91; 0.84–0.99), operation time (1.02; 1.00–1.03), and opioid consumption (0.96; 0.91–0.99). For night 2, regular use of hypnotics preoperatively (15.81; 1.52–164.27) and opioid consumption (1.07; 1.00–1.14) were independent risk factors for bad sleep. After the second night, no risk factors were disclosed. ConclusionsITM and EDA did not appear to affect the sleep quality postoperatively differently in women undergoing laparotomy for presumed gynecological malignancy. Risk factors for self-reported bad sleep quality varied during the first 3 days after surgery. Younger age, longer operation time, and preoperative use of hypnotics were associated with bad sleep quality, whereas the effect of opioid consumption on sleep quality varied depending on the time since surgery. These findings merit further studies.

Postoperative analgesia after major abdominal gynaecological surgery using surgical transversus abdominis plane block

Postoperative analgesia after major abdominal gynaecological surgery using surgical transversus abdominis plane block

Postoperative Acute Kidney Injury in Geriatric Gynecologic Oncology Patients After Major Open Abdominal Surgery: A Retrospective Cohort Study

Introduction: This investigation’s purpose was to determine the incidence of acute kidney injury, the associated risk factors, and the 90-day outcomes and kidney function of geriatric patients who underwent major open abdominal gynecologic oncologic surgery. Materials and Method: This retrospective cohort study involved patients aged ≥ 65 years who underwent major open abdominal gynecologic oncologic surgery. Results: The postoperative incidence of acute kidney injury in gynecologic oncologic surgical procedures was 22.1%, with a transient nature observed in 72% of patients. The in-hospital mortality rate was 4 %. Kidney function on the 90th day after acute kidney injury development revealed that estimated glomerular filtration rate regressed by over 25% in 6 patients (24%). Acute kidney injury development was associated with surgical time, intraoperative bleeding volume, bowel procedures, the presence of ascites, intraoperative hypotension, vasopressor use, postoperative diuretic use, postoperative hypoalbuminemia, prolonged post-anesthesia care unit, and hospital stay (p &lt; 0.05). A logistic regression analysis of the risk factors for acute kidney injury revealed that surgery duration was a significant one (p &lt; 0.05). Conclusion: Postoperative acute kidney injury is an important postoperative complication associated with the development or progression of chronic kidney disease. This leads to a prolonged stay in the post-anesthesia care unit and in the hospital. Although acute kidney injury is frequently transient in geriatric patients following major open abdominal gynecologic oncologic surgery, developing preventive measures, encouraging team collaboration, and monitoring serum creatinine concentration in the early postoperative period are critical in complex surgical procedures. Keywords: Postoperative Complications; Acute Kidney Injury; Geriatrics.

S-ketamine promotes postoperative recovery of gastrointestinal function and reduces postoperative pain in gynecological abdominal surgery patients: a randomized controlled trial

BackgroundThis prospective randomized controlled study was designed to evaluate the effect of S-ketamine with sufentanil given intraoperatively and postoperatively on recovery of gastrointestinal (GI) function and postoperative pain in gynecological patients undergoing open abdomen surgery.MethodsOne hundred gynecological patients undergoing open abdomen surgery were randomized into an S-ketamine group (group S) or placebo group (0.9% saline; group C). Anesthesia was maintained with S-ketamine, sevoflurane, and remifentanil-propofol target-controlled infusion in group S and with sevoflurane and remifentanil-propofol target-controlled infusion in group C. All patients were connected to patient-controlled intravenous analgesia (PCIA) pump at the end of the surgery with sufentanil, ketorolac tromethamine, and tropisetron in group C and additional S-ketamine in group S. The primary outcome was the time of first postoperative flatus, and the secondary outcome was postoperative pain score of patients. Postoperative sufentanil consumption within the first postoperative 24 h and adverse events such as nausea and vomiting were recorded.ResultsThe time of first postoperative flatus in group S was significantly shorter (mean ± SD, 50.3 ± 13.5 h) than that in group C (mean ± SD, 56.5 ± 14.3 h, p = 0.042). The patient’s visual analog scale (VAS) pain score 24 h after surgery at rest was significantly lower in group S than in group C (p = 0.032). There were no differences in sufentanil consumption within the first postoperative 24 h, postoperative complications related to PCIA between the two groups.ConclusionsS-ketamine accelerated postoperative GI recovery and reduced 24 h postoperative pain in patients undergoing open gynecological surgery.Trial registrationChiCTR2200055180. Registered on 02/01/2022. It is a secondary analysis of the same trial.

To Compare the Mean Postoperative Pain Score between Intravenous Paracetamol Vs Intravenous Ketorolac among patients undergoing Gynecological Abdominal Surgery

Background: Post-operative pain is one of the common concerns in all the surgical interventions including gynecological surgeries. There is always a need for the agent with better efficacy and minimal side effect profiles. Aim: To compare the mean postoperative pain score between intravenous Paracetamol vs intravenous ketorolac among patients undergoing gynecological abdominal surgery Study design: Randomized Controlled Trial Setting &amp; duration: Department of Anesthesia, Hameed Latif Hospital, Lahore from 12-06-2018 to 12-12-2018 Methodology: In this study, females with age 20 - 50 years with ASA I and II undergoing gynecological abdominal surgery were included. Group A was administered with intravenous paracetamol and group B with ketorolac. Pain was measured in terms of mean of numerical rating scale recorded at 12 hours postoperatively. Results: In the present study there were total 80 cases included, 40 in each group. The mean age in group B was 37.66±12.67 years and in group A was 41.29±11.36 years Mean post operative pain score was 3.05±0.61vs 3.56±0.89 in group B and A with p= 0.04 Mean post operative pain was 3.04±0.61 vs 3.51±0.77 with p= 0.03 in cases with BMI &gt; 25. There was no significant difference in terms of type of procedure and mean pain score in both groups. Conclusion: Ketorolac is significantly better than Paracetamol in gynecological abdominal surgeries and this difference is also significantly better in cases with BMI &gt; 25. Keywords: Pain, ketorolac, paracetamol, BMI

Effect of chiropractic therapy on the recovery of gastrointestinal function after gynecological abdominal surgery

Effect of chiropractic therapy on the recovery of gastrointestinal function after gynecological abdominal surgery

The effects of Kinesio taping and breathing exercises on pain management after gynaecological abdominal surgery: A randomized controlled study.

This study aimed to evaluate the effects of Kinesio taping and breathing exercises on pain management after gynaecological abdominal surgery. This randomized controlled study was conducted with 132 participants at a public hospital between June 2017 and 2018. The Kinesio taping method was applied once, immediately after the surgery during the hospital stay and breathing exercises were performed three times a day for 30 min on the first, second and third post-operative days. The median age of the women was 47 years. The mean body mass index was 27.6 ± 5.0kg/m2 . When the intervention and control groups were compared, the level of women's pain in the Kinesio taping group was significantly reduced. There was also a statistically significant difference in terms of the passage of gas and defecation time and wound healing in groups with Kinesio taping. Kinesio taping has been shown to be an effective intervention in the management of acute pain after surgery. The results of this study suggest that future studies may be indicated to study taping in other surgical conditions.

Patient-reported post-discharge opioid use after abdominal gynecologic surgery in an Enhanced Recovery After Surgery (ERAS) program (004)

<b>Objectives:</b> Over prescription of opioids is a major contributor to the opioid crisis. In an attempt to reduce this issue, we implemented a personalized tiered discharge opioid protocol, which included safe opioid disposal education. We aimed to determine post-discharge patient-reported opioid use after implementing a tiered discharge opioid protocol among women undergoing abdominal gynecologic surgery under an enhanced recovery after surgery (ERAS) program. <b>Methods:</b> We analyzed post-discharge opioid consumption among 582 patients (369 minimally invasive [MIS] and 213 open surgery). Eligible patients included those who underwent elective surgery, were not taking scheduled opioids preoperatively, and had received 5, 15, or 30 tablets of 5 mg oxycodone as per a tiered opioid prescribing regimen. A survey assessing discharge opioid consumption and knowledge about safe disposal was sent to patients through REDCap on post-discharge day-21. The survey was completed via email or telephone within a 7-day window from receipt. Descriptive statistics were used for analysis. <b>Results:</b> Of the 369 MIS patients included, 192 (52%) had malignant diseases. The median age was 55 years (range: 18-89), and the median length of stay (LOS) for this group was 0 days (range: 0-4). A total of 95.9% of these patients received five tablets, 2.7% received 15 tablets, and 1.4% received 30 tablets (Figure 1A). Overall, the median total opioid use after discharge of this cohort was one tablet (mean: 2.2). In the MIS group, 43.6% of patients used no discharge opioids and had a median LOS of 0 days (range: 0-3). In addition, 9.8% reported using only one tablet, and 14.4% used five tablets (Figure 1B). Between days 21-28 after surgery, 1.4% of patients reported continued use of opioids, and 60% of them attributed this need to postoperative pain. Of the 213 patients who underwent open surgery, 172 (80.8%) had malignant diseases. The median age was 55 years (range: 20-88), and the median LOS was three days (range: 1-19). Following the tiered discharge opioid protocol, 37.1% of these patients received five tablets, 34.3% received 15 tablets, and 28.6% received 30 tablets (Figure 1A). Overall, the median total opioid use after discharge in this cohort was three tablets (mean: 7.7). Of the open surgery group, 35.2% of patients reported not using discharge opioids (Figure 1B). By days 21-28 after surgery, 8.9% of these patients were still requiring opioids, with 78.9% attributing this need to postoperative pain. Of the evaluated patients, 46% reported not being aware of proper opioid disposal practices. <b>Conclusions:</b> Despite implementing the tiered discharge opioid algorithm, we still overprescribed opioids. Our study showed that 43.6% of MIS patients and 35.2% of open surgery patients did not use any prescribed opioids after discharge. Additionally, despite targeted education, nearly half of all patients (46%) did not know how to dispose of their opioid tablets. This data will be applied to refine the algorithm to reduce over prescription of opioids and improve safe disposal.Fig. 1

A Dose Response Study Of Oral clonidine as premedication in patients undergoing abdominal gynaecological surgery

Background: The current study was designed to investigate the safe and effective dose of oral clonidine onpost-operative analgesia in patients undergoing gynaecological laparotomy. The objective of the study was to see theeffectiveness of oral Clonidine as a preanesthetic medication and to determine which dose of oral Clonidine givesbetter analgesic effect. Method: In this prospective, randomized, double-blind, controlled study sixty adult female patients of ASA physicalstatus I &amp; II aged 18-40 yrs, undergoing gynaecological laparotomy received low dose clonidine 2-2.5mcg/kg (n=30)and high dose clonidine 4-4.5mcg/kg (n=30).These drugs were administered 105 min before the estimated time ofinduction of anesthesia. Heart rate &amp; arterial pressure were recorded prior to induction, 5 min intervally upto 20 minin peroperative time and 2 hour intervally upto 6 hours in postoperative period. In the Group-A (clonidine2-2.5mcg/kg) mean heart rate ranged from73.80 ±8.69 to 71.45±5.80, in Group-B mean heart rate decreased morefrom 70.85±7.64 to 67.85±6.47. Systolic blood pressure in Group-A (low dose clonidine) was 113.00±7.32, inGroup-B (high dose clonidine) was 120.00±10.38 and where p=0.024. Diastolic blood pressure of Group-A (low doseclonidine) was 76.15±5.29, in Group-B(high dose clonidine) was 80.10±5.3. Postoperative pain was assessed by ablinded observer using a VAS scale. This study was done in the department of anesthesiology of Apollo HospitalsDhaka over a period of six months. Results: Patients in group A (low dose) and group B (high dose) showed no significant hemodynamic changesbetween groups. Five patients in group B showed marked hypotension and bradycardia and treatedaccordingly.Group B patients (high dose clonidine) showed more post operative analgesia compared to group A. Conclusion: These data suggest that low dose clonidine (100mcg/kg) premedication is safe and effective to facilitatepost-operative analgesia with stable haemodynamics &amp; without any side effects. On the other hand,.high doseclonidine showed more post op analgesia &amp;.marked hypotension and bradycardia. JBSA 2022; 35 (2) : 12-16

Abdominal wall endometriosis misdiagnosed as a desmoid tumor: A case report.

IntroductionAbdominal wall masses have different aetiologies. Diagnosis includes desmoid tumors (DTs) and other benign and malignant lesions, among which abdominal wall endometriosis (AWE). Diagnosis is challenging if symptoms are aspecific, and the contribution of imaging may be weak. We present a case of AWE that according to clinical history and imaging was misdiagnosed as DT.Presentation of caseA healthy 35-year-old female presented, 4 years after a cesarean delivery, a rapidly growing painless subumbilical mass within the right rectus abdominis muscle. Ultrasound and magnetic resonance imaging suspected a DT. The patient underwent complete resection of the mass and pathological examination revealed foci of endometriosis in the muscle. Patient's post-operative course was uneventful and at 18-month follow-up, no recurrence has been detected.DiscussionThe current case highlights differences in clinical presentation and imaging in case of AWE and DTs, underlining possible pitfalls in diagnosis. In young women with previous gynaecological abdominal surgery, AWE is the most likely disease when a mass in the region of the scar appears. Differential diagnosis is complex and rare entities like DTs should nevertheless be taken into consideration. A complete surgical resection with negative margins is considered the primary treatment for AWE and for selected DTs. Final pathology of the tumor can state the precise diagnosis.ConclusionSince AWE and DTs share similar clinical signs and aspecific imaging exams, both diseases should be considered in case of abdominal wall mass in female patients of childbearing age and history of uterine-related surgery.

Perioperative Dexmedetomidine or Lidocaine Infusion for the Prevention of Chronic Postoperative and Neuropathic Pain After Gynecological Surgery: A Randomized, Placebo-Controlled, Double-Blind Study.

IntroductionThe transition of acute to chronic postoperative pain (CPP) remains a significant burden to the rehabilitation of patients. The research for adjuvants to prevent CPP continues; among others, dexmedetomidine and lidocaine seem promising agents.MethodsThis is a long-term follow-up of a randomized, placebo-controlled, double-blind study on women who underwent open abdominal gynecological surgery and received dexmedetomidine or lidocaine or placebo infusion perioperatively (n = 81). The effect of these adjuvants on the development of CPP and neuropathic pain was assessed during a 12-month follow-up. Eighty-one (81) women ASA I–II, aged between 30 and 70 years, were randomly assigned to receive either dexmedetomidine (DEX group) or lidocaine (LIDO group) or placebo (CONTROL group) perioperatively. Before anesthesia induction, all patients received a loading intravenous dose of either 0.6 μg/kg dexmedetomidine or 1.5 mg/kg lidocaine or placebo, followed by 0.6 μg/kg/h dexmedetomidine or 1.5 mg/kg/h lidocaine or placebo until last suture. Patients were followed up to obtain the long-term outcomes at 3, 6, and 12 months. At these time-points, pain intensity was assessed with the Numerical Rating Scale, (NRS: 0–10) and the development of neuropathic elements with the Douleur Neuropathique 4 (DN4) score. Prognostic parameters that could affect chronic pain and its components were also identified.ResultsData from 74 women were analyzed. Dexmedetomidine significantly reduced NRS scores comparing to placebo at 3 months (p = 0.018), while at 6 months, lidocaine was found superior to placebo (p = 0.02), but not to dexmedetomidine, in preventing neuropathic pain (DN4 < 4). Regarding secondary endpoints, higher NRS cough scores at 48 h were associated with statistically significant NRS and DN4 scores at 3, 6, and 12 months (p < 0.02). At 6 months, a statistically significant correlation was also found between higher NRS values and older age (p = 0.020).ConclusionsDexmedetomidine was superior to placebo regarding the duration and severity of CPP, while lidocaine exhibited a protective effect against neuropathic elements of CPP.Trial registrationClinicalTrials.gov identifier, NCT03363425.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00361-5.

Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery

Background &amp; Objective: Hyperbaric bupivacaine is the most commonly used local anesthetic for spinal anesthesia, alone or in combination with various adjuvants. Opioids are frequently used for their rapid onset and intense block characteristics. Fentanyl is the preferred intrathecal opioids with rapid onset of action but has a shorter duration of action. Buprenorphine is a mixed agonist-antagonist with high affinity at both mu and kappa opioid receptors. We compared administration of buprenorphine with fentanyl as adjuvants with intrathecal hyperbaric bupivacaine in gynecological surgeries.&#x0D; Methodology: After Institutional Ethical Committee approval and written informed consent, 60 patients aged 18–65 y, scheduled for lower abdominal gynecological surgery, were divided into two equal groups; Group F to receive 0.5% hyperbaric bupivacaine 2.5 ml with fentanyl 25 µg intrathecal and Group B to receive 0.5% hyperbaric bupivacaine 2.5 ml with buprenorphine 75 µg intrathecal. Block characteristics and associated side effects were compared between two groups. The data was analyzed using Chi square test and Fisher’s exact test. For comparing two group of mean, independent student’s t test was used. P-value &lt; 0.05 was considered as statistically significant.&#x0D; Results: The mean onset of sensory and motor block was significantly earlier in Group F than Group B (p &lt; 0.001). Mean duration of sensory block was significantly prolonged in Group B compared to Group F (p &lt; 0.05). Whereas, the duration of motor was comparable in both of the groups (p &gt; 0.05). Duration of analgesia was significantly prolonged in Group B than Group F (p &lt; 0.001).&#x0D; Conclusion: We conclude that when a longer duration of postoperative pain relief is needed, buprenorphine can be a suitable drug to be used with intrathecal hyperbaric bupivacaine for gynecological surgeries because of prolonged duration of action.&#x0D; Key words: Spinal anesthesia; Fentanyl; Buprenorphine; Bupivacaine&#x0D; Citation: Singh Y, Yadav AK, Vijeta Bajpai, Diwedi P, Verma S, Verma RK. Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery. Anaesth. pain intensive care 2021;26(1):39-43.&#x0D; DOI: 10.35975/apic.v26i1.1764

Effect of Wuda granule on gastrointestinal function recovery after laparoscopic intestinal resection: a randomized-controlled trial.

BackgroundPrevious studies have suggested that the Wuda granule (WDG) could promote the recovery of gastrointestinal (GI) function after gynecologic abdominal surgery. This trial aimed to investigate the efficacy and safety of WDG in the rapid recovery of GI function in patients after laparoscopic intestinal resection in the setting of enhanced recovery after surgery (ERAS)-based perioperative care.MethodsWe performed a randomized, double-blind, placebo-controlled pilot trial. Thirty patients who met the inclusion criteria were randomly assigned to either the WDG group or the placebo group in a 1:1 ratio. The patients received WDG or placebo twice a day in addition to ERAS-based perioperative care, starting on post-operative Day 1 until Day 3. The primary outcomes were time to first bowel movement and time to first tolerance of solid food. The secondary outcomes were time to first flatus, length of hospital stay (LOS), and post-operative ileus-related morbidity. Adverse events were also recorded.ResultsThere were no statistically significant differences in baseline characteristics between the two groups. The median time to first bowel movement was significantly decreased in the WDG group compared with the control group (27.6 vs 50.1 h; P < 0.001), but the median times to first flatus (22.9 vs 25.1 h; P > 0.05) and LOS (5.0 vs 5.0 days; P > 0.05) were not statistically different. The occurrence rates of post-operative nausea, vomiting, abdominal distension, and abdominal pain were similar in the two groups. No adverse events occurred in any patients.ConclusionsThe addition of WDG to ERAS post-operative care after laparoscopic intestinal resection can safely promote the rapid recovery of GI function.

Chinese herbal medicine hot compress based on midnight-noon ebb-flow theory in relief of postoperative gastrointestinal dysfunction in a patient undergoing abdominal gynecological surgery and related nursing management

Chinese herbal medicine hot compress based on midnight-noon ebb-flow theory in relief of postoperative gastrointestinal dysfunction in a patient undergoing abdominal gynecological surgery and related nursing management

Skin preparation for prevention of surgical site infection after obstetrics and gynecological abdominal surgery: A quality improvement project.

One of the most common causes of postoperative morbidity is postoperative surgical site infection (SSI). Healthcare-associated infection is a subject of great concern in healthcare services. The goal of the present study is to estimate the relative effectiveness of skin preparation solution chlorhexidine scrub followed by povidone-iodine painting in the prevention of SSIs after caesarean delivery and abdominal gynecological surgery. This is a 1-year randomized prospective research done at a tertiary care institution in western Rajasthan. Women who underwent caesarean and gynecological operations were randomly assigned to one of two groups. Enrolled patients were randomly assigned to have the surgical site painted with 10% povidone-iodine or a chlorhexidine-alcohol preparatory scrub followed by povidone-iodine paint. According to the Centres for Disease Control and Prevention criteria, the outcomes were any SSI occurring within a week or during the 30-day follow-up period following the operation, including any superficial or deep SSI. A total of 251 patients were randomly assigned to two groups. Group A (povidone-iodine paint) received 121 patients, whereas Group B (chlorhexidine scrub + povidone-iodine paint) received 129 cases. The overall SSI rate in the present study was 8.76%. The SSI rate was lower in Group B (chlorhexidine scrub + povidone-iodine paint) as compared to Group A (povidone-iodine paint only) (5.4% vs. 12.4%; p= 0.04). This study highlighted that chlorhexidine-alcohol scrubbing followed by povidone-iodine painting provides superior skin antisepsis in comparison to povidone-iodine painting alone.