Postoperative Recovery Period Research Articles

PD40-06 EFFECT OF OPERATIVE LOCAL ANESTHESIA ON POSTOPERATIVE PAIN OUTCOMES OF INFLATABLE PENILE PROSTHESIS : PROSPECTIVE COMPARISON OF TWO MEDICATIONS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy II1 Apr 2015PD40-06 EFFECT OF OPERATIVE LOCAL ANESTHESIA ON POSTOPERATIVE PAIN OUTCOMES OF INFLATABLE PENILE PROSTHESIS : PROSPECTIVE COMPARISON OF TWO MEDICATIONS Marilin Nicholson, Fernando Bianco, Angel Perez, and Edward Gheiler Marilin NicholsonMarilin Nicholson More articles by this author , Fernando BiancoFernando Bianco More articles by this author , Angel PerezAngel Perez More articles by this author , and Edward GheilerEdward Gheiler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2440AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contrast efficacy of dorsal penile nerve block (DPNB) in reducing postoperative pain following inflatable penile prosthesis (IPP) compared to patients without block and detect a difference between two injectable anesthetics. METHODS From 1/2013 to 6/2013, 131 patients were randomized prospectively into 3 groups. All IPP were first time, performed under general/spinal anesthesia with supplemental DPNB by high volume IPP surgeon with 24 hour observation. 40 patients were in Bupivacaine DPNB group, 47 in Ropivacaine DPNB group & 44 controls had no DPNB. Postoperative pain was quantitated by Visual analog scale (VAS). Oral/IV pain medication need was measured during hospitalization and every 24 h during first 7 days. RESULTS In first two hours VAS 2.13(CI 1.66-2.60) Bupivacaine group; 2.89(CI 2.44-3.24) Ropivacaine group and 6.55(CI 6.14-6.96) control group There was significant difference between medicated patients and control group (p<0.0001) but no significant difference between the two injectibles. 52.5% of Bupivacaine group were pain free at day 2 compared with 31.9% of Ropivacaine group and 38.6% control group. While most patients responded to oral pain pills, 42% of series required IV Morphine for relief. Mean Morphine IV usage was 0.85 for Bupivacaine group; 1.87 for Ropivacaine group and 1.67 in control group. The Bupivacaine group had less pain on second day and less need of Morphine (27.5%) but neither finding was significant. Virtually all patients required oral pain medication day 2-7. CONCLUSIONS DPNB during IPP with both anesthetics provides effective analgesia in the immediate post operative recovery period but does not impact longer term pain relief when compared to patients without penile block. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e837 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marilin Nicholson More articles by this author Fernando Bianco More articles by this author Angel Perez More articles by this author Edward Gheiler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Posterior symphyseal spurs – an unusual differential diagnosis in athletes with groin pain

We set out to highlight the significance of posterior symphyseal spurs as an unusual diagnostic possibility in athletes with chronic groin pain and to demonstrate that operative resection was successful in quickly and safely returning the patients to sporting activities. Five competitive nonprofessional male athletes, three soccer players, and two marathon runners (median age: 30 [26/33] years), who presented to us with significant groin and central pubic pain with duration of at least 12 months, and who had failed conservative or surgical interventions (symphyseal plating), were evaluated. Physical examination as well as pelvic radiographs confirmed the diagnosis of posterior symphyseal spurs. Four out of five athletes underwent complete resection of the spur. Size of spurs was 2.2 (1.3/2.9) cm (median) with four of them posterosuperiorly and one posterocentrally located. All of them had uneventful postoperative recovery period and were still pain-free at the latest follow up after 26.6 months (24/30). Median time-to-return to competitive sports level was 10 weeks (8/13). None of the patients developed pubic instability due to symphyseal spur resection. The results of considerable postoperative improvement in our patients highlight the significance of posterior symphyseal spurs as a diagnostic possibility in athletes with chronic groin pain.

Caring for perioperative patients

Preassessment of perioperative patients is essential to prepare patients for anaesthesia, surgery and recovery, and to ensure that they understand the anaesthetic and surgical procedures, as well as their postoperative recovery period. This role can be carried out by operating department practitioners (ODPs) and nurses, and they also need to understand the physiological status of the patient so they can inform perioperative staff (including anaesthetists, surgeons and perioperative practitioners) of any issues the patient has. This article covers preoperative assessment, planning and education, and postoperative care, including reducing postoperative complications.

The frequency of congenital long QT syndrome based on new formula in children with sensori-neural hearing loss

Introduction: Long QT syndrome (LQTS) is a repolarization cardiac disorder that can lead to syncope, cardiac arrest and sudden death in apparently healthy individuals. The congenital type can be accompanied with congenital sensory-neural deafness (Jervell-Lang-Nielsen syndrome). Although there are limited studies assessed the frequency of LQTS in these children in developed countries, regarding introducing the new formula, it is necessary to re-evaluate the frequency of this syndrome. Materials and Methods: This cross-sectional and descriptive study was done on 203 patients with congenital sensory-neural hearing loss (SNHL) that had cochlear implant surgery in Baqiyatallah cochlear implant center from 2008 to 2012. Corrected QT was calculated with this formula: QTC = QT + 1.75 (heart rate-60) Patients with QTC > 460 ms, were categorized in four groups: Long QT: QT > 460, Borderline: 440 470 and very markedly: >500. Also, cardiac arrhythmias or arrest were evaluated in patients during cochlear implant surgery and in the postoperative recovery period. Result: Prevalence of LQTS in patients was 12.32% (25 patients). Prevalence of markedly long QT and very markedly long QT were 8.87% (18 patients) and 2.46% (5 patients) respectively. The prevalence of borderline group was 14.29% (29 patients). None of the patients during or after surgery were affected by cardiac arrhythmias or arrest. Conclusion: This study showed higher prevalence of LQTS in patients with SNHL than the normal population, and we suggest that all patients with congenital deafness should be screen for LQTS.

Colon Stricture After Ischemia Following a Robot-Assisted Ultra-Low Anterior Resection With Coloanal Anastomosis.

Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.

Effects of different anesthetic approaches on postoperative complications in HIV-infected patients.

The aim of this study was to investigate the effects of three different methods of anesthesia on patients with human immunodeficiency virus (HIV) infection, which could lead to an improvement in postoperative outcomes in these patients. A total of 90 patients undergoing an operation while being treated for an HIV infection were included in this study. Patients were divided into three groups (N = 30/group) based on the type of anesthesia administered: general anesthesia, local anesthesia, and combined spinal epidural anesthesia (CSEA). The effects of local infiltration of anesthesia and peripheral nerve block local anesthesia were examined in the local anesthesia group. The CSEA group examined the effects of spinal anesthesia in HIV-infected patients. We compared the vital signs of the three groups during the preoperative period, at incision, and during the postoperative recovery period. The CSEA group had a significantly higher mean preoperative CD4(+) T lymphocyte count compared with the general anesthesia and local anesthesia groups (P < 0.05). We found that the three kinds of anesthesia methods administered to HIV-infected patients could be used with considerable safety and can be selected according to the clinical need and type of surgical procedure.

Sex reassignment surgery

Transsexualism, or gender incongruence, presents a state in which a person's assigned sex at birth conflicts with their psychological gender. It is classified in International Classification of Diseases as F64. Treating these persons require multidisciplinary approach, including psychiatrist, endocrinologist, gynecologist, urologist, plastic and reconstructive surgeon. Genital reconstruction is the final step in transition, and can be performed when all other conditions required by World Professional Association for Transgender Health (WPATH) are accomplished. Female to male sex reassignment surgery Several surgical procedures can be done in female to male transsexuals, including mastectomy, removal of female genitalia, metoidioplasty, scrotoplasty with implantation of testicular implants, as well as total phalloplasty. The current operative technique of metoidioplasty comprise the following steps: vaginal removal, the release of the ventral chordee and clitoral ligaments, straightening and lengthening of the clitoris, urethroplasty by combining buccal mucosa graft and genital flaps and scrotoplasty with insertion of testicle prostheses. The goal is to perform all these procedures in one stage, and that makes our team famous worldwide. Metoidioplasty results in excellent cosmetic outcome with completely preserved sensitivity and sexual arousal, enables voiding while standing, but without ability to penetrate due to small size of the neophallus. Considering these advantages, including low complication rate, patients often choose this option. For those who require bigger phallus which enables implantation of penile prosthesis, several surgical techniques have been reported using either available local vascularized tissue or microvascular tissue transfer. However, none of them satisfy all the goals of modern penile construction, i.e. reproducibility, tactile and erogenous sensation, a competent neourethra with a meatus at the top of the neophallus, large size that enables safe insertion of penile implants, satisfactory cosmetic appearance with hairless and normally colored skin. We developed a new technique using the musculocutaneous latissimus dorsi free transfer flap, which mostly satisfies the requirements noted above. It has many advantages, such as its workable size which enables prosthesis implantation, long neurovascular pedicle and minimal functional loss after removal, as well as small phallic retraction. Total phalloplasty using latissimus dorsi flap, including total removal of female genitalia, reconstruction of the neourethra to reach the top of the glans, glans and scrotal reconstruction, implantation of testicular implants and penile prosthesis, is performed in 2 or 3 stages, presenting very complex and demanding surgical procedure with longer postoperative recovery period. Male to female sex reassignment surgery Several feminizing surgical procedures are performed in male to female transsexuals, including facial, neck, breast and genital surgery. Genital reconstruction comprises vaginoplasty, introitoplasty, clitoroplasty, labioplasty and urethroplasty. There are two substantial tissues for vaginal replacement: skin and bowel. For transgender patients penile inversion vaginoplasty presents the best option. Procedure starts with bilateral orchidectomy. The penis is dissected into its anatomical components and corpora cavernosa are completely removed. Glans with neurovascular bundle is used to create clitoris with preserved sensation, while skin of the penis is inverted, as a pedicled flap preserving blood and nerve supplies to form a fully sensate vagina. Urethra is reconstructed as in a female. Available and hairless flap, elasticity of penile skin, preserved erogenous sensation, good cosmetic and functional outcome, are the main advantages of this technique. After penile inversion skin flap, and in cases of failed surgery, sigmoid colon technique presents the method of choice in male to female reassignment surgery. Beside aesthetic and functional result, psychosocial and psychosexual outcome of these procedures are necessary in achieving a good quality of life for these patients.

Electroencephalogram based quantitative estimation of pain for balanced anaesthesia

The purpose of this study was to quantify the pain experienced by the patients in the Post Anaesthetic Care Unit (PACU) and to design an Electroencephalogram (EEG) based system which could monitor the pain in real time and display the quantified value as pain index. Research has established that the EEG from different lobes of brain can be used to find out individual indices for different components of balanced anaesthesia. In the present study, the focus was on analgesia. During the study, EEG of 31 patients was recorded from different regions of brain in the pre-operative (normal) and post-operative (painful) state. After analysis, it was observed that EEG parameters ‘Hjorth Activity’ and ‘Spectral Entropy’ from parietal region reflect the pain experienced by the patient during post-operative recovery period. Based on these parameters, a pain estimation system was developed which gave a numerical graded output between 0 and 10. This developed pain scale by analyzing EEG signals of the patients in the post operative period was correlated with Visual Analogue Scale (VAS) and was found to be accurate to estimate the level of pain, when compared with the pain experienced by the patient.

Association of Psychiatric History, Attendance at Postoperative Support Groups, and Outcomes Following Gastric Bypass Surgery: A Pilot Study

Gastric bypass procedures (GBP) are becoming more commonly utilized for the treatment of morbid obesity. However, the range of sustained, long-term weight loss following the procedure varies considerably. An extraordinarily high incidence of comorbid anxiety, mood, and other psychiatric disorders exists among GBP recipients. Relatively little is known about how best to meet the postoperative psychological needs of this population, and standardized treatment protocols are lacking. GBP support groups represent one forum to improve long-term weight loss outcomes during the postoperative psychological recovery period. The purpose of this study was to report descriptive findings on factors associated with attendance of postoperative support groups and to identify variables common among group participants that influence outcomes. Using a combination of self-report measures and validated screening tools (including the Psychiatric Diagnostic Questionnaire (PDSQ) and Short Form-12 v2 (SF-12v2)), we found that approximately two-thirds of participants who underwent GBP screened positive for one or more Axis I diagnoses. Participants with no previous psychiatric treatment were significantly more likely to lose ≥30% of their preoperative weight when compared to those with a psychiatric history (OR=3.333 [CI 1.102, 10.085], p=0.0330). Those participants with a physical component summary score on the SF-12v2 that fell below the median of the group were significantly less likely to lose more than the median proportion of weight lost over time for the group when compared to those with a score greater than or equal to the median (OR=0.351 [CI 0.130, 0.947], p=0.0388).

Outcome of general anaesthesia by laryngeal mask airway (LMA) in ophthalmic surgery in the national institute of ophthalmology and hospital, Dhaka

Background Patient is very safe under general anaesthesia with laryngeal mask airway intra and post operatively in ophthalmic surgery.&#x0D; Methods Different ophthalmic procedures and surgery were done on different age group from five months to fifty years with ASA grade I and II under general anaesthesia by laryngeal mask airway (LMA) to see the haemodynamic status and other parameters during operation and post operative recovery period.&#x0D; Results Total number of ophthalmic surgery under G/A was 1814. General anaesthesia by orothracheal intubation was given only in twenty five (25) patients and general aneasthesia was given by Laryngeal mask airway insertion in 1789 patients. Complications occur in Laryngeal mask airway group patients only in 8 patients. Percentage of safe LMA insertion was 99.55% and percentage of complication was only 0.45%. Operation time ranges from few minutes to two hours. General aneasthesia through laryngeal mask airway insertion make the procedures easy and safe for the patients except minimum percentage of complications.&#x0D; Conclusion Laryngeal mask airway causes less changes of haemodynamic parameter. LMA is very effective in the spontaneously breathing patient. During operation patients become stable and no rise of intraocular pressure and on reverse the patient become smooth with less secretion, no spasm, no cough and no vomiting.&#x0D; JBSA 2012; 25(1): 28-31

Pediatric appendicitis in a developing country: what are the clinical predictors and outcome of perforation?

This study explored the risk factors and outcomes associated with perforation in children who underwent emergency appendicectomies. A retrospective cross-sectional study was conducted on children <13 years old who underwent appendicectomies in a Malaysian hospital in 2007. One hundred thirty-four children underwent appendicectomies of which 118 were confirmed histologically. Sixty-one (52%) were perforated. Children with perforation had significantly longer duration of symptoms (p < 0.001), higher white cell count and absolute neutrophil counts (p = 0.013), with longer intra-operative period (p < 0.001) and post-operative recovery period (p < 0.001). Of the 52 samples of pus collected intra-operatively, 37 (71.1%) yielded positive cultures that were predominantly Escherichia coli (n = 27). Both the patients who had Staphylococcus aureus cultured from pus collected intra-operatively had significant pyogenic complications (scrotal pyocele and intra-abdominal abscess). Children whose appendicitis were perforated had longer duration of symptoms, higher white cell counts and absolute neutrophil counts. Those with S.aureus cultured from intra-operative pus appeared to suffer more complications.

眼科全麻手术患者应用喉罩在术后恢复期常见问题与护理

The paper presented nursing care and common problems, such as choking cough , elevated intraocular pressure ,laryngospasm, reflux aspiration, laryngeal mask out carelessly or ventilation disorder,etc, during postoperative recovery period in patients undergoing ophthalmic general surgery with laryngeal mask airway anesthesia by studying 120 cases. Psychological care, preoperative preparation and targeted nursing can prevent and relieve the symptoms, ensure the operation effect, and improve the safety of patients.

Physical health problems experienced in the early postoperative recovery period following total knee replacement

BackgroundThe length of stay in hospital following total knee replacement is markedly shortened due to fast-track programmes. Patients have to be responsible for their recovery at a very early stage. The aim of this study was to investigate the prevalence of physical health problems and the level of exercising in the early recovery period after discharge from hospital following total knee replacement. MethodA cross-sectional survey was conducted using a questionnaire. A total of 86 patients were included following first-time elective total knee replacement. Descriptive statistics were used. ResultsThe majority of the patients experienced leg oedema (90.7%). Secondary to this were pain (81.4%), sleeping disorders (47.7%) problems with appetite (38.4%) and bowel function (34.9%) were the most frequently identified physical health problems. In total, 69.8% of the patients indicated that they did not exercise or only partly exercise as recommended, but without associated experience of pain. ConclusionPatients experienced a wide range of physical health problems following total knee replacement and deviation from recommended self-training was identified. These findings are valuable for health professionals in regard to improve treatment as well as patient education and information.

Postoperative Recovery Outcomes in Adult Scoliosis: A Prospective Multicenter Database With 5-Year Follow-Up

Study DesignRetrospective review of a prospective, multi-institutional database. ObjectivesTo determine postoperative quality of life outcomes in scoliosis patients using the Oswestry Disability Index (ODI) at defined time points. Summary of Background DataSpinal surgery provides significant improvement in both pain and disability in adults with scoliosis compared with conservative treatment; however, the postoperative timing of improvements in quality of life outcomes has not been studied. MethodsThis was a retrospective review of a prospective, multi-center database with 1,750 patients. All patients completed the ODI at first encounter and at 6 follow-ups (6 weeks, 6 months, and 1, 2, 3, and 5 years). The authors stratified by age, primary versus revision, staged surgery, anatomical region of surgery, complexity (osteotomy and levels), and complications (intraoperative and postoperative). ResultsAt baseline and most follow-up visits, older patients, those with revision surgeries, and those who had an osteotomy had significantly higher ODI scores than did young patients, those with primary surgeries, and those who did not have an osteotomy. All stratified groups showed a significant ODI score decrease between 6 weeks' and 6 months' follow-up. However, most of the stratified group patients' outcomes remained unchanged throughout the postoperative recovery period from 1 to 5 years. ConclusionsSurgical treatment has the potential to significantly improve the quality of life of patients with adult scoliosis. An understanding of the timing of improvement after surgery will improve both the counseling of surgical candidates and patient care pathways.

Cardiac Advanced Life Support–Surgical Guideline

Cardiac arrest in the immediate postoperative recovery period in a patient who underwent cardiac surgery is typically related to reversible causes—tamponade, bleeding, ventricular arrhythmias, or heart blocks associated with conduction problems. When treated promptly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. The Cardiac Advanced Life Support–Surgical (CALS-S) guideline provides a standardized algorithm approach to resuscitation of patients who experience cardiac arrest after cardiac surgery. The purpose of this article is to discuss the CALS-S guideline and how to implement it.

Delayed-onset hypovolemic shock after the Nuss procedure for pectus excavatum

The Nuss procedure, which is a minimally invasive approach for treating pectus excavatum, has better functional and cosmetic outcomes than other invasive procedures. Cardiac perforation is the most serious complication and several methods for the prevention of intraoperative events has been developed. Although most cardiac injuries are detected in the operating room, in the case described herein the patient experienced sudden hypovolemic shock during the postoperative recovery period. This indicates that special caution is mandatory even after successful execution of the Nuss procedure.

Cardiac Advanced Life Support–Surgical Guideline

Cardiac arrest in the immediate postoperative recovery period in a patient who underwent cardiac surgery is typically related to reversible causes-tamponade, bleeding, ventricular arrhythmias, or heart blocks associated with conduction problems. When treated promptly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. The Cardiac Advanced Life Support-Surgical (CALS-S) guideline provides a standardized algorithm approach to resuscitation of patients who experience cardiac arrest after cardiac surgery. The purpose of this article is to discuss the CALS-S guideline and how to implement it.

Post-operative intrapericardial hematoma presenting as isolated right atrial tamponade

A 57-year-old male underwent mechanical mitral valve replacement for severe mitral regurgitation of a prolapsed myxomatous mitral valve. The patient's post-operative recovery period was uneventful until the eighth day when he decompensated into pulseless electrical activity arrest. A bedside transthoracic echocardiogram revealed a large, smooth-edged mass nearly obliterating the right atrial cavity. Color Doppler demonstrated flow within the right atrium around the mass. After computed tomography scan showed that an intrapericardial hematoma was extrinsically compressing the right atrium, the patient underwent emergent mediastinal exploration with evacuation of 700ml of coagulated blood. The patient made a full recovery.<Learning objective: Loculated intrapericardial hematoma is an infrequently encountered but serious complication of cardiac surgery that may lead to life-threatening cardiac tamponade. When clinically suspected, computed tomographic imaging or transesophageal echocardiography may be useful to confirm diagnosis. Hemodynamically significant intrapericardial hematoma should be treated by urgent surgical evacuation.>

Evaluation of the potential anti‐adhesion effect of the PVA/Gelatin membrane

A common and prevailing complication for patients with abdominal surgery is the peritoneal adhesion that follows during the post-operative recovery period. Biodegradable polymers have been suggested as a barrier to prevent the peritoneal adhesion. In this work, as a preventive method, PVA/Gelatin hydrogel-based membrane was investigated with various combinations of PVA and gelatin (50/50, 30/70/, and 10/90). Membranes were made by casting method using hot PVA-gelatin solution and the gelatin was cross-linked by exposing UV irradiation for 5 days to render stability of the produced sheathed form in the physiological environment. Physical crosslinking was chosen to avoid the problems of potential cytotoxic effect of chemical crosslinking. Their materials characterization and mechanical properties were evaluated by SEM surface characterization, hydrophilicity, biodegradation rate, and so forth. Cytocompatibility was observed by in vitro experiments with cell proliferation using confocal laser scanning microscopy and the MTT assay by L-929 mouse fibroblast cells. The fabricated PVA/Gel membranes were implanted between artificially defected cecum and peritoneal wall in rats and were sacrificed after 1 and 2 weeks post-operative to compare their tissue adhesion extents with that of control group where the defected surface was not separated by PVA/Gel membrane. The PVA/Gel membrane (10/90) significantly reduced the adhesion extent and showed to be a potential candidate for the anti-adhesion application.

Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a case report

IntroductionAnterior bilateral temporomandibular joint dislocation is not an uncommon occurrence and has been reported before. However, its diagnosis can easily be overlooked, especially by clinicians who are unfamiliar with this pathology. Continuous discussion of the pathology is required to prevent delays in diagnosis, which can lead to long-term sequelae for the patient.Case presentationWe present the case of a 66-year-old Somali woman who experienced a bilateral anterior temporomandibular joint dislocation after a general anesthetic for an exploratory laparotomy for excision of a pelvic sarcoma. She first presented in the intensive care unit with preauricular pain and an inability to close her mouth, and was initially misdiagnosed and treated for a muscle spasm. The cause of her misdiagnosis was multifactorial - opioid-related sedation, language and cultural barrier, and unfamiliarity with the pathology. Her diagnosis was proven 18 hours after the completion of surgery with a plain X-ray. A manual closed reduction was performed with minimal sedation by oral surgery.ConclusionWe provided an in-depth discussion of temporomandibular joint dislocation and suggest a simple test that would prevent delayed diagnosis of temporomandibular joint dislocation in any patient undergoing general anesthesia. A normal mandibular excursion should be tested in every patient after surgery in the postoperative care unit, by asking the patient to open and close their mouth during the immediate postoperative recovery period or passively performing the range of motion test.