Pain In Immediate Postoperative Period Research Articles

Comparison of post-tonsillectomy analgesic drugs (Paracetamol,Diclofenac sodium, and Tramadol)

To compare the effectiveness of using paracetamol, diclofenac sodium, and tramadol in controlling post tonsillectomy pain in immediate post-operative period. Sixty patients from 10 to 30 years old undergoing tonsillectomy by classical cold steei method and homeostasis done by ligation r,vith or without electrocauterization. We divided them into three groups according to the type of analgesic drug received in the immediate post operative period: Group A (20 patients) received paracetamol injection 15mg/kg/dose. Group B. (20 patients) received diclofenac sodium injection l.25mglkg lday. Group C (20 patients) received tramadol injectionlmg/kg/dose. Post-operative pain assessed clinically and according to visual analogue scales during rest and deglutition. 8 patients (40%) of group A have good response VAS less than 30 mm with mild discomfort, 15 patients (75%) of group B have good response and in group C 17 patients (85%) have VAS less than 30 mm with mild discomfort. There was significant difference between group B and C in comparison with group A (p:0.039), but there was no significant difference between group'B and group C (p >0.05). Tramadol and diclofenac sodium are most effective in controlling post tonsillectomy pain even in those patients who have tonsillectomy with e lectrocauterization.

Sublay mesh versus Onlay mesh: a randomized comparative study

Introduction. Ventral hernias are the second most common hernia; Onlay and Sublay operating techniques are procedures commonly performed in such cases. There is no consensus on the superiority of these procedures. The aim of this study was to compare the results of both procedures in order to identify the recommended technique between the two options. Materials and Methods. A total of 106 patients with epigastric, umbilical, paraumbilical, incisional hernias were studied. These patients were grouped into group A (onlay) and Group B (sublay). The outcomes of the two techniques were compared with respect to operative time, pain, hospital stay, seroma, infection, recurrence and patient satisfaction. Results. The mean operative time was 81.30 minutes in group A, and 85.85minutes in group B. Twenty-two (42.5%) patients in group A and seven (12.96%) patients in group B developed seroma. Nine (17.3%) patients in group A, 3 (5.55%) patients in group B developed post-operative infection. 30 (57.69%) patients in group A and 47(87.3%) patients in group B reported moderate pain, whereas three (5.76 %) and seven (12.96%) patients in group A and group B were reported severe pain in immediate post-operative period. At 48 hours, 20 (38.46%) and 24 (44.44%) of patients in group A and B were reported moderate pain, whereas 32 (61.53%) and 30 (55.55%) patients in group A and B reported mild pain. The mean hospital stay was 10.11 days in group A and 6.22 in group B. Three (5.76 %) patients of group A has recurrence, none of the patients in sublay group has developed recurrence. Thirty-nine (72.22%) patients of sublay group expressed their satisfaction but only 20(38.46%) patients in onlay group expressed their satisfaction. Conclusion. With reference to all the study parameters except one, the sub lay technique of mesh placement appears to be better. The exception is pain in the immediate postoperative period.

Comparision of functional outcome of arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus and gracilis graft fixed with bioabsorbable interference screw against titanium interference screw

Background: Knee injuries are more common due to exponential increase in road traffic accidents and more involvement in sports related activities by common people. Anterior cruciate ligament injury is one of the most common injuries around knee and poses quiet a lot management controversy. Aims and Objectives: To do comparative analysis of the functional outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction using quadrupled semitendinosus and gracilis graft with endobutton as femoral fixation device and bioabsorbable interference screw against titanium interference screw as tibial fixation devices respectively. Materials and Methods: 60 Patients with ACL tear attending out patient department of a tertiary care hospital were recruited in this prospective, comparative study. Detailed proforma consisting of patient information, Lysholm and Gillquist scoring scale were administered pre and postoperatively for patient. The difference in clinical outcome of both groups was compared. Out of 60 patients 30 patients underwent ACL reconstruction using Titanium screw and 30 patients underwent ACL reconstruction using Bioabsorbable screw. All patients were followed up for a period of 6 months post operatively. Improvement in patient condition was measured in terms of improved Knee range of motion, walking with or without support, any instability, any locking of knee, any pain while activity. Results: Mean preoperative Lysholm score for Titanium group was 52.60 and postoperative score is 85.56. Mean preoperative Lysholm score for Bioabsorbable Group is 54.70 mean postoperative score for group is 87.63. The increase in both scores was statistically significant when compared within the groups. And when both groups are compared, there was no significant difference between 2 groups. Few of our patients presented with anterior knee pain in immediate post-operative period which subsided with physiotherapy and medication, none of them had chronic knee pain. Conclusion: Our study shows that there is no difference in functional outcome whether bioabsorbable or titanium interference screw was used.

Ultrasound-guided Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Background:Laparoscopic cholecystectomy (LC) is associated with moderate-to-severe pain in immediate postoperative period. Some patients even suffer from prolonged pain long after surgery.Aims:The aim of present study is to determine the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) in patients undergoing LC, time to ambulation after surgery, and incidence of prolonged pain up to 6 months later.Settings and Design:This was a double-blinded prospective randomized controlled trial.Materials and Methods:Eighty-five adults posted for elective LC were randomized to receive bilateral ESPB at T7 level with either 20 mL of 0.375% ropivacaine or 20 mL normal saline. Postoperative static and dynamic pain score as per the visual analog scale (VAS), intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted.Statistical Analysis:Independent t-test and Mann–Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data.Results:Static and dynamic VAS scores were significantly lower in ESPB group (P < 0.05). Intraoperative fentanyl requirement (165 ± 30.72 – ESPB, 180.95 ± 29.12 – controls, P = 0.020) and number of patients requiring diclofenac (28/42 – ESPB, 37/42 – controls, P = 0.019) were lower, while number of patients ambulating by 4 hours (20/42 – ESPB, 9/42 – control, P = 0.012) were higher in ESPB group. Patients suffering from pain at 1 week (22/42 – ESPB and 34/42 – control, P = 0.005) and 1 month (9/42 – ESPB and 13/42 – control, P = 0.207) were lower in ESPB group.Conclusion:ESPB provides effective analgesia and early ambulation after LC. The benefit extends to 1 week thereafter.

A comparative prospective randomised controlled study for mesh fixation by cyanoacrylate glue versus prolene sutures in patients undergoing Lichtenstein hernioplasty

Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio &gt;1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.

Role of coblation in reducing pain and morbidity of adenoidectomy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Adenoidectomy is one of the most commonly performed paediatric surgical procedure by otorhinolaryngologists. Over the past few decades, adenoidectomy has evolved and different techniques have been proposed to reduce morbidity and surgical risk. Controlled ablation or Coblation® is capable of low temperature molecular disintegration within soft tissue causing its dissolution. In this study, we report our experience of adenoidectomy using Coblation®, and its role in reducing pain, morbidity and its significant outcomes are discussed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total number of 25 children aged 3-15 years, who underwent coblation adenoidectomy between March 2017 and April 2018 were included in this study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age was 7.8 years (males 7.79 years and females 7.81 years). Pre operatively 100% patients had sleep disturbance and after coblation adenoidectomy only 12% patients have disturbed sleep and the rest 88% patients have comfortable sleep. 80% patients did not have pain in immediate post-operative period and 88% had no pain when they visited hospital for first review. 76% patients had less than one day of hospital stay and 24% patients had more than one day of hospital stay. 68% patients had no episode of upper respiratory tract infection (URTI) within the first one year after surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Over the years, many different adenoidectomy techniques have evolved and is surgeon specific or centre specific. Endoscopic-assisted coblation adenoidectomy is a safe and effective method of adenoidectomy.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Transinguinal preperitoneal technique of inguinal hernioplasty - a better alternative to lichtenstein procedure.

The Lichtenstein technique is currently one of the popular methods in practice as it provides very good results consistently. However many patients suffer from wound indurations' and chronic wound pain which are often underreported. The transinguinal preperitoneal technique (TPT) avoids these complications by placing the mesh in preperitoneal plane by open approach. In this study, 71 patients were randomized into two groups one, of which one underwent the Lichtenstein repair and the other preperitoneal repair by TPT. All the patients were followed up for two years. Patients in TPT group had less pain in immediate post-operative period (p - .005), less wound induration and chronic pain on follow-up. Patients were also able to return to work early (p =0.036) . Average duration of operation was slightly longer compared to Lichtenstein technique (p < .0061) .There was no recurrence in either group on 2 year follow-up. This study shows that TPT provides a better alternative to Lichtenstein technique with decreased incidence of wound complications and chronic groin pain, while having a similar recurrence rate. Preperitoneal mesh placement by open approach in TPT is also easier and eliminates the need for laparoscopy.

Gossypiboma in the early postoperative period: computed tomography appearance.

Recognition of postoperatively retained foreign body, referred euphemistically as gossypiboma, is essential but is very often considerably delayed. Legal implications as well as confusing configuration patterns cause considerable dilemma in the accurate diagnosis. A good understanding of the radiological appearances of this foreign body helps in appropriate early management of such patients. We present computed tomographic features of gossypiboma in patient who presented with symptoms of fever and pain in the immediate postoperative period.