Postoperative Recovery Research Articles

Impact of Preoperative Progressive Relaxation Exercises on Postoperative Pain, Comfort, and Recovery

Impact of Preoperative Progressive Relaxation Exercises on Postoperative Pain, Comfort, and Recovery

Manual Acupuncture for Postoperative Pain and Recovery after Abdominal Surgeries: A Systematic Review.

Introduction: Acupuncture's role in surgical and postoperative contexts is gaining traction. However, the evidence remains patchy and is often of low-grade quality, particularly in the context of postintestinal surgery. Purpose: To assess acupuncture's efficacy in pain relief and functional recovery after abdominal surgery. Methods: We searched PubMed, Cochrane, Web of Science, and Google Scholar for randomized trials using manual acupuncture as the main intervention. Outcomes included postoperative pain, analgesic use, nausea, gastrointestinal (GI) regeneration, and length of hospital stay. For risk of bias assessment Cochrane risk of bias tool 2 was employed. Registered with PROSPERO: CRD42022311718. Results: Of 700 records till May 2023, 8 trials (551 patients; 16-200/trial) were included. Due to factors such as varying experimental settings and unpublished protocols, there was high risk of bias and heterogeneity, making meta-analysis unfeasible. Safety data were documented sufficiently by two trials. However, acupuncture showed marked benefits in pain relief, less analgesic use, fewer nausea cases, and improved GI recovery. One study reported reduced hospitalization time. Conclusion: Due to the varied methodologies and potential biases in existing studies, the definitive effectiveness of acupuncture remains unclear. To confirm the potential benefits of acupuncture as suggested by the reviewed studies, it's imperative to have more standardized study protocols, well-defined interventions and controls, and objective measures of efficacy.

A rib-sparing unilateral transpedicular thoracic corpectomy using the ultrasonic bone scalpel: a novel technique and pictorial guide

BackgroundThe thoracic corpectomy is a well-described technique for the surgical treatment of vertebral column fractures with spinal canal compromise. Traditionally, the posterolateral approach to this procedure required the removal of the approach side rib in order to introduce the corpectomy cage. This rib removal, however, has been identified as a major contributor to post-operative morbidity. Rib-sparing techniques have been shown to be beneficial in minimizing post-operative morbidity in non-spinal surgeries. Herein, we present a previously undescribed technique of a rib-sparing thoracic corpectomy that avoids sequalae of rib resection with assistance from an ultrasonic bone scalpel (UBS).MethodsA retrospective chart review was conducted on patients having undergone this thoracic corpectomy technique. Data on patient age at operation, indication for surgery, number of corpectomies per case, estimated blood loss (EBL), operative time (OT), intra-operative complications, and post-operative length of stay (LOS) were collected and analyzed. A pictorial step-by-step guide was created to highlight the advantages of an entirely posterior rib-sparing unilateral transpedicular technique for thoracic corpectomy.ResultsA total of 36 corpectomies were performed on 32 patients between August 2015 and March 2023. Patients ages ranged from 17 to 85 years (mean = 63). The most common indication was oncological (n = 22, 69%), followed by degenerative/traumatic deformity (n = 7, 22%), and infection (n = 3, 9%). For the cases for which data was accessible, mean EBL was 853 cc and mean OT was 178 min. The average post-operative LOS was 6.5 days.ConclusionThe described surgical approach makes it possible to create a transpedicular corridor with no costectomy for implantation of an expandable titanium cage and anterior column reconstruction. The use of the UBS in this approach is critical as it minimizes bony removal and avoids sequelae of rib resection. The described technique has the potential to circumvent post-costectomy pain, thereby expediting post-operative recovery after thoracic corpectomy.

Impact of enhanced recovery after surgery on postoperative blood management following primary total knee arthroplasty: a propensity score-matched analysis.

To evaluate the efficacy of blood management in patients underwent unilateral Total Knee Arthroplasty (TKA)under an enhanced recovery after surgery (ERAS) program. Patients underwent unilateral TKA from January 2019 to October 2023 in a university hospital were retrospectively studied. A total of 200 cases were selected in the analysis. After matching with propensity scoring, 51 patients in each group were included. The postoperative Haemoglobin (Hb), albumin (Alb), C-reactive protein (CRP), total length of stay (LOS), and estimated blood loss after operation were compared between the two groups. Clinical outcomes including Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF-12, and Oxford Knee Score (OKS) were also compared atsixweek and threemonth follow-up. The results showed that the Hb of the ERAS group was significantly higher than those of the non-ERAS group (P < 0.05) on the third postoperative. The mean CRP level was lower, LOS was shorter, and Alb level was higher in the ERAS group compared to that in the non-ERAS group (P < 0.05). The clinical outcomes such as WOMAC and OKS, SF-12 scores were higher in the ERAS group at both follow-up. ERAS protocol effectively minimizes perioperative blood loss and supports optimal nutrient levels in patients. ERAS management significantly contributes to the postoperative recovery of knee function in patients undergoing primary total knee arthroplasty.

Second-Generation Supraglottic Airway Devices Versus Endotracheal Intubation in Adults Undergoing Abdominopelvic Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Second-generation supraglottic airway (SGA) devices are widely used, but thought to have inferior safety performance to endotracheal tubes (ETTs), but might be equally efficacious while improving patient-centered outcomes. We compared second-generation SGAs with ETTs for perioperative safety, efficacy, and quality of recovery in adults undergoing abdominopelvic surgery under general anesthesia. Our primary objective was to assess safety in the form of major airway complications. Secondary objectives were other safety, efficacy, and quality of recovery outcomes. METHODS: We searched 4 databases for randomized controlled trials of adult patients having abdominopelvic surgery comparing second-generation SGAs and ETTs. After 2-person screening and data extraction, pairwise meta-analysis was conducted and the grading of recommendations, assessment, development, and evaluation (GRADE) approach was applied to assess the certainty of evidence. RESULTS: A total of 51 studies, randomizing 5110 patients, were included. Second-generation SGAs significantly reduced the risk of major perioperative airway complications (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.23–0.71; P = .007; low certainty), with no clear clinically relevant difference in regurgitation or pulmonary aspiration (low certainty). SGAs significantly increased the risk of inadequate ventilation (RR, 3.36; 95% CI, 1.43–7.89; P = .011; very low certainty); however, postoperative sore throat (RR, 0.52; 95% CI, 0.38–0.70; P &lt; .001; moderate certainty), hoarseness (RR, 0.32; 95% CI, 0.231–0.48; P &lt; .001; low certainty), coughing at the emergence of anesthesia (RR, 0.17; 95% CI, 0.08–0.36; P &lt; .001; low certainty), and postoperative nausea and vomiting (RR, 0.64; 95% CI, 0.42–0.98; P = .042; very low certainty) were all less frequent with SGAs. No other clinically relevant differences were observed for other remaining outcomes. CONCLUSIONS: Second-generation SGAs reduce the risk of major airway complications compared with ETTs in adults undergoing abdominopelvic procedures under general anesthesia, with no reported clinically relevant differences in the risk of regurgitation or pulmonary aspiration. Additionally, they improve the quality of postoperative recovery with lower risk of sore throat, hoarseness, and postoperative nausea and vomiting. These data provide an opportunity for clinicians to reassess the implications of conservative airway management, and potentially expand the role of second-generation SGAs in routine clinical practice.

Postoperative recovery in peroral versus intravenous antibiotic treatment following laparoscopic appendectomy for complicated appendicitis: a substudy of a cluster randomized cluster crossover non-inferiority study.

Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis. This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire. The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications. Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles. ClinicalTrials.gov NCT04803422.

Advantage of post-operative inflammatory status after laparoscopic distal pancreatectomy.

Introduction Laparoscopic distal pancreatectomy (LDP) is a safe and effective procedure; however, its impact on perioperative inflammatory reactions compared with open distal pancreatectomy (ODP) remains unclear. This study aimed to assess short-term outcomes following LDP and ODP regarding inflammatory reactions. Methods This retrospective study of 77 consecutive patients who underwent distal pancreatectomy for low-grade malignancies between 2005 and 2022 compared white blood cell (WBC) count, C-reactive protein (CRP) level, serum albumin level, and CRP/albumin ratio (CAR) between LDP and ODP. Complications, especially postoperative pancreatic fistula (POPF), recovery program, and hospital stay period were also compared. Results POPF (17.1% vs. 38.7%, p = 0.039) and surgical morbidity (≥Clavien-Dindo Grade III, 12.2% vs. 32.3%, p = 0.038) were significantly lower in LDP than in ODP, as for the difference in postoperative inflammatory response, including CRP and CAR, was just temporary. By multivariate analysis, CAR≥6.94 on POD 3 was significant predictor of POPF (42.1% vs. 13.2%, Odds ratio 4.828, p=0.030) Conclusion LDP has lower POPF and earlier postoperative recovery. CAR could be a predictor of POPF.

Three-dimensional Morphometric Analysis of the Effectiveness of Kinesio Taping on Postoperative Discomfort Following Mandibular Third Molar Surgery: A Prospective Randomized Split-mouth Study

This study investigates the efficacy of Kinesio taping (KT) in reducing postoperative discomfort, including edema, trismus, and pain, following mandibular third molar extraction. A prospective randomized split-mouth design was employed, involving 7 patients with impacted mandibular third molars. KT was applied immediately postsurgery, and outcomes were assessed on the third and seventh postoperative days using a Visual Analog Scale (VAS) for pain, 3D morphometric analysis for swelling, and caliper measurements for trismus. Results showed significant reductions in pain, swelling, and trismus on the KT-treated side compared with the control side. The most notable differences were observed on day 7, where KT demonstrated superior effectiveness in alleviating symptoms. The control group showed improvement over time, but the KT-treated group experienced faster and more pronounced recovery. In conclusion, KT proved to be a safe and effective method for improving postoperative recovery following mandibular third molar surgery, offering a low-cost, accessible option to enhance patient comfort and quality of life.

Opportunities and challenges in the development of artificial intelligence research in spinal surgery

Artificial intelligence has emerged as a game-changer in the field of spine surgery, offering transformative diagnostic and therapeutic approaches for spinal conditions. The application of AI in spine research encompasses a diverse range of diseases, with usage scenarios becoming increasingly widespread and technological integration going deeper. AI technology shows immense promise and value in the diagnosis of spinal diseases, the formulation of treatment strategies, surgical navigation, prognostic evaluation, and postoperative rehabilitation. Through deep learning and machine learning, AI can aid doctors in enhancing diagnostic accuracy, creating personalized treatment plans, and executing precise maneuvers during surgery, thus improving operational safety. Moreover, AI can provide intelligent support for patients' postoperative recovery, facilitating the restoration of their functions. However, current research is still in its nascent stage and confronts several challenges, such as the lack of standardized databases, the simplicity of algorithmic learning models, the inadequate fusion of multi-modal clinical information, and the limited clinical applicability. By developing open-source, standardized spine databases, incorporating innovative intelligent core algorithms, and establishing normalized screening, diagnostic, and predictive models for spinal conditions, we trust that we can drive the innovation and refinement of diagnostic and treatment technologies in spine surgery. This will realize an effective conjunction between technological provision and clinical demands, continuously elevating the intelligence level of spine surgery and offering safer, more effective medical services to a vast array of patients.

Early non-compliance to ERAS in gynecological open surgery for malignancies, and post-operative complications: a multicenter, prospective, observational, cohort study

BackgroundOpen surgical procedures for gynecological malignancies have a potential risk of post-operative complications and hence prolonged hospitalization, despite adherence to an Enhanced Recovery After Surgery (ERAS) protocol.Primary ObjectiveTo investigate the...

Comparison of Analgesia Methods Through a Web Platform in Patients Undergoing Thoracic Surgery: Pilot Design, Implementation, and Validation Study.

Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children's Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy. This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality.

Deep Neuromuscular Block with Low Pressure Pneumoperitoneum in Laparoscopic Abdominal Surgeries: A Randomized Controlled Trial

Background: Postoperative pain management remains a challenge in laparoscopic abdominal surgeries. Objectives: The purpose of this research was to determine the effects of deep neuromuscular blockade (NMB) in conjunction with low-pressure pneumoperitoneum )PP) on postoperative pain, surgical parameters, and recovery outcomes. Methods: This randomized controlled double-blind study included 44 participants undergoing laparoscopic abdominal surgery. Patients were randomized equally into two groups (22 each): Group D received deep NMB, while group M received moderate NMB using cis-atracurium, through the utilization of computer-generated random numbers enclosed within sealed, opaque envelopes, following a parallel approach. Regarding deep NMB, following an initial dose of 0.15 mg/kg, a continuous infusion of 0.06 - 0.12 mg/kg/hr was administered to maintain a post-tetanic count between 1 and 2, with low PP pressure of 10 - 12 mmHg. Conversely, for moderate NMB, after the same initial dose of 0.15 mg/kg, the continuous infusion commenced upon the train-of-four count returning to 2, with the rate adjusted to sustain a count between 1 and 3, and standard PP pressure of 15 mmHg. The primary outcome was postoperative pain intensity as measured by Numerical Rating Scale (NRS) scores in the post-anesthesia care unit (PACU). The secondary outcomes included postoperative pain intensity measured by NRS scores from 2 hours to 48 hours post-surgery, time to first analgesic administration, cumulative opioid consumption within the initial 48-hour postoperative period, and patient-reported satisfaction with postoperative pain management. Statistical analysis using SPSS v26 included tests for normality (Shapiro-Wilks), with parametric data analyzed by t-test, non-parametric data by Mann-Whitney, and qualitative data by chi-square/Fisher's test. Results: Group D experienced a considerably longer time until the first analgesic rescue compared to group M (9.82 ± 1.5 hours vs. 7.23 ± 1.19 hours, P &lt; 0.001). Morphine consumption in the first 24 hours was lower in Group D (10.77 ± 1.51 mg vs. 13.09 ± 1.74 mg, P &lt; 0.001). At 6, 8, and 12 hours postoperatively, group D exhibited significantly lower pain scores (P &lt; 0.05). Surgical duration, surgical field quality, complication rates, and patient satisfaction were comparable between groups. Conclusions: Deep NMB combined with low-pressure PP provided superior postoperative analgesia without compromising surgical field quality or increasing complications in laparoscopic abdominal surgeries.

A comparative study between dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound guided interscalene block for arthroscopic shoulder surgery

Background &amp; Objectives: Arthroscopic surgery is a preferred approach for shoulder surgeries due to its documented advantages of early postoperative recovery. However, postoperative pain remains a concern for which different techniques are used. Interscalene block (ISB), using dexmedetomidine (DXM) or dexamethasone (DXA) as adjuvants to local anesthetics (LA), is a common analgesic method. We conducted this comparative study to establish if any one of the adjuvants is better in terms of postoperative analgesia. Methodology: Patients undergoing shoulder arthroscopy were assigned randomly to three groups: Group A (LA alone), Group B (ISB with DXM), and Group C (ISB with DXA). Assessment of intraoperative and postoperative hemodynamics, visual analog scale (VAS) pain scores, time to first rescue analgesic, and rescue analgesic (ketorolac) consumption were recorded. Results: Intraoperative and postoperative heart rate and mean arterial pressure showed no significant differences among the three groups, suggesting comparable hemodynamic control. VAS pain scores were equivalent at 1, 2 and 6 h postoperatively, but at 12, 18 and 24 h, Groups B and C demonstrated significantly lower scores compared to Group A (P &lt; 0.001). Time to first rescue analgesic was prolonged in Groups B and C, indicating improved and longer-lasting analgesia. Groups B and C consumed considerably less ketorolac overall than Group A (P &lt; 0.001). Conclusion: While all three groups exhibited equivalent intraoperative and postoperative hemodynamic control, the addition of dexmedetomidine or dexamethasone to local anesthetics for interscalene block prolonged postoperative analgesia, reduced pain scores at 12, 18 and 24 h, delayed time to first rescue, and decreased total analgesic consumption. Both adjuvants showed advantages over local anesthetics alone, emphasizing their potential in multimodal analgesia for shoulder arthroscopy. Abbreviations: ISB - Interscalene block; DXM - Dexmedetomidine; DXA - Dexamethasone; HR – Heart Rate; MAP – Mean Arterial Pressure; VAS Visual Analog Scale. Trial registry: PACTR202210507488378 Keywords: Analgesia; Analgesia, postoperative; Dexmedetomidine; Dexamethasone; Interscalene block; Pain, postoperative; Shoulder arthroscopy Citation: Nashaat P, Mohamed O, George S, Mohammed A, Samy E. A comparative study between dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound guided interscalene block for arthroscopic shoulder surgery. Anaesth. pain intensive care 2024;28(5):850−858; DOI: 10.35975/apic.v28i5.2566 Received: June 13, 2024; Reviewed: June 20, 2024; Accepted: July 18, 2024

Comparative outcomes of cardioplegic arrest versus beating heart in pediatric undergoing extracardiac total cavopulmonary connection

BackgroundTotal cavopulmonary connection (TCPC) is a definitive palliative procedure for functionally univentricular congenital heart disease. The study aims to compare the impact of on-pump cardioplegic arrest and on-pump beating heart cardiopulmonary bypass (CPB) on the prognosis of pediatric patients undergoing extracardiac TCPC.MethodsThe medical data of patients (< 18 years) who underwent extracardiac TCPC with CPB between January 2008 and December 2020 in the cardiac surgery center were retrospectively analyzed. Depending on CPB strategies, the patients were assigned to the beating-heart (BH) and cardioplegic arrest (CA) groups. Data including baseline characteristics, intra/postoperative variables, and clinical outcomes were collected for analysis with 1:1 propensity score matching and multivariable stepwise logistic regressions.ResultsFifty-seven matched patient pairs were obtained. No significant difference existed between the two groups in the in-hospital mortality (3.5% vs. 1.8%, P = 1) and one-year survival rate (100% vs. 96.4%, P = 0.484). The BH group had significantly less intraoperative platelet transfusion (10 mL vs. 150 mL, P = 0.019) and blood loss (100 mL vs. 150 mL, P = 0.033) than the CA group. The CA group had significantly higher vasoactive-inotropic scores (P < 0.05) and longer postoperative ICU stays (2.0 d vs. 3.7 d, P = 0.017). No significant difference existed between the two groups in the incidence of postoperative adverse events.ConclusionAlthough both CPB strategies are safe and feasible for extracardiac TCPC, the BH technique would cause less intraoperative platelet transfusion and blood loss, and achieve faster early-term postoperative recovery.

Summary of Best Evidence for Perioperative Management Practices in Hair Transplantation Patients : Facial Skeleton.

To integrate and summarize the best evidence on perioperative management practices for hair transplantation patients, providing an evidence-based reference for clinical. An exhaustive literature search was conducted to identify the best evidence for managing patients undergoing hair transplantation during the perioperative period. The databases searched included Up To Date, BMJ Best Practice, UK National Institute for Health and Care Excellence, National Guideline Clearing House, Scottish Intercollegiate Guidelines Network, Guidelines International Network, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, PubMed, Web of Science, European Dermatology Forum, China National Knowledge Infrastructure, Wanfang Data, Medlive Guideline Network, and Sinomed. The search spanned publications from February 2013 to February 2024, focusing on clinical decisions, evidence summaries, guidelines, and expert consensus. We finally identified 22 articles with high-quality results (consisting of 9 clinical decisions, 6 guidelines, 7 expert consensuses), providing 41 pieces of evidence across seven categories: assessment of transplantation conditions, transplant planning and preoperative preparation, anesthetic preparations, surgical methods and operation skills, postoperative wound management, medication-related guidance, optimization of nursing and treatment strategies. Special emphasis has been placed on the sections covering anesthesia preparation, surgical methods, and operational techniques, with detailed explanations provided. The summarized best evidence on perioperative management practices for hair transplantation patients can serve as evidence-based guidelines for clinical. It is recommended that clinical staff adopt evidence-based recommendations to improve and optimize patient outcomes and promote postoperative recovery. As these evidences came from different countries, factors such as the clinical environment should be evaluated before application. This 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 .

Effects of 60 degrees of flexion and perioperative use of tranexamic acid on recovery after knee replacement

Abstract OBJECTIVE To explore the effect of 60 knee flexion combined with multiple tranexamic acid application on postoperative recovery of knee replacement patients. METHODS Knee replacement patients admitted to our hospital from October 2020 to September 2022 were selected as the study subjects, and randomly divided into two groups. Postoperative D-dimer, prothrombin time and partial thrombin time were recorded in the two groups, and the differences between the two groups were compared. Erythrocyte, hemoglobin and erythrocyte volume were recorded before, 1 day and 3 days after surgery and the affected limb circumference were also assessed. RESULTS On the 1st and 3rd day after surgery, the red blood cells, hemoglobin, and hematocrit levels in the experimental group were higher than those in the control group, and the differences were statistically significant(P&amp;lt;0.05). The difference in VAS score and circumference between the two groups on the 1st day and 3rd day after surgery was compared, and the difference was statistically significant. The difference in VAS score and circumference was lower in the control group(P&amp;lt;0.05). After surgical treatment, knee joint function recovered, knee joint mobility and HSS score improved, and the difference between the experimental groups was statistically significant (P&amp;lt;0.05). CONCLUSION Perioperative 60-degree flexion combined with multiple tranexamic acids can significantly reduce blood loss in patients undergoing knee replacement surgery, increase red blood cells, hemoglobin levels and red blood cell volume on postoperative days 1 and 3, and reduce postoperative swelling of the affected limb.

The effect of preadmission education given to bariatric surgery patients on postoperative recovery: A randomized controlled study.

To investigate the effect of preadmission education given to laparoscopic sleeve gastrectomy patients on preoperative and postoperative anxiety, postoperative pain, and patient vital signs. The study was designed as randomized, controlled, experimental, and single-blind. This study was conducted with 68 patients who met the inclusion criteria and underwent laparoscopic sleeve gastrectomy in the general surgery clinic of a university hospital between December 2022 and October 2023. Data were collected using the 'Perioperative Form,' 'Visual Analog Scale,' and 'State Anxiety Scale I-II.' Intervention group patients were informed and educated about the surgical process in the outpatient clinic. The anxiety levels of all patients were determined with the State Anxiety Scale the day before surgery. In the postoperative period, vital signs (once), anxiety (on the first day after surgery), and pain levels (eight times during 48 h) were measured. In the analysis between the groups, the difference between the duration of postoperative hospital stay (p = 0.007), pain (p = 0.000 for all measured), and anxiety levels (p = 0.000) was statistically significant. There were also significant differences in the diastolic blood pressure (p = 0.007), body temperature (p = 0.000), and saturation values (p = 0.000). Patients' readiness level for surgery was the most influential factor in postoperative pain levels (p = 0.000). The education given to the patients before hospitalization decreased preoperative and postoperative anxiety levels, postoperative hospital stay and pain levels, and positively affected diastolic blood pressure, body temperature and saturation levels. One-to-one education given to patients in the outpatient clinic also contributes positively to their readiness for surgery. This study provides valuable evidence to the wider global clinical community by demonstrating the important benefits of preadmission education for patients undergoing bariatric surgery. Implementation of similar educational interventions in diverse healthcare settings worldwide may lead to increased postoperative recovery and improved overall patient well-being after bariatric surgery.

Analysis of different surgical approaches to the treatment of thymoma

BackgroundSurgical approach in the treatment of thymoma is varied. This retrospective study aimed to evaluate the outcomes of different surgical approaches in the treatment of thymoma.MethodsFrom January 2020 to December 2023, a total of 208 patients underwent thoracoscopic surgical treatment and were diagnosed with thymoma by postoperative pathological result in our institution. We collected and then analysed potential factors including general conditions, surgical approaches, preoperative clinical symptoms, surgical procedures, postoperative hospital stay, postoperative drainge, postoperative pain score, postoperative complications and postoperative follow-up.ResultsOf the 208 patients, 98 patients underwent surgery via subxiphoid approach (47.1%) and 110 patients via lateral intercostal approach (52.8%). The duration of the surgical procedure (P = 0.02), intraoperative blood loss (P = 0.045), total postoperative drainage (P = 0.021), postoperative drainage per day (P = 0.004) and Postoperative pain score (Day1 P = 0.010 and Day2 P = 0.002)showed a significant difference between these two groups. 31 patients (14.9%) received postoperative radiotherapy. One patient died due to postoperative radiotherapy. No recurrence occurred in one-year follow-up.ConclusionsThe present study not only showed that subxiphoid approach was a safe and feasible technique for thymoma, with a potentially faster postoperative recovery and less postoperative pain.

Single-port laparoscopic reversal of Hartmann's procedure through the colostomy site: technical aspects and early postoperative outcomes.

Single-port laparoscopic surgical approaches offer improved cosmetic outcomes and enhance recovery following surgery. The purpose of the study was to assess the reliability and efficacy of a single-port laparoscopic Hartmann's reversal(SPL-HR) through the colostomy site. Prospective data from consecutive patients who underwent SPL-HR between 2020 and 2024 was analysed. Once the colostomy was detached from abdominal wall, a single-port device was introduced through the colostomy site. After mobilizing the rectal stump and afferent colon, colorectal anastomosis was carried out using a circular stapler transanally under laparoscopic vision. Postoperative care and discharge decisions were made following the ERAS protocol. Patient demographics, details of Hartmann's procedure, intraoperative outcomes, and early postoperative outcomes were evaluated. SPL-HR was successfully performed in 23 of 27 patients (85.1%), with a median operation time of 92 (50-172) min and a median blood loss of 100 (10-360) mL. Five patients (21.7%) experienced a postoperative complication. Two of them experienced grade 3a complications according to Clavien-Dindo classification: one with an intraabdominal abscess and one with a hematoma at the colostomy site, both requiring drainage under local anaesthesia. Anastomotic leak or mortality wasn't observed in patients. Functional recovery measures such as first flatus time and time to resuming a soft diet were favourable, with a median length of hospital stay of 4 (2-9) days. The SPL-HR technique is a reliable and efficient method that is easy to perform. It has acceptable complication rates while improving postoperative recovery and reducing the length of hospital stay.

A new surgical technique of robotic-assisted laparoscopic nephroureterectomy without re-docking in a single position: a single center experience.

A nephroureterectomy conventionally consists of two independent section, which will considerably prolong the operation time. We developed a novel surgical technique for robotic-assisted laparoscopic nephroureterectomy without re-docking in a single position and aimed to access the safety, feasibility, and efficiency of our novel surgical technique. From August 2021 to October 2023, 53 patients who received robotic-assisted laparoscopic nephroureterectomy were retrospectively enrolled in this study. 25 patients underwent traditional nephroureterectomy and 28 patients underwent single-position nephroureterectomy. The basic characteristics of the enroll patients, perioperative parameters, and oncological outcomes were gathered and compared between novel technique robotic surgery group and traditional surgery group. The basic characteristics between two groups had no significantly difference except for the proportion of anticoagulation therapy. The operation time in novel technique robotic surgery group was shorter than that in traditional robotic surgery group, although there was no significant difference (p = 0.403). Lymph-node dissection in novel technique robotic surgery group was obvious more common than that in traditional robotic surgery group (p = 0.037), while the incision length in novel technique robotic surgery group was obviously shorter than that in traditional robotic surgery group (p < 0.001). The oncological outcomes showed no difference between two groups. Compared with traditional robotic-assisted laparoscopic nephroureterectomy, the innovative surgical technique of robotic-assisted laparoscopic nephroureterectomy in a single position showed the advantages of less surgical time, streamlined lymph-node dissection, less trauma, and expedited postoperative recovery, which is worth promoting in clinical practice.