Need For Painkillers Research Articles

Continuous versus Six Months a Year Maximal Androgen Blockade in the Management of Prostate Cancer: A Randomised Study

ObjectiveTo evaluate systematically interrupted androgen suppression (SIAS) 6 mo a year compared with continuous androgen suppression (CAS) in prostate cancer treatment. Patients and MethodsAll patients underwent maximal androgen blockade for 6 mo. Then, depending on the randomisation arm, they continued (CAS) or stopped their treatment for 6 mo before they resumed it a year later and so on (SIAS). Primary end points were patient's health-related quality of life (HQOL) and time to progression. Secondary end points were cancer-specific and overall survival. Progression was defined by a clinical event or PSA value exceeding double the value obtained at the end of the first 6 mo of therapy. ResultsSixty-two patients were randomised to CAS and 67 to SIAS. There were no significant differences between groups at baseline. Androgen suppression was associated with HQOL deterioration except for an improvement in urinary symptoms. The 6-mo off-therapy period was not long enough to regain normal testosterone values. There was no difference in HQOL scores between CAS and SIAS except that men in the latter group reported a greater need for painkillers but a better ability to have an erection. Progression occurred in 62 patients (48.1%) with no significant difference between CAS and SIAS with a mean follow-up of 44.8 mo. Death occurred in 41 patients and specific death in 19 patients (10% and 19% of the CAS and SIAS groups, respectively). ConclusionsAlthough patients in the SIAS group were maintained off-therapy 50% of the time, insufficient testosterone recovery in this group likely explains why differences between the two groups were moderate or absent with regards to HQOL and survival, respectively.

Comparison between the use of the Joel-Cohen incision and its modification during Stark's cesarean section

Objective. A comparative evaluation between the Joel-Cohen incision and its modification for the Stark's cesarean section (CS).Materials and methods. In a retrospective study, 477 women who underwent a Stark's CS were evaluated: 204 with the Joel-Cohen incision (JC) and 273 with a modified Joel-Cohen incision (MJC). All patients were checked for the following parameters: febrile morbidity, the need for painkillers, duration of hospital stay, and ultrasound examination for blood collection (BC) on the third postoperative day. The collections, when diagnosed were divided into three groups: (1) in the abdominal wall, (2) in the pouch of Douglas, and (3) in the lower uterine segment (LUS). Those included in the study were low-risk primiparae at term, presenting for CS for breech presentation, macrosomia, and on demand, and who had combined spinal–epidural anesthesia. Statistical evaluation was performed using SAS/V12 software.Results. There were no statistical differences between the two groups with regard to febrile morbidity, duration of need for painkillers, and hospital stay. Statistically more blood collections were found in the MJC incision group (5.4% in the abdominal wall, 12.4% in the pouch of Douglas, and 11.7% in the LUS) than in the classical JC incision group (3.9% in the abdominal wall, 10.2% in the pouch of Douglas, and 8.8% in the LUS), however without any clinical significance.Conclusions. The routine use of the classical JC incision during the Stark's CS seems to be more rational, and causes fewer blood collections.

Local Anesthesia for Arthroscopy of the Knee in Day-surgery Patients

In this study we assess the effectiveness of local anesthesia in knee arthroscopies carried out in outpatients and the use of subsequent postoperative analgesia. From January to December 2003, within the framework of our Outpatient Program, 56 patients with different knee conditions underwent arthroscopy with local anesthesia and postoperative intraarticular infiltration with bupivacaine. The effectiveness of local anesthesia and postoperative analgesia were assessed by determining pain intensity using a visual analogical scale and by quantifying the use of postoperative analgesia after arthroscopy. Fifty of the 56 patients, had no pain during surgery, with the remaining 6 requiring supplementary analgesia. All patients were discharged from hospital during the 6 hours following surgery and no complications were seen. Local intraarticular anesthesia is ideal for knee arthroscopy since it allows this surgical procedure to be performed as part of an outpatient program, it decreases the need for pain-killers and shows high rates of patient satisfaction. It allows early recovery, rehabilitation, and hospital discharge. En este artículo valoramos la eficacia de la anestesia local para la cirugía artroscópica de la rodilla en pacientes ambulatorios y la analgesia postoperatoria. De enero a diciembre de 2003 y dentro del programa de cirugía ambulatoria fueron intervenidos 56 pacientes de diferentes patologías de la rodilla mediante cirugía artroscópica y bajo anestesia local, e infiltración intraarticular postoperatoria con bupivacaína. Se ha valorado la eficacia de la anestesia local y la analgesia postoperatoria determinando la intensidad del dolor mediante la escala visual analógica y el consumo de analgésicos tras la cirugía artroscópica. De los 56 pacientes, 50 no tuvieron dolor durante la cirugía, en los otros 6 fue necesario suplementar la analgesia. Todos los pacientes fueron dados de alta hospitalaria en las primeras 6 horas tras la cirugía y no se detectó ninguna complicación. La anestesia local intraarticular es un método ideal para la artroscopia de la rodilla dentro del programa de cirugía ambulatoria, permitiendo la realización de esta técnica quirúrgica disminuyendo el consumo de analgésicos por proporcionar una adecuada analgesia y una alta satisfacción. Permite una recuperación, un alta hospitalaria y una rehabilitación precoces.

A case report of vaginal injury with peritoneal perforation from a water-jet accident: the first report of treatment by laparoscopic operation

Objective To describe a unique case of vaginal injury with peritoneal perforation from a water-jet accident that was treated by laparoscopic assisted operation. Subject A woman was transferred to our unit with a vaginal laceration caused by impact of water flow to the perineum after falling off of the back seat of a Jet-ski. A part of the appendix epiploica was seen in the vagina. Interventions In this particular case, by using a laparoscope and washing and draining the pelvic cavity, it was confirmed by the surgeon that there was no intestinal injury despite part of the colon having entered the vagina. The perforated vaginal wound was sutured transvaginally while draining the abdominal cavity. Compared with what would have been the case with laparotomy, the patient's need for pain killers and her recovery time were greatly reduced. Conclusions Patients with vaginal lacerations are often encountered in the emergency room. In treatment it is necessary to stop the bleeding and prevent infection. In the case of vaginal perforation, it is also important to check for intestinal or pelvic injury. Usually, open surgery is performed for these reasons. However, the authors managed to treat the woman using a laparoscopically assisted approach, and therefore the treatment was minimally invasive.