Postoperative Patient Discomfort Research Articles

Effect of magnesium sulfate perioperative infusion on postoperative catheter-related bladder discomfort in male patients undergoing laparoscopic radical resection of gastrointestinal cancer: a prospective, randomized and controlled study

BackgroundLaparoscopic radical resection of gastrointestinal cancer is associated with a high incidence of postoperative catheter-related bladder discomfort (CRBD). Studies on the benefits of magnesium sulfate intravenous infusion during the perioperative period post-laparoscopic surgery are yet lacking.MethodsA total of 88 gastrointestinal cancer male patients scheduled for laparoscopic radical resection were randomly divided into two groups: normal saline (control) and magnesium. In the magnesium group, a 40 mg/kg loading dose of intravenous magnesium sulfate was administered for 10 min just after the induction of anesthesia, followed by continuous intravenous infusion of 15 mg/kg/h magnesium sulfate until the end of the surgery; the control group was administered the same dose of normal saline. Subsequently, 2 μg/kg sufentanil was continuously infused intravenously by a postoperative patient-controlled intravenous analgesia (PCIA) device. The primary outcome was the incidence of CRBD at 0 h after the surgery. The secondary outcomes included incidence of CRBD at 1, 2, and 6 h postsurgery, the severity of CRBD at 0, 1, 2, and 6 h postsurgery. Remifentanil requirement during surgery, sufentanil requirement within 24 h postsurgery, the postoperative numerical rating scale (NRS) score at 48 h after the surgery, magnesium-related side effects and rescue medication (morphine) requirement were also assessed.ResultsThe incidence of CRBD at 0, 1, 2, and 6 h postoperatively was lower in the magnesium group than the control group (0 h: P = 0.01; 1 h: P = 0.003; 2 h: P = 0.001; 6 h: P = 0.006). The incidence of moderate to severe CRBD was higher in the control group at postoperative 0 and 1 h (0 h: P = 0.002; 1 h: P = 0.028), remifentanil requirement during surgery were significantly lower in the magnesium group than the control group. Sufentanil requirements during the 24 h postoperative period were significantly lower in the magnesium group than the control group. The NRS score was reduced in the magnesium group compared to the control group in the early postoperative period. Magnesium-related side effects and rescue medication (morphine) did not differ significantly between the two groups.ConclusionsIntravenous magnesium sulfate administration reduces the incidence and severity of CRBD and remifentanil requirement in male patients undergoing radical resection of gastrointestinal cancer. Also, no significant side effects were observed.Trial registrationChictr.org.cn ChiCTR2100053073. The study was registered on 10/11/2021.

Optical Fiber-Based Needle Shape-Sensing in Real Tissue: Single-Core versus Multicore Approaches

Flexible needle insertion procedures are common in minimally invasive surgeries for diagnosing and treating prostate cancer. Bevel-tip needles provide physicians the capability to steer the needle during long insertions to avoid vital anatomical structures in the patient and reduce post-operative patient discomfort. To provide needle placement feedback to the physician, sensors are embedded into needles for determining the real-time 3D shape of the needle during operation without needing to visualize the needle intra-operatively. Through expansive research in fiber optics, a plethora of biocompatible, MRI-compatible, optical shape-sensors have been developed to provide real-time shape feedback, such as single-core and multicore fiber Bragg gratings. In this paper, we directly compare single-core fiber-based and multicore fiber-based needle shape-sensing through similarly constructed, four active-area-sensorized bevel-tip needles inserted into phantom and ex-vivo tissues on the same experimental platform. In this work, we found that for shape-sensing in phantom tissue, the two needles performed identically with a [Formula: see text]-value of 0.164 > 0.05, but in ex-vivo real tissue, the single-core fiber-sensorized needle significantly outperformed the multicore fiber configuration with a [Formula: see text]-value of 0.0005 < 0.05. This paper also presents the experimental platform and method for directly comparing these optical shape sensors for the needle shape-sensing task, as well as provides direction, insight, and required considerations for future work in constructively optimizing sensorized needles.

TENTING POLE ABUTMENT TECHNIQUE FOR THE EASY RECONSTRUCTION OF SEVERELY RESORBED ALVEOLAR RIDGES

Dental implant-supported oral rehabilitation is a widely used procedure in modern dentistry. However, implant placement on an atrophic alveolar ridge remains a challenging task due to the insufficient quantity and poor quality of bone. To address this issue, various surgical techniques have been employed to overcome vertical bone deficiency at implant sites, including guided bone regeneration (GBR) using non-resorbable barrier membranes or titanium mesh, onlay block grafting with intraosseous or extraosseous bone blocks, distraction osteogenesis, sandwich osteotomy with an interposition bone graft, and the ramus split bone technique. These surgical procedures are not without their drawbacks, however. They can be technically challenging, require longer surgery times, and result in significant postoperative patient discomfort. Additionally, because the implants are not placed simultaneously, the patient's edentulous healing period is prolonged. The utilization of tenting pole implants and abutments in conjunction with GBR procedure is a safe and effective technique for advanced ridge augmentation. This procedure has minimal complications. Future investigations are required to validate the effectiveness of this technique.

Application and research progress of autologous soft tissue substitute materials in gingival augmentation of natural teeth

Subepithelial connective tissue or free gingival grafts are often used in traditional mucogingival surgery to treat gingival recession and keratinized gingival insufficiency. However, due to the disadvantages of autologous soft tissue grafts, such as the preparation of the second surgical site, the limited amount of tissue in the donor site, and postoperative discomfort for patients, the research on autologous soft tissue substitute materials has attracted extensive attention. A variety of donor-substitute materials from different sources are currently used in membranous gingival surgeries, including platelet-rich fibrin, acellular dermal matrix, xenogeneic collagen matrix, etc. This paper reviews the research progress and application of several different types of substitute materials in soft tissue augmentation for natural teeth, providing a reference for the application of autologous soft tissue substitutes in clinical gingival augmentation surgery.

Creating and Testing a Model to Predict Postoperative Discomfort in Patients with Hepatocellular Carcinoma Receiving Transarterial Chemoembolisation

Background: Abdominal pain is a frequent adverse event in patients with hepatocellular carcinoma (HCC) after transarterial chemoembolisation (TACE). However, there remains uncertainty regarding the determinants of post-TACE pain. Objectives: We aimed to create and verify a prediction model for postoperative pain in patients with HCC after TACE treatment. Methods: This prospective study included all patients with HCC undergoing TACE in our hospital. According to the time of treatment, the dataset was divided into two cohorts (development and validation) in a 3: 2 ratio. After TACE, the participants used a visual analog scale to quantify their pain level at rest over a 24-hour period. The age, gender, tumor location, tumor size and number, medication administration route, and presence of portal vein tumor thrombosis (PVTT) were recorded in all patients. Results: In total, 137 (mean age: 60.3 ± 10.1 years; 78.1% male) and 91 (mean age: 61.1 ± 10.5 years; 73.6% male) patients were included in the development and validation cohorts, respectively. Furthermore, 46.0% and 39.6% of the patients experienced acute moderate to severe pain after TACE in the development and validation cohorts, respectively. The tumor location, the drug delivery method, and the presence of PVTT were independently associated with post-TACE pain, all of which were combined to develop a prediction model based on a logistic equation. The discrimination of this risk score was satisfactory in both the development (area under the curve (AUC): 0.693, 95% confidence interval (CI): 0.609 to 0.769, P < 0.001) and validation (AUC: 0.652, 95% CI: 0.544 to 0.748, P = 0.002) cohorts. There was no significant difference between the two cohorts (difference: 0.042, 95% CI: -0.081 to 0.164, P = 0.506). The risk score had good specificity for predicting post-TACE pain in both the development (83.8% (95% CI: 73.4% to 91.3%)) and validation (76.4% (95% CI: 63.0% to 86.8%)) cohorts. Conclusions: The presence of PVTT, the tumor location, and the drug administration method were risk factors for post-TACE discomfort. A prediction model based on these risk factors was useful for identifying patients who were vulnerable to post-TACE pain. However, further studies are required to validate these findings and optimize the model’s performance.

ADVANTAGES OF LAPAROSCOPIC SURGERY IN CALCULOUS CHOLECYSTITIS

Purpose: The aim of the study is the comparative analysis of the operating time, blood loss during surgery, postoperative discomfort, and pain, hospital stay, cost-effectiveness, and patient satisfaction in patients undergoing laparoscopic cholecystectomy and conventional cholecystectomy in UMHATEM "N.I.Pirogov". Material and Methods: For a one-year period (from 01.01.2018 to 01.01.2019) 512 patients with calculous cholecystitis were operated on the Department of General, Visceral, and Emergency surgery on UMHATEM "Pirogov". In 487 of these cases, laparoscopic cholecystectomy was performed (group I), the remaining 25 cases were treated with conventional cholecystectomy (group II). Women with laparoscopic cholecystectomy (group I) were 392 (75.82%), men 95 (24.18%). From the open surgery cohort (group II), women were 19 (75.41%), men 6 (24.59%). The age in this retrospective analysis varied from 18 to 83 years (average 52.7 years). Results: From group I (lap. cholecystectomy), women were 392 (80.49%), men 95 (19.51%). In group II (open cholecystectomy), women were 19 (76%), men 6 (24%). Age in this retrospective analysis ranged from 18 to 83 years (average 52.7 years) for both groups. There was no significant difference between demographic variables in the two groups. The operating time varied between 23 and 165 min (average 39.4 min) for group I and 35 to 104min (average 44.6min) for group II respectively. The hospital stay was recorded from 48 hours to 7 days (2.7 days on average) for group I and 3 to 9 days (average 4.5 days) for group II respectively. Surgical morbidity included 12 patients (operative wound suppuration, ileus, postoperative hernia, jaundice), 7 from group I (1.44%) and 5 from group II (20%), which was considered a significant difference. Conclusion: Laparoscopic cholecystectomy is an easy intervention, reduced time-consuming procedure, with shortened complication rates compared to open cholecystectomy. It completely debates an advantage of a decreased hospital stay and early return to work compared to open surgery.

Attached Oral Mucosal Wound Closure using Blue Glue - A Prospective Clinical Study.

Traditionally, sutures have been widely used to close intraoral wounds. Various alternatives have been developed amongst which newer tissue adhesives such as N-butyl-2-cyanoacrylate having accepted clinical properties are gaining popularity. The primary purpose of the present study is to evaluate the efficacy of N-butyl-2-cyanoacrylate for intraoral attached mucosal wound closure following alveoloplasty. In this prospective split-mouth study, 25 patients requiring alveoloplasty in either maxillary or mandibular arch bilaterally with a total of 50 sites were divided into two equal groups, namely silk suture (Group 1) and cyanoacrylate (Group 2). Each patient was evaluated on the first, third, seventh, 14th and 21st post-operative days. Parameters evaluated were time taken to close incision and to achieve haemostasis, pain, oedema, post-operative wound healing, patient discomfort and possible complications. Time taken to close incision, time taken to achieve haemostasis, post-operative pain and oedema were found to be less in Group 2. Wound healing too was found to be better in Group 2. There was one case of adhesive peel off on the first post-operative day which was managed by reapplying the tissue adhesive. The incidence of wound dehiscence and wound infection was observed more in Group 1 on the third post-operative day. Suture breakage (16%) and adhesive dislodgement (8%) were reported on the seventh post-operative day. The use of cyanoacrylates' inherent benefits, such as improved wound seal off in attached mucosa, quick polymerisation and bacteriostatic characteristics can be beneficial when performing minor oral surgical procedures on elderly, young and mentally challenged patients.

Single-dose intravenous nefopam on postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of prostate: a randomized, double-blind placebo-controlled trial.

Transurethral resection of prostate (TURP) with postoperative catheter traction can lead to significant catheter-related bladder discomfort (CRBD). This condition causes many postoperative complications and low patient satisfaction.This study aimed to evaluate the effectiveness ofpreoperative single-dose intravenous nefopam on the incidence and severity of CRBD and its adverse effects. This randomized, controlled, double-blind study included patients who underwent TURP under spinal anesthesia with postoperative urinary catheter traction. Patients were allocated into nefopam (NF) and normal saline (NS) groups. Twenty mg of nefopam in normal saline solution (NSS) 100mL or NSS 100mL were given intravenously before TURP. The primary outcome was the incidence of CRBD. Seventy-three patients were randomized into NF (n = 37) and NS (n = 36) groups. There were 35 and 33 patients in the NF and NS groups, respectively, in the final analysis. The incidences of CRBD were 45.71% and 84.85% in the NF and NS groups at 6h after operation, respectively, OR 0.54 (95% CI 0.36, 0.73), while before the end of catheter traction, the corresponding incidences were 37.14% and 75.76%, respectively, OR 0.49 (95% CI 0.28, 0.84). The CRBD scores were statistically significantly lower in the NF group at both time points. Morphine consumptions and adverse effects were not different between groups. Patient satisfaction was higher in the NF group. Single-dose nefopam significantly reduced the incidence and severity of CRBD in patients undergoing TURP with urinary catheter traction at 6h after the procedure and before the end of catheter traction without increasing the adverse effects.

Endoscopic Endonasal Transpterygoid Approach for Resection of Carotid Sympathetic Plexus Schwannomas: A Cadaveric Stepwise Dissection, Technical Nuances and Surgical Outcomes

Carotid sympathetic plexus (CSP) schwannomas are rare brain tumors located in a complex site around the cavernous sinus and carotid canal in the petrous bone. This study describes 3 cases of CSP schwannomas that underwent surgical removal of the tumor through an endoscopic endonasal transpterygoid approach. Between 2016 and 2021, 3 cases of CSP schwannomas were treated using an endoscopic endonasal transpterygoid approach. Preoperative tumor size, preoperative and postoperative symptoms, internal carotid artery (ICA) displacement, extent of tumor resection, intraoperative findings showing tumor origin, and surgical complications were evaluated in all patients. Two tumors were in the petrous region, and the other one was in both the petrous and cavernous regions. The median tumor diameter was 41.3mm. In the 3 cases, the ICA was displaced to the superolateral side, the anterolateral side, and the posterior side, respectively. Near-total resection was achieved in all 3 cases via an endoscopic endonasal transpterygoid approach. There were no endonasal postoperative complications, and the cranial nerve disability improved in all 3 patients at 1-year follow-up. The surgical technique for CPS schwannoma using an endoscopic endonasal transpterygoid approach may be a viable option because endoscopy has been proven to offer better intraoperative visualization and reduce postoperative discomfort for patients. Tumors located medial and inferior to the ICA pars cavernous sinus or anterior, inferior, and medial to the paraclival ICA are ideal candidates for surgery using this endoscopic approach.

Prophylactic Tramadol versus Nefopam for Post-operative Catheter-Related Bladder Discomfort in Patients Undergoing Elective Percutaneous Nephrolithotomy: Randomized Controlled Trial

Prophylactic Tramadol versus Nefopam for Post-operative Catheter-Related Bladder Discomfort in Patients Undergoing Elective Percutaneous Nephrolithotomy: Randomized Controlled Trial

Digitally prefabricated versus conventionally fabricated implant-supported full-arch provisional prosthesis: a retrospective cohort study

BackgroundTo evaluate and compare the clinical outcomes of digitally prefabricated and conventionally fabricated implant-supported full-arch provisional prostheses.MethodsIn this retrospective study, a total of 39 patients (22 males and 17 females) who underwent implant-supported full-arch rehabilitation using the All-on-4 concept with an immediate loading protocol were included: 20 patients treated with digitally prefabricated provisional prostheses were assigned into Group A, and 19 patients treated with conventionally fabricated provisional prostheses were assigned into Group B. Implant/provisional prosthesis survival rates and complications were reviewed. Marginal bone loss (MBL) was investigated by CBCT. Surgical time, restorative time, and total operative time were analyzed. Postoperative pain and swelling were evaluated with the visual analog scale (VAS). The oral health impact profile (OHIP) questionnaire was administered before and after surgery.ResultsThe implant/provisional prosthesis survival rate was 100%, and complications appeared with low frequency in both groups, while the mean MBL was 0.30 ± 0.29 mm in Group A and 0.31 ± 0.41 mm in Group B after 3~ 6 months (P > 0.05). The average restorative time in Group A (116.16 ± 16.61 min) was significantly shorter than that in Group B (242.11 ± 30.14 min) (P < 0.05). Patients in Group A showed lower pain/swelling VAS scores after surgery than Group B (P < 0.05). Low OHIP scores with high satisfaction with the overall effects were shown in both groups.ConclusionPrefabricated prostheses reduced the prosthetic time and postoperative discomfort in patients whose immediate rehabilitation was based on the All-on-4 concept. This prefabrication technology may be a predictable alternative to improve the short-term clinical outcome of implant-supported full-arch provisional rehabilitation.

Healing of Alveolar Sockets Treated with Concentrated Growth Factors: A Split-Mouth Study.

Background: tooth extraction is a common procedure in oral surgery. The socket healing process involves hard and soft tissues and is characterized by intense remodeling, which may determine consistent dimension changes. Several autologous platelet concentrates (APCs) proved to be effective for enhancing alveolar socket healing after tooth extraction, accelerating socket closure and countering alveolar bone resorption. Concentrated growth factors (CGFs) are one of the most recently developed APCs, and their effect on the socket healing process still needs to be confirmed. Aim: The aim of the present split-mouth study was to evaluate the effectiveness of CGFs in enhancing the healing process in the postextraction alveolar socket and reducing postoperative pain. Methods: One hundred and fifty-four extractions were performed. One of the extraction sockets of each patient was treated with CGFs (test site), and the other socket was unfilled (control site). The main outcomes were: healing index, alveolar dimensions at the crestal level, socket closure, and pain perception. Descriptive statistics of the results were analyzed. Follow-up data were compared to baseline using paired tests. Results: The healing index on day 7 was significantly better (p < 0.001) in the test group (5.01 ± 1.30) as compared to the control group (6.65 ± 1.41). The mean visual analog scale for pain (VAS) was significantly higher for the control group when compared to the CGF group in the first 5 days postextraction. There was a trend toward greater socket closure in the CGF group, indicating faster healing, as compared to the control group at 7, 14, and 21 days. Conclusions: CGFs can represent a useful adjunctive tool, considering their mechanical and biological properties, for improving alveolar socket healing and reducing postoperative patient discomfort.

Evaluation of Postoperative Pain and Discomfort in Patients Undergoing Surgical Exposure of Impacted Maxillary Canines.

ABSTRACTObjectivesThe purpose of the retrospective study was to evaluate pain and discomfort related to surgical exposure according to initial localization of impacted maxillary canines.Material and MethodsPre-treatment cone-beam computed tomography (CBCT) data and discomfort evaluation questionnaire of 25 patients (17 female, 8 male), treated with combined surgical-orthodontic approach was analysed. The questions included: level of discomfort during surgery (0 to 10), level of pain (0 to 10) in the evening, one, two days and a week after surgery. CBCT analysis consisted of evaluation of impacted maxillary canines mesiodistal inclination, horizontal, vertical dislocation from alveolar process edge, labiopalatal localization and length of eruption path. To carry out research objectives a Spearman and interclass correlation coefficients, Mann-Whitney U test, Cohen’s kappa coefficient were used. Level of significance was 0.05.ResultsAverage level of discomfort during the procedure was 2.8 (SD 2.3). Pain level the evening after the surgery was the highest - 3.3 (SD 2.1) and decreased over the week. Pain level differed significantly between different days (P < 0.001). Neither labial or palatal location nor the unilateral or bilateral impaction had effect on the level of pain (P > 0.05). The results showed that pain during different stages of measuring as well as level of discomfort during surgical exposure did not differ statistically significantly depending on severity of impaction (P > 0.05).ConclusionsThere was no significant relation between the discomfort and the location of the impacted canine. Patient’s gender or age did not have an impact on discomfort and pain.

Piezosurgery Versus Conventional Method Alveoloplasty: A Comparative Study.

The conventional alveoloplasty approach which uses manual equipment results in more resorption of the underlying alveolar ridge that makes denture prosthesis unstable. The goal of this study was to compare results of piezosurgery alveoloplasty to those of conventional alveoloplasty. This was an in-vivo comparative study consisting of ten edentulous individuals who needed alveoloplasty due to bilateral bony projection. On one side, a conventional alveoloplasty was performed with a bone rongeur and bone file, whereas the contralateral side was treated with a piezosurgery unit. The clinical parameters were analyzed using SPSS version 21 software including operating time, postoperative pain evaluation on day 3 and a healing on day 7. There was a statistically significant difference between the two groups in terms of outcome variables such as operating time, pain and healing. The Conventional group has a lower mean of operating time, a higher mean rank of VAS and a lower mean rank of healing index compared to the piezosurgery group. Piezosurgery alveoloplasty not only lowers postoperative patient discomfort but also preserves alveolar bone integrity by not disrupting soft and hard tissue architecture thus allowing faster tissue healing and easier prosthesis replacement in the future.

Discomfort of postoperative patients with aortic dissection after discharge: telephone follow-up analysis of a cross-sectional study

BackgroundPostoperative discomfort is one of the important manifestations of disease changes, but few studies have reported detailed description of postoperative discomfort in patients with aortic dissection after discharge. The aim of this study is to investigate the discomfort symptoms and to explore the possible influencing factors of discomfort symptoms.MethodThis cross-sectional study based on convenience sampling collected medical records from 999 patients hospitalized in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology, Wuhan, Hubei, China from January 1, 2019 to December 31, 2019. Postoperative patients with first onset and confirmed aortic dissection were eligible for follow-up. Telephone follow-up was conducted from July 20, 2020 to August 20, 2020. Symptoms of discomfort were reported by patients or their immediate family members. Univariate and multivariable logistic regression analysis were performed to identify factors associated with symptoms of discomfort.ResultsA total of 675 patients were followed up, 185 patients (27.4%) were lost to follow-up, and the remaining 490 patients were divided into survival group (N = 428) and death group (N = 62) and were included in the study. There was no difference in gender and age among the three groups. 152 of 428 patients reported discomfort. The uncomfortable symptoms of postoperative patients were diverse, and mainly manifested as back and chest pain (32.24%, 49/152), chest tightness (15.79%, 24/152), dizzy (10.53%, 16/152) and weakness (10.53%, 16/152). Multivariable logistic regression analysis of postoperative discomfort showed length of discharge (OR 0.995; P 0.018; 95% CI 0.990–0.999) and positive history of drinking (OR 3.519; P 0.018; 95% CI 1.236–10.022) were significant among patients with Stanford A AD, and diagnosis was made in the first visiting hospital (OR 0.395; P 0.001; 95% CI 0.230–0.677) was a protective factor for patients.ConclusionsThe incidence of postoperative discomfort in patients with aortic dissection was high and the symptoms were diverse and not single. In order to reduce the possibility of postoperative discomfort, it is important to formulate effective public policies to limit the public to drink alcohol and timely diagnose aortic dissection. Long term follow-up is necessary for patients with aortic dissection to observe the recovery process of aortic dissection.

The Modified Procedure of Totally Tubeless PNL

Mini percutaneous nephrolithotomy (mPNL) is a standard treatment for kidney stones larger than 1.5 cm, with the placement of a nephrostomy drainage at the end of it, which is considered the standard procedure, but tubeless/ totally tubeless mPNL techniques reduce postoperative discomfort in patients and shorten hospital stays. The aim of article was to compare the efficacy and safety of our proposed modified method of totally tubeless mPNL with control of the parenchymal canal, with existing methods of tubeless/totally tubeless mPNL. Novelty of the study presented by modified method of totally tubeless mPNL. During the period from 2018 to 2020 we performed 486 mPNL were performed in our clinic in total, among which 63 (12.9%) patients underwent tubeless PNL. Patients whose surgeries ended with using tubeless techniques were divided into three groups: Group I – 22 patients who had tubeless mPNL (with ureteral stent), Group II (20 patients) – totally tubeless mPNL with a safety thread (the proposed procedure), Group III (21 patients) – totally tubeless mPNL. In all three groups, the access point was most often made through the lower group of renal calyces: Group I – 12 (54.5%), Group II – 14 (70.0%), Group III – 13 (61.9%); then through the middle calyx: Group I – 8 (36.4%), Group II – 6 (30.0%), Group III – 7 (33.3%); and the upper calyx: Group І – 2 (9.1%), Group ІІ – 0%, Group ІІІ – 1 (4.8%), no differences in the distribution of access points between groups were found (p=0.67). There were no differences in the distribution of tract sizes between the groups (p=0.95) with tract dilatation to 16.5/17.5 Fr was performed most often: Group I – 12 (54.5%), in Group II – 11 (55.0%) and Group III – 11 (52.4%). The mean duration of surgery in Group I was 83.0±22.9 min, in Group II – 74.9±13.6 min, in Group III – 72.6±12.0 min (p=0.47). This study confirms the high effectiveness of totally tubeless mPNL. The proposed modification to perform totally tubeless mPNL allows you to have permanent postoperative control over the parenchymal channel and in case of postoperative bleeding it enables you to immediately insert nephrostomy drainage through the safety thread. Study contributes to practical methods as an intermediate step for surgeons who are considering transition to a totally tubeless PCNL technique.

Tough Hydrogel Bioadhesives for Sutureless Wound Sealing, Hemostasis and Biointerfaces

AbstractHydrogel bioadhesion technology has offered unprecedented opportunities in minimally‐invasive surgeries, which are routinely performed to reduce postoperative complication, recovery time, and patient discomfort. Existing hydrogel‐based adhesives are challenged either by their inherent weak adhesion under wet and dynamic conditions, or potential immunological side‐effects, especially for synthetic hydrogel bioadhesives. Here, a kind of synthetic hydrogel bioadhesives from a variety of polymer precursors are reported, featuring instant formation of tough biointerface, allowing for wet and robust adhesion with highly dynamic biological tissues. Moreover, by getting rid of monomers during the hydrogel fabrication, these hydrogel adhesives do not cause any inflammatory response during the in vivo wound sealing, promising for immediate vascular defects repairing and surgical hemostasis. Additionally, they could also serve as human–electronics interfacing materials, enabling bioelectronics implantation for real‐time physiological and clinical monitoring.

Local application of hyaluronic acid in conjunction with free gingival graft: a randomized clinical trial.

To assess the effect of the application of hyaluronic acid (HA) in conjunction with free gingival graft (FGG) on postoperative patient discomfort and wound healing. A total of 24 healthy non-smoker patients requiring FGG were recruited for the study. Subjects were randomly assigned into study groups, local application of HA on both donor and recipient sites and control group, application of normal saline. The FGG dimensions were evaluated using digital photographs. Post-operative pain was evaluated for 14days. Color matching and patient satisfaction were evaluated at 6months. In this randomized clinical trial, 21 patients (mean age 23years, (15 females and 6 males) completed the study. Baseline characteristics were comparable across treatment groups. Pain scores in donor sites were statistically significant and higher in control group than study group until day 7 (p < 0.05). Mean of the surface area of the graft at baseline in study vs control group were (169 ± 21), (183 ± 22) (2mm), respectively. While at 6months, were (147 ± 30) and (139 ± 32) (2mm), in study and control group, respectively (p > 0.05). Color match showed no statistical significance difference. Topical application of HA may exhibit significant improvement of postoperative pain and no significant difference in graft dimensions and patients' satisfaction. Topical application of HA is recommended as a dressing material in FGG surgeries to reduce postoperative pain and accelerate healing.

Study of Effects of Soaking Oro-Pharyngeal Pack with Triamcinolone Acetonide in Or-Base Form on Postoperative Throat Discomfort in Patients Undergoing Functional Endoscopic Sinus Surgeries

Abstract Background Post-operative throat complaints frequently arise after general anesthesia in the first 2 postoperative days, but they are of limited intensity and duration and often regard it as a relatively minor complication. Objectives The aim of this study was to determine the effect of adding triamcinolone acetonide to Oropharyngeal packs on decreasing the postoperative throat discomfort. Patients and Methods After obtaining approval from the Research Ethical Committee, Faculty of Medicine, Ain Shams University No. FWA 000017585 at 10th of April 2019, this study was conducted in the operating theaters of Otorhinolaryngology department, Ain Shams University Hospitals, Cairo, Egypt. Prospective, interventional double – blinded, randomized, controlled trial. Study Period: From 10th of April 2019 to 10th of September 2019. Results Post was followed up in the studied patients in 30 minutes postoperative, and at the duration of 2 to 6 hours postoperative and 24 hours postoperative and the median was calculated. The median IQR of patients who developed sore throat after use of oral packs in our study from 2 to 6 hours postoperative in control group was 4 with range (3 -5), median IQR in study group during the same period was 3 with range (4 -5) with test value 2.194 using Mann-Whitney test with P-value 0.028 with significant result. Conclusion The use of oral packs with triamcinolone acetonide showed lower proportion of patients who developed dysphagia and hoarseness of voice in patients group compared to control group, while no one of the studied patients showed postoperative nausea and vomiting as complication of use of oral packs.

Effect of chlorpheniramine administration on postoperative catheter-related bladder discomfort in patients undergoing transurethral excision of bladder tumor: a prospective randomized study

Catheter-related bladder discomfort (CRBD) is postoperative distress caused by a urinary catheter. CRBD is related to muscarinic receptor activation. Chlorpheniramine has antimuscarinic properties. Hence, this investigation was undertaken to evaluate the efficacy of chlorpheniramine in preventing CRBD in patients undergoing transurethral resection of bladder tumor (TURBT). Seventy-six patients scheduled for TURBT under general anesthesia were assigned into two groups. In the chlorpheniramine group (n = 38), 100ml normal saline containing 0.1mg/kg chlorpheniramine was infused after general anesthesia induction. In the control group (n = 38), 100ml normal saline alone was infused. The incidence and severity of CRBD were assessed at 1, 6, and 24h postoperatively. The 1-h postoperative incidence of CRBD was lower in the chlorpheniramine group based on the unadjusted analysis [16 (42%) vs. 28 (74%), risk difference 32%, 95% confidence interval 8-51, p = 0.005]. After adjusting the size of the urinary catheter, post hoc analysis showed that the 1-h postoperative incidence of CRBD was lower in the chlorpheniramine group (p = 0.004). The CRBD severity score was lower in the chlorpheniramine group at 1 and 6h after operation based on the unadjusted analysis (p = 0.012 and p = 0.007, respectively). After adjusting the urinary catheter size, post hoc analysis showed that 1- and 6-h CRBD severity score was lower in the chlorpheniramine group (p = 0.012 and p = 0.008, respectively). The incidence of rescue medication was lower in the chlorpheniramine group [10 (26%) vs. 20 (53%), risk difference 26%, 95% confidence interval 3-47, p = 0.019]. The overall incidence of complications such as nausea, vomiting, dry mouth, flushing, dizziness, and blurred vision was comparable between the two groups. Chlorpheniramine administration significantly reduces the incidence and severity of CRBD in the patients undergoing TURBT. KCT0004880 ( https://cris.nih.go.kr/ ).