Patients In Postoperative Period Research Articles

Osteopenia and osteoporosis in patients after bariatric surgery: mechanisms of development, course and prognosis

In recent decades, the medical community around the world has been searching for ways to combat morbid obesity, and despite the variety of methods and techniques, great progress has been noted in recent years in the field of bariatric surgery. Despite its effectiveness, bariatric surgery still has a large number of questions related to the effectiveness of certain methods, their long-term results and the choice of surgery. The purpose of this literature review: to consider the mechanisms of formation, development and course of osteopenia and osteoporosis after bariatric surgery, as well as the frequency of their occurrence depending on the type of bariatric procedure (sleeve gastrectomy, Roux-en-Y gastric bypass, gastric banding, biliopancreatic diversion). To achieve this goal, a literature search on this issue was conducted on the PubMed, eLIBRARY.RU, Google scholar platforms. The material was summarized and analyzed in order to find previously unexplored links in the pathogenesis of osteopenia and osteoporosis and, in general, the mechanisms of mineral metabolism disorders in the postoperative period in patients who underwent bariatric surgeries of varying volumes.

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PurposeThe purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia. DesignThis was a randomized controlled experimental trial. MethodsThe research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate. FindingsWhen the groups’ VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05). ConclusionsVR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Biomarkers as Predictors of Severity Multiple Organ Dysfunctions After Cardiac Surgery (Case Series Study)

Introduction. The question of the possibility of predicting the severity of multiple organ failure that developed in the postoperative period in cardiac surgery patients is not sufficiently covered in the literature.The aim of the study is determine the prospects of studying the relationship between the level of biomarkers and the severity of multiple organ failure in patients undergoing cardiac surgery.Materials and methods. A series of seven observations was carried out on the clinical course of the immediate postoperative period in patients who underwent elective cardiac surgery. In the preoperative period, the risk of in-hospital mortality was assessed using the EuroSCORE II scale and the presence of multiple organ failure using the SOFA scale. Before surgery and at the beginning of the first postoperative day, the plasma level of presepsin was studied. Also, at the beginning of the first postoperative day, plasma levels of transferases and troponia T were studied, and the severity of multiple organ failure was analyzed using the SOFA scale. The length of stay of patients in the ICU was assessed. The results of the study are presented in the form of tables and graphs and subjected to visual analysis.Results. The obtained data do not allow us to accurately link the level of tissue damage markers (aspartate aminotransferase, alanine aminotransferase, troponin T) and the marker of the systemic inflammatory reaction presepsin with the severity of multiple organ failure in patients after cardiac surgery. At the same time, they do not exclude the existence of such a connection.

Acute Symptomatic Epileptic Seizures After Microsurgical Removal of Supratentorial Meningiomas

RELEVANCE. One of the problems complicating the early postoperative period in patients with supratentorial meningiomas is epileptic seizures, which in 9-16% of cases first develop within the first 7 days after tumor removal (acute symptomatic epileptic seizures).AIM OF THE STUDY. To identify risk factors for the occurrence of acute symptomatic epileptic seizures in the early postoperative period in patients with supratentorial meningiomas and to evaluate the effectiveness of prophylactic antiepileptic therapy.MATERIAL AND METHODS. A prospective, single-blind, randomized, placebo-controlled study was conducted using the sequential, alternate-arm randomization method. The treatment of 102 patients with supratentorial meningiomas was analyzed, in whom the tumor was removed between 01.01.2021 and 30.09.2023 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. To identify risk factors for the development of acute symptomatic epileptic seizures in patients, we assessed the data of the anamnesis, examination of the patient, electroencephalography before surgery, neuroimaging before and after tumor resection, as well as the characteristics of the intraoperative period, duration and outcomes of hospitalization. To evaluate the effectiveness of the prophylactic use of antiepileptic drugs, patients were divided into two groups. The first group consisted of 49 patients who took an antiepileptic drug as a prophylaxis of early epileptic seizures. The second group consisted of 53 patients who took a placebo drug. Both groups were divided into two subgroups each depending on the development of an epileptic seizure or its absence after surgery. In the first group, patients with epileptic seizures were considered the main subgroup, the patients without seizures were considered the control. We assessed the placebo group similarly.RESULTS. In the placebo group, a risk factor for the development of acute symptomatic epileptic seizures was the transection of one or more veins, which was necessary to achieve sufficient surgical access, leading to a change in cerebral venous blood flow (p=0.013, odds ratio (OR)=11.43; 95% CI [1.75–74.73]). In both the antiepileptic drug group and the placebo group, risk factors included an increase in the volume of cerebral edema according to postoperative CT scan data compared with preoperative (p=0.05, OR=18.8; 95% CI [2.0–182.7] and p=0.01, OR=12.6; 95% CI [2.36–68.0], respectively), as well as hemorrhagic transformation of the perifocal edema zone (p=0.03, OR=8.75; 95% CI [1.36–56.4] and p=0.02, OR=9.7; 95% CI [2.1–44.6], respectively). The efficacy of prophylactic use of antiepileptic drugs in reducing the incidence of acute symptomatic epileptic seizures in the first 7 days after surgery was not established (p=0.295, OR=0.533; 95% CI [0.181–1.572]).CONCLUSION. We have identified the following risk factors for the development of acute symptomatic epileptic seizures: an increase in the volume of cerebral edema compared to the preoperative level according to postoperative computed tomography, the development of hemorrhagic transformation of cerebral edema in both groups, and the intersection of one or more veins during surgery (in the placebo group). Confirmation of the efficacy of routine use of antiepileptic drugs for the prevention of acute symptomatic epileptic seizures not received.

Prophylactic antibiotic therapy during endovascular closure of patent foramen ovale: a clinical study

Purpose of the study. To study the effect of prophylactic antibiotic therapy on the course of the postoperative period in patients undergoing endovascular closure of patent foramen ovale (PFO). Material and methods. The study included 276 patients who were submitted to endovascular closure of PFO. The follow-up duration was 12 months. Depending on prophylactic antibiotic therapy the patients were divided into 2 groups - those who did not receive and those who received prophylactic antibiotic therapy (115 and 161 patients, respectively). Results. Cephalosporins were prescribed to patients as prophylactic antibiotic therapy, and in the presence of allergic reactions they were replaced by glycopeptides. In total, patients received 1 to 2 drugs per prophylaxis course. Postoperative complications were present in 37 (22.98 %) patients who received prophylactic antibiotic therapy and 12 (10.43 %) who did not receive prophylaxis (p = 0.007). Access site complications were the most identified, but they were not inflammatory in nature. An elevation of body temperature over 37.1 °C was observed in 19 (11.80 %) patients receiving prophylactic antibiotic therapy compared to 5 (4.35 %) who did not receive prophylaxis (p = 0.03). Meanwhile, marked leukocytosis was absent in both groups. The duration of body temperature elevation did not differ between the groups. They also had a longer duration of hospitalization, 7.00 [6.00; 8.00] bed days, compared to 6.00 [4.00; 7.00]. Discussion. It has been suggested that hyperthermia may be associated with prophylactic administration of antibacterial drugs causing death of persistent microflora. In patients who did not receive prophylactic antibiotic therapy, their concentration was lower, which did not lead to an increase in body temperature. Since there are no indications on the necessity of prophylactic antibiotic therapy before endovascular closure of PFO in clinical recommendations, it is suggested to evaluate its appropriateness for each patient individually.

Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD). Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction. Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%). Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p &lt; 0.0001).

Dynamics of changes in the diameter of the great saphenous vein in the postoperative period in patients operated on using non-thermal methods

Dynamics of changes in the diameter of the great saphenous vein in the postoperative period in patients operated on using non-thermal methods

Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock.

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery.

Lymphoblock surgical solution for the prevention of lymphogenic complications during robot-assisted radical prostatectomy and pelvic lymphadenectomy: first-use experience

Introduction. The clinical guidelines recommend performing extended pelvic lymph node dissection for patients with intermediateor high-risk cancer prostate. The incidence of lymphocele development reaches 10.3%.Objective. The aim of this study was to evaluate the efficiency of the drug Lymphoblock after radical prostatectomy with pelvic lymphadenectomy.Materials &amp; methods. The study involved 79 patients with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymphadenectomy, that were randomized into three treatment groups: 1. Patients with free peritoneal flap fixed to the pubic bone (n = 26); 2. Patients who received Lymphoblock: during the surgery (n = 26); 3. Control group (n = 27). The median follow-up was 180 d.Results. In postoperative period lymphocele was diagnosed in 8 (10.1%) patients: group 1 — 2 (7.7%) patients, group 2 — 1 (3.8%), group 3 — 5 (18.5%). Lymphocele had no clinical manifestation in group patients who received Lymphoblock.Conclusions. Preliminary results of Lymphobloc use indicate that it can reduce the incidence of lymphogenic complications in the postoperative period in patients undergoing robot-assisted radical prostatectomy with pelvic lymphadenectomy.

Improvement of Single-port Laparoscopic Cholecystectomy

The desire of both surgeons and patients to reduce the trauma of the operation and shorten the length of hospital stay, on the one hand, and on the other hand, the development of new technologies and the emergence of special devices led to the development and implementation of video endoscopic minimally invasive methods of surgical intervention. The results of single-port laparoscopic cholecystectomy and the possibility of choosing instrumental support when performing these operations should be analyzed. Our study included 116 patients hospitalized for planned surgical treatment with chronic calculous cholecystitis from 2019 to 2023. The patients were divided into two groups: the first main group consisted of 52 (44.8%) patients with chronic calculous cholecystitis who underwent single-port laparoscopic cholecystectomy (SLP) using the single access technique (SAL). The second group (TLCE) consisted of 64 (55.2%) patients with CCC who underwent laparoscopic four-port cholecystectomy. A comparative analysis of the results of the intraoperative and early postoperative periods in patients after TLCE using the single access method, the number of complications was minimal than with TLCE using a four-port approach. Long-term results of surgical treatment of patients with cholelithiasis after OLCE using the single access method are characterized by the least complications, high cosmetic effect, and low morbidity.

Evaluation of the use of tranexamic acid in the postoperative period in patients with scoliosis undergoing posterior fusion.

Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.

Clinical evaluation of the efficiency of combined phytotherapy in the postoperative period in patients with uterus cancer

As it is well known, that operative procedures which influence on ovary functions and relieve the patient of some suffering and danger from diseases, are realized by pronounced changes in hormonal self-regulation, homeostasis disturbance, deep psycho-emotional disorders, which leads to a change in the quality of life, an increased risk of long-term complications development (cardiac vascular pathology, osteoporosis, etc.).Some authors explain the changes in neurovegetative and endocrine homeostasis after hysterectomy not only by the insufficient development of collateral blood flow, but also by the removal of one of the links of the self-regulatory system – APUD – the uterine system, which causes the disorders in hypothalamic-pituitary-ovarian relationships. Menopausal symptoms with the appearance of neurovegetative, psychoemotional disorders, urological disorders, sexual dysfunction, as well as metabolic manifestations do not always provide an opportunity to assess the parameters of a woman’s health, which are combined into the concept of quality of life.The article presents the results of a study on the use of Cimicifuga racemosa for the treatment and prevention of post-hysterectomy syndrome in patients with uterine cancer in the postoperative period.The objective: to study the clinical effectiveness of the drug, which contains the estrogen receptor modulator Cimicifuga racemosa, in patients after surgical treatment for hormone-dependent uterine tumors.Materials and methods. The study included 50 uterine cancer patients after hysterectomy. 30 patients (main group) of them had rehabilitation therapy in the postoperative period (postoperative antibacterial prophylaxis, analgesic therapy, vaginal sanation) and, starting from the second month, they additionally received a herbal preparation with an extract of Cimicifuga racemosa, 1 tablet 1 time a day for 4 months.The control group included 20 women who received only rehabilitation therapy after surgery.Quality of life was assessed after 6 months of therapy based on a comprehensive assessment using the modified MENQOL scale and the study of such important indicators as energy, sleep, emotional reactions, social isolation, physical activity, and pain.All types of statistical processing were performed using the standard package «Statistica for Windows – 10».Results. The use of selective combined herbal therapy of the post-hysterectomy syndrome in patients with hormone-dependent tumors after 6 months of treatment leads to a decrease in the frequency of hot flashes by 63.3%, profuse sweating by 63.4%, sleep disturbances by 43.3%, increased fatigue by 40.0%, depressive disorders – by 36.7% and irritability – by 33.3%.Additional use of the herbal preparation with Cimicifuga racemosa extract reliably (p&lt;0.05) reduces the manifestations of post-hysterectomy syndrome, improves the quality of life, is well tolerated and has no side effects.Conclusions. The use of selective combined herbal therapy in the postoperative period in patients with cancer of the uterine body allows to reliably improve the quality of life of patients and reduce the clinical manifestations of post-hysterectomy syndrome, which is especially relevant in patients with cancer of the uterine body, for whom replacement hormone therapy is contraindicated. Selective herbal therapy is well tolerated by patients and can be used for a long time.

Features of the clinical course of penile cancer

Introduction. Penile cancer (PC) is one of the rare tumors, accounting for 1-2% of all neoplasms of the genitourinary system. The clinical course of the cancer process raises many questions among both urologistsoncologists in hospitals and outpatient doctors. A retrospective analysis of articles indicates that this process has not been sufficiently studied and requires more clinical observations to determine the diagnosis and correct treatment tactics for such patients.Materials and methods. Clinical observations of the development of human cancer in patients are presented. An analysis of original articles was also carried out in the following databases: Pubmed, Scopus, Scopus, Web of Science from 2007 to 2022, dedicated to this disease.Results. When a tumor of the penis was detected, one patient underwent surgical intervention to the extent of amputation of the glans penis. In the second patient, total damage to the penis was revealed, which required more radical surgical treatment including: Emasculation with urethroplasty. The third patient underwent radiation therapy and subsequently circumcision of the foreskin. The postoperative period in patients was without complications. No relapse was observed.Conclusion.Penile cancer, despite its rarity, is a pressing problem in modern oncology. Even with proper examination and treatment, it is difficult to predict the further development of the disease. These clinical cases force specialists to examine patients more carefully so as not to miss pathology that can cripple the patient and change his future lifestyle, and also shows different options for treatment outcomes for penile cancer.

CHOICE OF ANESTHESIA TECHNIQUE FOR MINE-EXPLOSIVE OR GUNSHOT INJURIES TO THE LIMBS

Introduction. Despite the overall advancement of medicine, the issue of adequate pain management for patients with combat injuries remains relevant today at all stages of providing care to the wounded. Limb injuries dominate the structure of traumatic damage due to combat trauma, accounting for 44-52 % of cases. Adequate control of pain syndromes in the postoperative period allows reducing the incidence of complications, shortening the patient's stay in the hospital and intensive care unit, accelerating the start of rehabilitation for the injured. Regional pain management methods are becoming more widespread; however, they often require a more specialized approach and specific training for anesthesiologists to conduct multimodal analgesia effectively. At the same time, the use of regional pain management methods is associated with fewer anesthesia complications, significant economic advantages compared to general anesthesia. Objective. To improve the treatment outcomes of patients with blast and gunshot limb injuries by determining the optimal method of anesthesiological support. Materials and methods. This study includes data on 61 patients hospitalized at the Municipal Clinical Hospital № 17 in Kyiv with a diagnosis of blast and/or gunshot limb injuries and treated at the mentioned hospital from February 2022 to October 2023. Discussion of research results. The study results convincingly demonstrate the significant benefits of using regional anesthesia methods during primary and staged surgical interventions in patients with blast and gunshot limb injuries compared to the use of general anesthesia. Regarding anesthesiological support using regional anesthesia techniques, they have significant advantages over general anesthesia in patients with blast and gunshot limb injuries. Conclusion. The application of regional pain management methods enables better control of pain syndromes and a substantial reduction in the use of narcotic analgesics in the postoperative period for patients with blast and gunshot limb injuries, promoting faster recovery and early rehabilitation for this patient group.

The significance of clinical and morphological characteristics of spinal cord astrocytomas in the choice of surgical tactics

Objective — to determine the factors affecting the dynamics of the neurological status in the postoperative period in patients with intramedullary spinal cord astrocytomas (SCA) in order to improve the results of their surgical treatment. Materials and methods. Between 2010 and 2019, we conducted a retrospective study on the surgical treatment outcomes of 39 SCA patients operated on at the SI “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine”. The age of the patients ranged from 19 to 67 years, with an average age of 41.4 years. Out of the total, 25 patients (64%) were men and 14 patients (36%) were women. We observed cervical localization in 11 (28%) clinical cases, thoracic localization in 25 (64%), and conus medullaris in 3 (8%). All patients underwent a comprehensive clinical and instrumental examination using magnetic resonance imaging with intravenous enhancement, computed tomography, and spondylography. The dynamics of neurological symptoms were evaluated using the modified McCormick before surgery, at the time of the patient’s hospital discharge, and during follow‑up examinations. Results. Total removal of SCA was performed in 7 (18%) patients, subtotal in 25 (64%), and partial in 7 (18%). Pilocytic astrocytoma (PA) (World Health Organisation (WHO) grade I) was detected in 19 (49%) patients, diffuse astrocytoma (DA) (WHO grade II) in 17 (43%), and anaplastic astrocytoma (AA) (WHO grade III) in 3 (7%). Partial regression of neurological symptoms was noted in 29 (74%) patients, the neurological status remained at the preoperative level in 6 (15%) patients, and a slight increase in the neurological deficit was noted in 4 (10%) patients. Age &lt;60 years is significantly more frequently associated with the growth of PA, while age &gt;60 years is significantly more frequently associated with the growth of AA. The duration of anamnesis (&lt; 1 year and &gt;1 year) and the degree of radicality of the operation were identified as significant factors that can influence the neurological status in the late postoperative period, mainly in patients with PA and DA. However, such factors as tumour location and the degree of infiltration of nearby structures are not statistically significant. AA is associated with an unfavourable prognosis across all important criteria. Conclusions. The most important determinants of SCA prognosis are preoperative and postoperative neurological condition, resection extent, and histological grade. Patients with minor neurological damage at the time of surgery, those under the age of 60, and those with highly differentiated SCA had the greatest surgical treatment outcomes. Assessment of the preoperative neurological status and determination of the histological type of the tumour are important factors in choosing the optimal surgical tactics, which сan improve treatment outcomes and the quality of life in SCA patients.

Удосконалена мініінвазивна ретромускулярна алопластика в пацієнтів із діастазом прямих м’язів живота

Diastasis recti abdominis contributes to the occurrence of defects with the formation of hernias of the white line. The recurrence of diastasis after alloplasty may also be associated with the presence of thinned posterior aponeurotic walls of the rectus abdominis muscles. Aim - to іncrease the effectiveness of surgical treatment of diastasis recti abdominis by using minimally invasive retromuscular techniques. Materials and methods. An analysis of surgical treatment of patients with diastasis recti abdominis was conducted in 126 patients. Average age - 51±1.2 years old. Diastasis width from 3 to 10 cm. In the I (main) group (n=64) surgical treatment it was performed according to the mini-invasive method we improved retromuscular technique. In the II group (comparison) (n=62) surgical treatment was performed according to the traditional «onlay» technique. In the postoperative period in patients of the I and II groups evaluated term stay of a patient in a hospital, direct and remote results. The methods of variational statistics were used: the averages for each studied feature, the errors of the arithmetic mean. Results. Term stay in a hospital patients of the I group was 2.1 days, the II group - 6.2 days. Among complications and on the side of the surgical wound in patients of the I group, a hematoma was observed in 2 (3.1%), seroma - in 4 (6.2%), wound infection was not observed, while in patients of the II group a hematoma was observed in 6 (9.7%), seroma - in 10 (16.1%), wound infection - in 3 (4.8%). Distant the results in terms of 2 to 36 months showed that among 35 patients of the II group, chronic postoperative pain was relapses were diagnosed in 2 (3.1%). diastasis direct muscles occurred in 7 (11.3%), and among 34 patients of the I group chronic postoperative pain diagnosed in 6 (9.7%) and relapse only in 1 (1.5%). Conclusions. Advanced mini-invasive retromuscular alloplasty is more effective, which is confirmed by a decrease in hospital stay and a decrease in postoperative complications. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the specified institution. Informed consent of the patients was obtained for the research. The authors declare no conflict of interest.

The effects of smoking on pain scores, vital signs, and analgesic consumption in patients undergoing tympanomastoidectomy surgery.

In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke.

Intranasal Tapentadol Versus Intravenous Paracetamol for Postoperative Analgesia in Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia: A Single Blind RCT.

We aimed to compare the analgesic effectiveness of intranasal tapentadol nasal spray 44.5mg and intravenous (IV) paracetamol 1gm during the postoperative period in patients undergoing lower limb orthopedic surgeries under spinal anesthesia. This prospective, randomized, single-blind clinical trial was carried out in a tertiary care teaching hospital. Patients aged between 18 and 60 years of physical status ASA grade 1-3 were included in the study. Postoperative pain scores were measured using the visual analog scale (VAS) in centimeters (cm) every 12 hours in 37 patients per group. The patients were administered either intranasal tapentadol or IV paracetamol every 6 hours for 72 hours, beginning 3 hours after surgery. There was a significant group by intervention effect favoring intranasal tapentadol, suggesting a greater reduction in VAS pain scores after the intervention at 72 hours (estimate: -1.58 cm; SE:0.2; P<0.001). Group by time effect for all the measured time frames, except for 36 hours, favored intranasal tapentadol with estimated values for greater reduction in VAS pain scores ranging from -0.8 cm to -1.6 cm. The results of the present study suggests that intranasal tapentadol results in a greater reduction of postoperative pain compared with IV paracetamol in lower limb orthopedic surgeries. The ease of administration of tapentadol may make it a preferred option over IV paracetamol in such surgeries.

Evaluation of effects of intravenous infusion of dexmedetomidine or lignocaine on stress response and postoperative pain in patients undergoing craniotomy for intracranial tumors: A randomized controlled exploratory study.

Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4-8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.

Prevention of chronic postoperative pain syndrome after Lichtenstein hernioplasty

THE OBJECTIVE was to analyze the development of chronic pain syndrome after performing standardized Lichtenstein hernioplasty.METHODS AND MATERIALS. The prospective single-center study was conducted with 40 patients with inguinal hernias (20 patients in the study group and 20 patients in the control group) who underwent Lichtenstein hernioplasty with adherence to standardization criteria and without. The comparative analysis of the early and long-term postoperative periods was performed.RESULTS. When comparing the early and long-term postoperative periods in patients after standardized Lichtenstein hernioplasty, the following data were obtained: pain syndrome according to the Visual Analogue Scale (VAS) was less pronounced after applying standardization criteria (p &lt; 0.001), and statistically significantly lower number of complications (seroma, paresthesia) developed (p=0.045, p=0.019). In the group of patients who underwent standardized Lichtenstein hernioplasty, chronic pain syndrome was not observed in the long-term postoperative period (p &lt; 0.001).CONCLUSIONS. Prevention of chronic postoperative pain syndrome after hernioplasty using the Lichtenstein method is the significant issue. This article emphasizes the importance of considering various factors and implementing preventive strategies to minimize the risk of this complication and ensure optimal surgical outcomes.