Operative Pain Score Research Articles

Impact of computed tomography/magnetic resonance imaging registration on rehabilitation after percutaneous endoscopic decompression for lumbar stenosis: Retrospective study.

Percutaneous endoscopic lumbar decompression (PELD) shows promise for lumbar spinal stenosis (LSS) treatment, but its use is limited by the disease's complexity and procedural challenges. In this study, the effects of preoperative planning and intraoperative guidance with computed tomography (CT)/magnetic resonance imaging (MRI) registration techniques on PELD for LSS and postoperative rehabilitation outcomes were evaluated. This retrospective study was conducted with data from patients who underwent PELD for LSS between January 2021 and December 2023. Patients were assigned to preoperative CT/MRI registration and control groups. Data collected included the operative time, length of hospital stay, visual analog scale (VAS) scores for low back and leg pain, and the Japanese Orthopaedic Association (JOA) lumbar spine score. Differences between groups were assessed using Student's t test. Data from 135 patients (71 in the CT/MRI registration group, 64 in the control group) were analyzed. The operative time was significantly shorter in the CT/MRI registration group (P = 0.007). At 2 months postoperatively, both groups showed significant reductions in VAS leg and low back pain scores (all P < 0.001) and improvements in the JOA score (both P < 0.001). No complication or death occurred. Preoperatively, pain and JOA scores were similar between groups (P = 0.830, P = 0.470, and P = 0.287, respectively). At 2 months postoperatively, patients in the CT/MRI registration group reported lower leg and low back pain levels (P < 0.001 and P = 0.001, respectively) and had higher JOA scores (P = 0.004) than did patients in the control group. Preoperative CT/MRI registration for PELD for LSS reduced the operative time and VAS pain scores at 2 months and improved JOA scores, demonstrating enhanced effectiveness and safety.

Comparison of the efficacy of tibial transverse transfer and periosteal distraction techniques in the treatment of diabetic foot refractory ulcers.

To investigate the efficacy of comparing tibia transverse transport (TTT) and periosteal distraction in treating diabetic foot ulcers. A retrospective analysis of 19 patients with diabetic foot ulcers treated with both procedures between February 2020 and November 2022, 8 of whom were treated with the tibial transverse transfer technique (transfer group) and 11 with the osteochondral distraction technique (distraction group), was performed to compare and analyze the clinical efficacy of the two methods. All wounds were healed in both groups, and the healing time ranged from 15 to 41days with a mean of 28d. The limb preservation rate was 100%. The operative time, intraoperative bleeding, and pain score in the operative area were significantly less in the distraction group than in the removal group, with statistically significant differences (P < 0.05). Intra-group comparison between the two groups of patients after surgery revealed that the skin temperature, ABI, TcPO2, SWM and VAS of the affected limb were significantly improved compared with those before surgery, and the difference was statistically significant (P < 0.05). The expression levels of VEGF, bFGF, EGF and PDGF were significantly higher than before surgery in both groups, and the difference was statistically significant (P < 0.05). No statistically significant differences were found in skin temperature, ABI, TcPO2, SWM, VAS, VEGF, bFGF, EGF and PDGF between the two groups at the corresponding time points preoperatively and postoperatively (P > 0.05). The Periosteal distraction technique can significantly promote the healing of diabetic foot ulcers. It has the same efficacy as TTT in promoting the healing of diabetic foot ulcer wounds and improving the peripheral circulation of affected limbs. In addition, the periosteal distraction technique has the advantages of small trauma, simple operation, few complications, and convenient nursing care.

TO ASSESS THE ROLE OF NASAL TAPENTADOL AS PRE-EMPTIVE ANALGESIA, IN BREAST SURGERY PATIENTS

Patients undergoes moderate to severe postoperative pain after surgery, which is troublesome during the postoperative period. Inadequately treated acute post operative pain causes prolonged morbidity to patients. Pre-emptive analgesic minimises the pain in perioperative period by central neuro sensitization. We assessed the role of Nasal Tapentadol in breast surgery patients, as a pre-emptive analgesic, in the reduction of post-operative analgesic requirement. In a double blinded prospective randomized control study, sixty breast surgery patients, received nasal spray of tapentadol (Group A) or saline Spray (Group B), 30 minutes prior to general anaesthesia. Perioperative analgesic requirement, time taken for first analgesic requirement in post operative period, post operative pain and sedation scores, we compared the following parameters in the first 24h during the postoperative period in all patients: Analgesic requirement during perioperative period, time taken for first post operative analgesic dose, pain score and sedation score in postoperative period.Data Of all sixty patients were analysed. Patients in Tapentadol Group A had significantly lower requirement of analgesics and lower Visual analog scale (VAS) than Saline group in the post operative period. However, Ramsay sedation score was more in Tapentadol group, immediately after shifting the patient to the postanaesthetic care unit. Single Pre-emptive nasal spray of tapentadol (45mg) is an effective intervention to, reduce the surgical pain and lesser requirement of analgesics, in post operative period, without added side effects.

Indications and Early Outcomes of WALANT among Patients Undergoing Surgical Procedures at a Tertiary Care Hospital, Mwanza, Tanzania

Introduction: The concept of "Wide Awake Local Anesthesia No Tourniquet" (WALANT) technique is gaining popularity in the field of plastic, orthopedic and general surgery owing to its benefits of reduced cost, improved safety, improved patient satisfaction, avoiding costly preoperative tests, decreased operative time, reduced utilization of hospital resources and length of hospital stay. Objective: To determine indications for surgery and early outcomes of "Wide Awake Local Anesthesia No Tourniquet" among patients undergoing surgical procedures at Bugando Medical Centre (BMC). Method: This was a 4 months’ prospective longitudinal study conducted from April to July 2023 involving 91 patients aged 12 years and above who underwent surgical procedures from plastic, orthopaedics and general surgery departments at Bugando Medical Centre. Structured questionnaire was used to obtain operative information and the Visual Analogue Scale (VAS) was used to obtain intra operative pain score. Results: The most common indication for using WALANT was surgeon's preference (65/91,70%). The most common procedure done was sloughectomy (16/91,17.6%) the least being colostomy placement (1/91, 1.1%). Intraoperative VAS score range from 0 to 4 with a mean of 1.1 (±0.39). (88/91, 97%) of the participants had no any complication post-operatively and the majority of the remaining few presented with tachycardia (2/91, 2.2%). The level of satisfaction was significant associated with the length of hospital stay having the p-value of 0.00. Conclusions: The WALANT technique can be performed as the best alternative type of anesthesia for both minor and selected major surgeries with minimal pain score, high patient’s satisfaction rate, minimum risk of infection and significant reduced length of hospital stay.

247 Prophylactic Use of 3D Intraperitoneal Mesh in the Prevention of Parastomal Hernia in Permanent Colostomies After Rectal Cancer Resection

Abstract Background Parastomal hernia (PSH) is the most common complication of stomas associated with significant morbidity. Prophylactic mesh in preventing PSH is less well studied, and evidence is conflicting. We compare PSH rates in patients in whom 3D intraperitoneal mesh was and was not used prophylactically in a cohort of rectal cancer patients undergoing elective curative resection. Method Retrospective data from the Somerset Database and Electronic Patient Record were collected on patients under a single consultant surgeon between May 2016 and December 2021. Follow up was for a minimum of 2 years (excluding deaths). Appropriate statistical tests of difference significance were performed for proportions of categorical data, and time to hernia occurrence in patients with and without Dynamesh IPST placement. (Fisher’s Exact test; Kaplan Meier) Results From 397 colorectal cancer patients under the care of a single surgeon, 223 had elective surgery with curative intent, of which 63 (28%) underwent total mesorectal excision (TME) (30 TME &amp; ileostomy, 12 TME Hartmann and 21 APER) - 90% laparoscopic. 16 patients had prophylactic mesh used. Demographics and co-morbidities between groups were similar. PSH incidence was 1 (6%) (radiological) vs.7 (41%) (clinical) in the mesh vs. non-mesh group; P=0.039. Post operative complications and pain scores differed only slightly. Time to hernia development did not differ between groups. Conclusions Use of prophylactic mesh during permanent stoma formation in our practice appears safe, and effective in preventing PSH. Further studies may answer the question “Should 3D collared mesh be routinely placed during the formation of permanent stomas to prevent parastomal hernia?”

Tranexamic Acid Subcutaneously Administered with Epinephrine and Lidocaine in Upper Blepharoplasty: A Randomized Double-Blind Control Trial

BackgroundEyelid surgery is one of the top five aesthetic procedures. It is performed to improve both appearance and function, but intraoperative bleeding leads to adverse events which perturb patients. The objective of this study was to demonstrate the efficacy of TXA combined with epinephrine in decreasing intraoperative blood loss and postoperative inflammation.MethodsThis prospective randomized control trial was performed on the 30 eyelids of 15 patients who underwent upper blepharoplasty. One of each patient’s eyes was randomly assigned to the TXA group, and the other eye was in the control group. Eyes in the TXA group were given 2% lidocaine with epinephrine (1:100000) mixed with TXA (50 mg/ml) in 1:1 mixture subcutaneously as a local anesthetic. The eyes in the control group received 2% lidocaine with epinephrine (1:100000) diluted with normal saline in 1:1 mixture. Intraoperative blood loss and postoperative swelling were compared between the two groups.ResultsIntraoperative blood loss was significantly higher in the TXA group [4.86 (1.83) ml] than it was in the control group [2.53 (1.49) ml] (p < 0.001). There was no statistically significant difference between the two groups in operative time (p = 0.645), pain score (p = 0.498), lid crease (p = 0.548), or MRD1 (p = 0.626). On postoperative day 7, there was no difference in lid crease (p = 0.879), MRD1 (p = 0.463), pain score (p = 0.934), or ecchymosis (p = 0.976) between two groups.ConclusionsTXA in lidocaine with epinephrine was found to increase intraoperative bleeding compared to lidocaine with epinephrine alone, but there was no difference in postoperative swelling or ecchymosis. TXA combined with lidocaine and epinephrine injected subcutaneously should be avoided until additional relevant data are obtained. Further drug interaction study is needed.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comparison of efficacy and safety of open and laparoscopic proximal ureterolithotomy for ureteral stone management: A systematic review and meta-analysis.

Despite advances in non-invasive and minimally invasive techniques, some proximal ureteral stones with impaction require open or laparoscopic surgery. No systematic reviews or meta-analyses have compared the efficacy and safety of open proximal ureterolithotomy and laparoscopic approaches. The aim of this study was to compare the efficacy and safety between open and laparoscopic proximal ureterolithotomy for ureteral stone management. Following the PRISMA guidelines, systematic searches were conducted in five databases (PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest) to identify articles comparing those two surgical approaches. Operative time, blood loss, pain score, hospital stay, recovery time, and complications were collected and compared. Heterogeneity-based meta-analysis with random-effects or fixed-effects models were conducted. Two randomized controlled trials and four observational cohort studies with 386 participants met the criteria. Open surgery had significantly less time than laparoscopic ureterolithotomy (mean difference (MD): 26.63 minutes, 95%CI: 14.32, 38.94; p<0.0001). Intraoperative blood loss (MD: -1.27 ml; 95%CI: -6.64, 4.09; p=0.64) and overall complications (OR: 0.68; 95%CI: 0.41, 1.15; p=0.16) were not significantly different between two approaches. Laparoscopic ureterolithotomy reduced visual analogue scale (VAS) pain scores (MD: -2.53; 95%CI: -3.47, -2.03; p<0.00001), hospital stays (MD: -2.40 days; 95%CI: -3.42 to -1.38 days; p=0.03), and recovery time (MD: -9.67 days; 95%CI: -10.81 to -8.53 days; p<0.00001). In conclusion, open proximal ureterolithotomy had less time, but laparoscopic surgery reduced postoperative pain, hospital stay, and recovery time. Both methods had comparable intraoperative bleeding and complications.

Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis.

Aim of our study was to review the current evidence on single port robot-assisted radical prostatectomy (SP-RARP) and SP robot-assisted simple prostatectomy (SP-RASP) procedures. A comprehensive bibliographic search on multiple databases was conducted in July 2023. Studies were included if they assessed patients with non-metastatic prostate cancer or candidate for benign prostatic hyperplasia surgery (P) who underwent SP-RARP or SP-RASP, respectively, (I), compared or not with other surgical techniques (C), evaluating perioperative, oncological, or functional outcomes (O). Prospective and retrospective original articles were included (S). A meta-analysis of comparative studies between SP-RARP and MP-RARP was performed. A total of 21 studies investigating 1400 patients were included in our systematic review, 18 were related to SP-RARP while 3 to SP-RASP. Only 8 comparative studies were eligible for meta-analysis. Mean follow-up was 8.1 (±5.8) months. Similar outcomes were observed for SP-RARP and MP-RARP in terms of operative time, catheterization time, pain score, complications rate, continence and potency rates, positive surgical margin, and biochemical recurrence. Length of hospital stay was shorter in the SP group after sensitivity analysis (WMD -0.58, 95% IC -1.17 to -0.9, p < 0.05). Subgroup analysis by extraperitoneal approach did not show any statistical difference, except for a lower positive margins rate in the SP extraperitoneal technique compared to MP-RARP. Overall, SP-RASP exhibited shorter hospital stay and lower rate of de novo urinary incontinence when compared to other techniques, while no differences were reported in terms of postoperative International Prostate Symptom Score, post void residual and maximum flow. Overall comparable oncological, functional, and perioperative outcomes can be achieved with SP platform. Subgroup analysis by different approaches did not reveal significant variations in outcomes. However, the retrospective nature of the studies, the limited follow-up, and the relatively small sample size of selected Centers may impact these results.

Mastopexy under local anesthesia: A case series and systematic review

ABSTRACT Background: Mastopexies are most frequently executed under general anesthesia. Local anesthesia (LA) on the breast tissue could make it possible to perform this type of operation without the need for (intravenous [IV]) sedation. This case series analyzes the procedure, operative pain scores, and postoperative outcomes of mastopexies performed under LA. The aim of this articles is to determine the feasibility of a mastopexy procedure under LA without the need for IV sedation. Methods: All patients, who underwent a mastopexy under LA, were retrospectively contacted and asked to fill in a questionnaire after informed consent. A systematic review was performed to identify all research available on this procedure. Results: A total of 51 patients, with an average age of 40.7 years, filled in the questionnaire. The mean Numeric Rating Scale (NRS) scores during the operation ranged from 3.47 (first intradermal injections) to 3.05 (subcutaneous injections) to 1.07 during the operation itself. Forty-five patients confirmed they would undergo the operation under LA again. Six patients did not want to undergo the same operation under LA anymore. Four patients had minor postoperative complications. Articles on mastopexy under LA without any type of IV sedation could not be found. Conclusions: This case series illustrates that mastopexies can be safely performed under LA. The peroperative and postoperative pain scores were low and patient satisfaction was high. This first-ever case series on mastopexy under LA without sedation shows promising results, which need to be confirmed in future studies. Level of Evidence: Level IV, case series.

A pilot study of intraoperative application of cooled radiofrequency to reduce post-operative pain following total knee arthroplasty

BackgroundTotal Knee Arthroplasty (TKA) is a successful treatment for end stage knee osteoarthritis (OA), but can be associated with significant pain in the early post-operative period. Cooled radiofrequency ablation (CRFA) has reported to reduce knee OA pain by targeting the periarticular nerves. The objective of this pilot study was to assess the effectiveness of intra-operative CRFA for reducing pain and opiate use after TKA. MethodsThis was a non randomised prospective study with control group. Participants were sequentially recruited preoperatively and underwent TKA, with CRFA to 6 targeted sites prior to cementing of implants, and were compared to controls who underwent TKA without CRFA. The primary outcome was Day 3 pain scores, and secondary outcomes included week one pain scores, and opiate use up to six weeks post-operative. Results17 participants were recruited to the control group and 12 were recruited to the CRFA group. There was no significant difference in demographics or baseline pain scores between the groups. On day 2 the CRFA group had a lower mean pain VAS score of 3.2 compared to 4.4 in the control group (p = 0.03). The mean post operative VAS pain score did not differ between the groups for Day 1, 3, 4, or any other time points up to 6 weeks. There were no significant reduction in opiate use in the CRFA group compared to the control group. There were no adverse events. ConclusionThis study demonstrated intra-operative CRFA was not effective in reducing pain by 50% after TKA in a pilot study.

The efficacy of preoperative tranexamic acid administration among patients undergoing arthroscopic rotator cuff repair: A systematic review and meta-analysis of randomized controlled trials

Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated the effectiveness of tranexamic acid (TXA) among patients undergoing arthroscopic rotator cuff repair (ARCR). Methods Five databases were screened until December 18, 2022. The included RCTs were assessed for risk of bias, and the endpoints were summarized as mean difference/standardized mean difference (MD/SMD) or risk ratio (RR) with the 95% confidence interval (CI) in a random-effects model. Results Seven RCTs with 510 patients (TXA = 261 and control/placebo = 249) were analyzed. The overall risk of bias was “low” and “unclear” in four and three RCTs, respectively. The mean operative time (n = 5 RCTs, MD = −9.64 min, 95% CI [−15.74, −3.54], p = 0.002) and mean postoperative pain score on postoperative day 1 (n = 5 RCTs, MD = −0.56, 95% CI [−1.06, −0.05], p = 0.03) were significantly reduced in the TXA group compared with the control group. However, there were no significant differences between both groups regarding visual clarity, amount of irrigation solution, and estimated intraoperative blood loss. Conclusion Among patients undergoing ARCR, preoperative TXA did not reduce intraoperative blood loss or improve visual clarity. However, TXA administration correlated with significant reductions (statistically) in operative time and postoperative day 1 pain score compared with the control group. Level of evidence: Level I; Systematic Review and Meta-analysis of Randomized Controlled Trials

Transversus Abdominis Plane Block VS. Local Wound Infiltration for Elective Minimally Invasive Cholecystectomy in Children: A Prospective Randomized Trial

BackgroundThe efficacy of transversus abdominis plane (TAP) block versus local anesthetic wound infiltration (LWI) in pediatric laparoscopic surgery is largely unknown. The objective of this study was to prospectively analyze this in minimally invasive cholecystectomy. We hypothesized that TAP block would be superior to LWI in terms of pain control and post-operative complications. MethodsWe conducted a prospective, randomized, single-blinded, controlled trial between 2017 and 2022 after obtaining Institutional Review Board (IRB) approval. After randomization, patients received a standard amount of ropivacaine via either 1) ultrasound-guided TAP block after general anesthesia induction or 2) local injection at port insertion by the operating surgeon. We collected data including operative time, pain scores, and medication usage post-operatively. We used descriptive statistics to report all endpoints and compared data with t-tests and Fisher's exact tests. A p-value less than 0.05 was considered statistically significant. ResultsWe enrolled 85 patients (43 LWI, 42 TAP). Mean [standard deviation] age and body mass index (BMI) in the LWI and TAP groups were 14.8 [1.9] and 14.7 [2] years and 29.9 [7.2] and 27.4 [8.2] kilogram/meter2 (kg/m2) respectively. We did not find any significant differences in postoperative opioid use, pain scores, and gastrointestinal symptoms. TAP patients had significantly longer time between anesthesia-start and procedure-start (p < 0.001), although total time under anesthesia was not significantly different (p = 0.540). ConclusionThere are no significant differences between equal administration of local anesthetic by TAP block and surgeon administered LWI during minimally invasive cholecystectomy. Type of StudyRandomized clinical trial. Level of EvidenceLevel II.

309 Comparison of Lichtenstein Procedure with and Without Mesh Fixation for Inguinal Hernia Repair in Terms of Postoperative Pain

Abstract Aim Although advanced techniques have been adopted in inguinal hernia repair parallel to those in developing medical technologies, currently no consensus has been reached on the best method among all existing methods. Post-operative pain is the main reason far longer hospital stay and delay in return to daily routine work. Aim of study was to compare the mean post operative pain of Lichtenstein procedure with and without mesh fixation for inguinal hernia repair. Methods Randomized control trial was conducted for six months after approval of synopsis. After permission from the concerned authorities and ethical committee and informed consent, patients were selected from indoor-patient department. All patients were assessed by consultant surgeons with more than 2 years of experience after fellowship, and the patients were prepared for hernia repair. Two groups were formed, Group-A included those managed by without mesh fixation and Group-B who were managed withmesh fixation. All the patients were assessed for postoperativepain at 24 hours by visual analogue scale (VAS). Results In our study, comparison of mean post operative pain score in both groups shows 3.23+0.77 in Group-A and 3.98+0.76 in Group-B, p value was 0.0001. Conclusion We concluded that post-operative pain is less in patients managed by Lichenstein repair without mesh fixation as compared to patients managed with mesh fixation.

SP10.14 Comparing packing and non-packing of the abscess cavity post incision and drainage of perianal abscess. A meta-analysis

Abstract Aims Wound packing following incision and drainage of perianal abscess has been found to be very painful. The aim of this study is to compare packing the wound and not packing the wound after incision and drainage of perianal abscess. Methods Standard medical electronic databases were searched and relevant published randomised controlled trials (RCT) were shortlisted according to the inclusion criteria. The summated outcome of post-operative pain score, recurrence rate and rate of occurrence of perianal fistula was evaluated using the principles of meta-analysis on RevMan 5 statistical software. Results Three RCTs on 490 patients undergoing incision and drainage of perianal abscess were included. In the random effects model analysis, the post operative pain score was statistically lower in NPG [risk ratio 0.66, 95%, CI (0.36, 0.97), Z=4.25, P=0.0001]. There was no heterogeneity [Tau2 = 0.15; chi2 = 9.32; df = 6; I2 = 36 %; p= 0.16] between the studies, however, statistically it was not significant. In addition, there was no statistical difference between the 2 groups in terms of recurrence of perianal abscess or the occurrence of perianal fistula [risk ratio 0.64, 95%, CI (0.31, 1.31), Z=1.23, P=0.22], [risk ratio 1.41, 95%, CI (0.89, 2.23), Z=1.47, P=0.14] respectively. Conclusion Not packing the wound post incision and drainage of perianal abscess is associated with significantly reduced VAS pain scores and has no effect on recurrence rate or the occurrence of perianal fistula. However, more RCTs recruiting a greater number of patients are required to endorse these findings.

Comparing packing and non-packing of the abscess cavity post incision and drainage of perianal abscess: A meta-analysis

Background: Pain is a very important factor in patient recovery and satisfaction. Following incision and drainage of perianal abscess, wound packing has been found to be very painful. The aim of this study is to compare packing the wound and not packing the wound after incision and drainage (I&amp;D) of perianal abscess, taking into account recurrence rate, rate of occurrence of perianal fistula as well as post-operative pain. Materials and Method: Standard medical electronic databases were searched with the help of a local librarian and relevant published randomised controlled trials (RCT) were shortlisted according to the inclusion criteria. The summated outcome of post-operative pain score, recurrence rate, and rate of occurrence of perianal fistula was evaluated using the principles of meta-analysis on RevMan 5 statistical software. Result: Three RCTs on 490 patients undergoing I&amp;D of perianal abscess were found suitable for this meta-analysis. In the random effects model analysis, the post operative pain score was statistically lower in NPG [risk ratio 0.66, 95%, CI (0.36, 0.97), Z=4.25, P=0.0001]. There was no heterogeneity [Tau2=0.15; chi2=9.32; df=6; I2=36 %; p=0.16] between the studies, however, statistically it was not significant. In addition, there was no statistical difference between the 2 groups in terms of recurrence of perianal abscess or the occurrence of perianal fistula [risk ratio 0.64, 95%, CI (0.31, 1.31), Z=1.23, P=0.22], [risk ratio 1.41, 95%, CI (0.89, 2.23), Z=1.47, P=0.14] respectively. Conclusion: Not packing the wound post I&amp;D of perianal abscess is associated with significantly reduced VAS pain scores, which may result in improved recovery and patient satisfaction and has no effect on recurrence rate or the occurrence of perianal fistula. However, more RCTs recruiting a greater number of patients are required to endorse these findings.

Supine Versus Prone Percutaneous Nephrolithotomy (PCNL): A Single Surgeon's Experience.

Percutaneous nephrolithotomy (PCNL) is one of the greatest advances in the field of urology and has been considered the gold standard in the treatment of renal calculi of more than 2 cm in size. While both the supine and prone positions offer their unique advantages, it is still being debated which position offers the most in terms of surgical outcomes. We have evaluated the two approaches in terms of operative time, success rate, stone clearance rate, safety, and complications. This prospective cohort study was done in the urology department of a tertiary care center in South India between January 2018 and October 2020. A total of 166 patients, with 83 in supine and 83 in prone positions, were included in the study. Both groups were matched in terms of age, body mass index, stone size and location, co-morbidities, medications taken, presence of diverticular stone, history of surgery, and baseline creatinine level. Mean operative time and pain scores were noted to be less in supine position as compared to prone. Ease of puncture was superior in supine position. Stone residue was noted to be higher in supine PCNL as well. Supine PCNLs are preferred in high-risk patients while the prone position is preferred in bilateral PCNLs, complex anatomy, or larger stone burden.

Ropivacaine 0.25% versus bupivacaine 0.25% in immediate post tonsillectomy pain management: a randomised control trial

Background: Tonsillectomy is one of the most common surgeries performed by an otolaryngologist, with post operative pain during the initial 24 hours being one of the most common challenging concerns. This makes it a need to find a suitable mode for managing the post operative pain imperative. This study aims to: assess the post operative pain control with ropivacaine 0.25% and bupivacaine 0.25% and to assess which among these two drugs are better in controlling the post operative pain and safer. Methods: The 70 patients were selected, randomized, double blinded into group 1 and group 2 and given intraoperative infiltration of either 0.25% ropivacaine or 0.25% ropivacaine respectively into the tonsillar bed after tonsillectomy. The surgeries were done by the same surgeon by cold steel method of tonsillectomy. Post operative pain was evaluated using VAS (visual analogue scale) at regular intervals. Other parameters like hemodynamic status, surgical duration, any adverse reactions to the medications are also recorded. Results: There was a statistically significant difference seen in the post operative pain scores between the two groups at all time intervals, with group 1 having a lower score compared to group 2. Conclusions: Intraoperative infiltration of local anesthetics into the tonsillar bed was effective in controlling the post operative pain, with ropivacaine suitable anesthetic agent as compared to bupivacaine due to its higher efficacy and safety.

COMPARATIVE STUDY BETWEEN OPEN AND LAPAROSCOPIC VENTRAL HERNIA REPAIR

Introduction: In today's era laparoscopy has gained quite popularity still there is debate on its use for ventral hernia. The main challenges in hernia management lie in deciding the surgical approach and type of repair procedure to perform, that is, laparoscopic or open surgery. A prospective observational comparative study was Material and methods: carried which included 90 patients out of which 45 patients underwent open mesh repair for ventral hernia and 45 patients underwent Laparoscopic mesh repair for ventral hernia were included in the study. Patients were follow up on post operative day 1, day 2, day 10, day 30 and day 60. The average duration of Results: surgery was slightly higher for the patients who underwent laparoscopic repair (95.11 vs 78.26 mins) with a P value of &lt;0.0001 suggestive of statistically signicant difference. The intraoperative blood loss was slightly lower lap repair group but the difference was not signicant statistically (P=0.1347). The mean VAS post operative pain scores were higher for the patients who underwent open hernia repair. Conclusion: The study concluded that laparoscopic repair took more time than compared to the open group of patients. However, the laparoscopic group of patients had a much better post operative outcome in terms of reduced intra operative blood loss and post operative pain

MP23-01 A RANDOMISED CONTROLLED STUDY COMPARING STANDARD TUBELESS PCNL &amp; TUBELESS MINI-PCNL FOR RENAL STONES LESS THAN 2 CM

You have accessJournal of UrologyCME1 Apr 2023MP23-01 A RANDOMISED CONTROLLED STUDY COMPARING STANDARD TUBELESS PCNL & TUBELESS MINI-PCNL FOR RENAL STONES LESS THAN 2 CM Aditya Yelikar Aditya YelikarAditya Yelikar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PCNL has become a standard minimally invasive treatment for renal stones. Tubeless PCNL is associated with less morbidity. Miniaturisation of instruments leads decrease morbidity of procedure. We compared standard tubeless PCNL to Miniperc tubeless PCNL for morbidity and stone free rates in order to improve outcomes of PCNL with minimal morbidity. METHODS: Our study included 100 patients, 50 patients in group 1 (standard tubeless PCNL) & 50 patients in group 2 (tubeless mini PCNL) , with single renal stone less than 2 cm. Patients with CKD, solitary kidney, ectopic kidney and previous diversion were excluded. Tract was dilated upto 24 Fr in group 1 & upto 16 Fr in group 2. No percutaneous nephrostomy was kept. Post operative pain score was monitored at 12 and 24 hours. Additional analgesia was given if needed. Hemoglobin was measured pre operatively & on post op day 1. Stone clearance was checked with ultrasonography & XRay KUB (kidney-ureter-bladder). Total Operative time , pain score, analgesic requirement, haemoglobin drop, complications (bleeding, fever, urinary leak, urosepsis, hydro or pneumothorax) and stone free rate were compared. RESULTS: Miniperc operative time was longer than standard PCNL (45±10 vs 35±8 mins. p<0.001). Median pain score at 12 and 24 hours was more in group 1 than in group 2 (6±1 VS 4±1, p<0.0001 and 3±1 vs 2±1, p<0.001). Post operative hemoglobin drop was more in group 1 than in group 2 (0.95±0.2 VS 0.6±0.1, p<0.0001). Stone clearance in group 1 was 100% while in group 2 it was 95%. There was no significant difference in complications between the two groups. CONCLUSIONS: Both Standard tubeless PCNL & tubeless Mini PCNL are effective for renal stones less than 2 cm. Operative time is more in tubeless Mini PCNL whereas pain score, analgesics requirement and hemoglobin drop are more in standard tubeless PCNL comparatively. Stone clearance in both groups is comparable and more than 95%. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Yelikar More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of analgesic efficacy of topical tramadol versus topical lidocaine in the control of postoperative pain in children after tonsillectomy: A randomized double-blinded clinical trial

Background and aim Tonsillectomy is considered one of the most frequent minor surgeries conducted on a day-case basis on children, and usually associate with pain and sore throat. This study aimed to compare the effect peritonsillor tramadol and lidocaine in pain alleviation after tonsillectomy in pediatrics. Patients and methods This prospective, randomized, double blind, controlled clinical study included 80 children, aged 4–15 years. They were distributed into two groups; Group T (n=40) patients received swabs soaked with tramadol 5% diluted with saline 0.9% up to 10 ml; group L (n=40) patients received swabs soaked with ledocaine 2% 2 mg/kg diluted with saline 0.9% up to 10 ml. Post operative pain scores, bleeding, nausea, vomiting, sore throat, otalgia, fever, halitosis, and trismus were recorded. Results Pain score was significantly reduced in the lidocaine arm within two hours after surgery, compared to the tramadol arm (P&lt;0.05). The mean modified VAS score at day 7 was significantly reduced in the tramadol arm, compared to lidocaine arm (1.21 Vs 2.42, P&lt;0.05). No significant difference between the two arms was reported, in terms of postoperative nausea and vomiting, halitosis, fever and otalgia. More serious complications like post-tonsillectomy bleeding or trismus were not reported in either groups Conclusion Topical 5% tramadole and lidocaine has a significant value in post tonsillectomy analgesic effect. Lidocaine had rapid onset at 15 min and duration prolonged up to 2 hours. Tramadol had delayed onset and prolonged duration from 4 hr up to 7 days.