Seventh Postoperative Day Research Articles

Clinical effects of platelet-rich fibrin (PRF) following surgical extraction of lower third molar

Abstract Objective The purpose of this study was to assess the effect of platelet-rich fibrin (PRF) on postoperative pain, analgesic consumption, soft tissue healing and socket complications following the extraction of mandibular third molars. Methods A total number of 50 impacted third molars were surgically removed from 47 patients (13 males and 34 females; with a mean age of 25.24 ± 7.04 years). PRF clots were placed in the extraction sockets of patients included in the study group, while the sockets remained empty in the control group. The variables assessed were pain, analgesic consumption, soft tissue healing and socket complications encountered during the first postoperative week. Results In the study group, a significantly less pain was recorded in the fifth, sixth and seventh postoperative days ( P = 0.041, 0.031 and 0.005 respectively). Patients included in the study group also significantly consumed less analgesics for the second, third, sixth and seventh postoperative days ( P = 0.019, 0.039, 0.045 and 0.020 respectively). PRF significantly reduced the incidence of alveolar osteitis ( P = 0.037) but not the infected or inflamed sockets ( P = 1.00 and 0.312 respectively). No significant difference was observed between PRF and control groups regarding soft tissue healing ( P = 0.187). Conclusion PRF could reduce alveolar osteitis, pain, and analgesic consumption following removal of impacted mandibular third molars.

Thulium Laser Prostate Enucleation in Refractory Urinary Retention: Operative and Functional Outcomes in a Large Cohort of Patients

To evaluate the functional and operative results of thulium laser enucleation of the prostate (ThuLEP) in patients with indwelling catheters for refractory urinary retention. Patients with indwelling catheter, undergoing ThuLEP for benign prostate hyperplasia, were prospectively enrolled. Every episode of urinary retention was treated with urinary catheter positioning followed by at least 2 attempts of catheter removal. Patients were investigated with flowmetry and the self-administered International Prostate Symptom Score questionnaire at 30 and 90 days following ThuLEP. Three hundred eighty-one patients underwent ThuLEP, and 99 of these had indwelling catheters, but only 93 (24%) were eligible according to the inclusion criteria. In 46 patients the bladder catheter was removed on the first postoperative day, in 31 patients on the second postoperative day, in 5 patients on the third postoperative day, in 6 patients on the fourth postoperative day, in 1 patient on the fifth postoperative day, and in 2 patients each on the sixth and seventh postoperative days. The average hospital stay was 2.3 (±1.7) days. No patients undergoing ThuLEP, at the 90-day follow-up, required further catheterization. Flowmetry showed significant improvement in all parameters, and the mean International Prostate Symptom Score dropped from 21.33 preoperatively to 3.2 (P = .004) at 90 days postoperatively. This prospective study shows that ThuLEP is a safe and effective approach in refractory urinary retention patients. In our case series, no patients required postoperative intermittent catheterization. All functional outcomes investigated reported a statistical significant improvement.

Transanal tube NO COIL® after rectal cancer proctectomy. The "G. Paolo II" Cancer Centre experience.

Covering stoma is the main method used to protect low-lying anastomosis after cancer proctectomy. Intraluminal rectal pressure could be a potential risk factor for anastomotic leakage. We present our personal experience with an alternative and original device, the transanal tube NO COIL®, evaluating its feasibility and safety based on a preliminary manometric study. From May 1998 to March 1999, an experimental manometric study on 35 subjects was performed to assess the pathophysiological basis of intraluminal rectal pressure with or without the transanal tube. Subsequently, from April 1999 to December 2009, 184 patients (107 males, 77 females, average age 68.2 ± 10 years) with primary adenocarcinoma of the rectum (≤12 cm from anal verge) were selected. Eighty-two underwent total proctectomy and 102 subtotal proctectomy. No stoma were fashioned. At the end of the operation, the silicone transanal tube NO COIL ®, 60-80 mm long, 2 mm thick with a calibre of up to 2 cm, was applied and secured to the perineal skin by two stitches, then removed on the seventh postoperative day if no signs of leakage occurred. The intraluminal rectal pressure with transanal tube was strongly reduced from 13.8 + 8.5 mmHg to 4.8 + 3.7 mmHg (P <0.01). Nine patients (4.8%) developed an anastomotic leakage, 2 males and 7 females. In 10 patients, the transanal tube NO COIL® did not remain in situ for the planned seven days, and 18 patients suffered from ulcers in the perianal skin. Leakage subsided with conservative treatment in 4 patients, whereas 5 patients required loop colostomy. The stoma rate was 2.7%. No leakage-related deaths occurred, and overall mortality was 1.3%. The transanal tube NO COIL® does not abolish the risk of anastomotic leakage but could be an alternative option to covering stoma after cancer proctectomy in selected patients. In our experience, this simple and cheap device could reduce the rate of stoma without leakage-related mortality. Further studies within a randomized controlled trial are required to better define our results.

Intraocular lens implantation without the use of ophthalmic viscosurgical device.

The purpose of this study was to determine whether single-piece hydrophilic acrylic intraocular lens can be safely implanted without the use of ophthalmic viscosurgical devices. This retrospective study comprised 100 eyes having phacoemulsification and intraocular lens implantation without the use of ophthalmic viscosurgical device. 80 eyes with the use of a viscosurgical device are used as control group. In this intraocular lens implantation technique, the anterior chamber was maintained with an irrigation cannula and intraocular lens was implanted with a lens injector. Visual acuity, corneal clarity and edema, intraocular pressure, and corneal endothelial cell count were evaluated preoperatively and postoperatively at days 1, 7, and 30. Corneal endothelial cell count was repeated 2weeks after surgery. Complications of this technique were also evaluated. No significant complications of this intraocular lens implantation technique, such as posterior capsule rupture, intraocular lens buttonholing, zonular dialysis, Descemet's tear/detachment, occurred. On the seventh postoperative day, 90% of eyes achieved 20/20 or better vision. There was no difference in corneal endothelial cell loss between viscoelastic device-used and not-used cases (p=0.356). When implanting intraocular lens without the use of ophthalmic viscosurgical device, significant intraoperative complications did not occur. The possible advantages are shortened surgery time, avoidance of postoperative IOP spike from ocular viscosurgical device (OVD) remnant, and reduced cost.

Negative-Pressure Therapy to Reduce the Risk of Wound Infection Following Diverting Loop Ileostomy Reversal: An Initial Study.

To evaluate if the application of a negative-pressure therapy system (Prevena Incision Management System, Kinetics Concepts Inc, [KCI] an Acelity Company, San Antonio, Texas) on ileostomy-closure surgical wounds would reduce surgical site infections (SSIs) in comparison with conventional closure and dressing. Prospective interventional pilot study. La Paz University Hospital, tertiary care academic hospital in Madrid, Spain. The Prevena device was applied on the wounds of 17 consecutive patients undergoing ileostomy reversal. Control subjects were 43 patients undergoing the same procedure, in which conventional dressings were used for the wound. The device was applied on the wound immediately after surgery (under sterile conditions) and maintained for 5 to 7 days. Patients were evaluated daily, and on the seventh postoperative day, the device was removed and wounds carefully inspected. Another evaluation was performed a month after the surgical intervention in the outpatient clinic. The primary end point of the study was the detection of SSI (defined according to the Centers for Disease Control and Prevention definitions). Other intervention-related complications were also registered. There were no significant differences in demographic variables between groups. In the control group, 9 patients (21%) presented SSI, with statistical significance (P < .038) when compared with the intervention group (0%). There were no complications associated with the application of the Prevena device. Other complications (for example, ileus or obstruction) occurred in 30% of patients. The negative-pressure Prevena System was safe and easy to use and may prevent SSIs in dirty wounds, such as those from ileostomy closure.

Postoperative discomfort after Nd:YAG laser and conventional frenectomy: comparison of both genders

Evidence has suggested that males and females experience and report feeling pain differently. The aim of this study was to determine the postoperative perception levels of both females and males after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser frenectomy and conventional frenectomy, and to compare the perceptions between genders. Eighty-nine patients requiring frenectomy were randomly assigned to have treatment with either the conventional frenectomy or with the Nd:YAG laser. Postoperative discomfort (pain, chewing, talking) was recorded using a visual analog scale (VAS) on the operation day and postoperative days 1, 3, 7 and 10. According to the female VAS scores of the pain, chewing and speaking discomfort were statistically higher in the conventional group than those of the laser group on the operation day, and on the first and third postoperative days. Pain discomfort in males was statistically higher in the conventional group than those of the laser group on the operation day. Speaking discomfort in males was statistically higher in the conventional group than those of the laser group on the operation day and the first postoperative day. The present study indicated that Nd:YAG laser treatment used for frenectomies provides better postoperative comfort for each gender, especially in females in terms of pain, chewing and speaking than the conventional procedure up to the seventh postoperative day. According to our results, Nd:YAG laser may provide a safe, bloodless, painless surgery and an impressive alternative for frenectomy operations.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations

IntroductionThe main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. ObjectiveThe current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. MethodsPatients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. ResultsNo significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. ConclusionsSilicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Risk Factors Associated with Wound Infection Following Caesarean Section - A Hospital Based Study

Aim: To find out the risk factors associated with wound infection following caesarean section. Design: Prospective cohort study. Place and Duration of Study: This study was carried out in the Department of Obstetrics and Gynaecology, Lalla-Ded Hospital, Government Medical College, Srinagar from October 2014 to September 2015. Methodology: Total of 1560 women who had undergone CS for delivery during study period were considered as eligible. Wound was observed for the development of infection on the third, fifth and seventh postoperative day. Patients who developed wound infection constituted the cases (116) and those with healthy wound constituted the controls (1444). Results: Incidence of wound infection following caesarean section was found to be 7.4% in this Original Research Article Afzal and Nawaz; BJMMR, 14(2): 1-6, 2016; Article no.BJMMR.23909 2 study. Wound infection was found to be common in women who had BMI of ≥25, who had absent membranes before surgery, who were diabetic, who underwent emergency surgery and the woman who had vertical skin incision. Conclusion: The risk of developing wound infection after caesarean section depends on multiple factors. Therefore, increased awareness on these risk factors and prevention of these infections should be a clinical and public health priority.

A comparative evaluation of the effect of diclofenac sodium with and without per-orally administered methylprednisolone on the sequelae of impacted mandibular third molar removal: A cohort randomized double-blind clinical trial.

Aim and Objectives:This study evaluated the efficacy of oral methylprednisolone and diclofenac sodium on post-operative sequelae after third molar surgery.Settings and Design:A randomized double-blind clinical trial was conducted (with institutional and university approval for dissertation) to evaluate the effect of methylprednisolone with diclofenac sodium (group A) as compared with diclofenac sodium and placebo (group B) on three variables: Pain, swelling and trismus, after third molar surgery.Materials and Methods:Thirty consecutive consenting patients for surgical removal of mandibular impacted third molar were randomly placed into two groups of 15 each (groups A and B). Pain, swelling and trismus were observed by visual analog scale, facial measurements and inter-incisal opening. Scores were recorded after 24 and 72 h and on the seventh post-operative day. Results were subjected to the Chi-square test and independent sample t-test (P = 0.05).Results:Mean difference in pain experienced between the two groups was statistically significant at 24 h (P = 0.015) and 72 h (P = 0.001) and on the seventh day (P = 0.005). Difference in inter-incisal distance was insignificant (P = 0.239) pre-operatively, but significant after 24 h (P = 0.014) and 72 h (P = 0.001) and on the seventh post-operative day (P = 0.001). Mean difference in swelling was highly significant after 24 h (P = 0.001) and 72 h (P = 0.0001) and on the seventh post-operative day (P = 0.047).Conclusions:The combination of oral dose of methylprednisolone (a corticosteroid) diclofenac sodium (a non-steroidal anti-inflammatory drug) was found to be more effective than diclofenac sodium alone on the sequelae of surgical removal of impacted mandibular third molar.

A late presentation of pulmonary valve endocarditis following closure of patent ductus arteriosus in the childhood: A case report

Background: Infective endocarditis is a microbial infection of the endothelial surface of heart and great vessels frequently involving Mitral and Aortic valve. Pulmonary valve endocarditis leading to Severe Pulmonary Regurgitation is extremely rare and is often diagnosed late due to non specificity of symptoms. We intend to report such a case to bring the attention of everyone the long term consequences of Pulmonary Regurgitation. Here we also describe method of replacing Pulmonary valve with Bioprosthetic Aortic valve. Methods: We describe the technique of replacement of pulmonary valve with Bioprosthetic Aortic valve in case of severe Pulmonary regurgitation. Result: The patient successfully underwent replacement of both Pulmonary and Tricuspid valve with bioprosthetic valve and was discharged from the hospital on seventh post operative day. During successive follow up there was considerable improvement in exercise tolerance and she being presently in NYHA class II. Conclusion: Pulmonary valve replacement with bioprosthetic tissue valve should be considered for patients with Pulmonary regurgitation and volume overload of Right ventricle. Emphasis should be on Right ventricle dilatation before setting of RV dysfunction rather then severity of Pulmonary regurgitation alone.

The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery.

BackgroundSurgery on the lower impacted third molar usually involves trauma in the highly vascularized loose connective tissue area, leading to inflammatory sequelae including postoperative pain, swelling, and general oral dysfunction during the immediate post-operative phase. This study aimed to investigate the effectiveness of preoperative injection of a single dose of 8 mg dexamethasone for postoperative pain control in lower third molar surgery.MethodsA controlled, randomized, split-mouth, prospective study involving lower third molar surgery was performed in 31 patients. The randomized sampling group was preoperatively injected, after local anesthesia, with a single dose of dexamethasone (8 mg in 2 ml) through the pterygomandibular space; 2 ml of normal saline (with no dexamethasone) was injected as a placebo.ResultsThe pain VAS score was significantly different on the day of the operation compared to the first post-operative day (P = 0.00 and 0.01, respectively), but it was not significantly different on the third and seventh postoperative day between the control and study groups. There was a significant reduction in swelling on the second postoperative day, and a difference between the second postoperative day and baseline value in the study group (P < 0.05). Trismus was highly significantly different on the second postoperative day and between baseline and second postoperative day between the groups (P = 0.04 and 0.02, respectively). Descriptive statistics and independent-samples t- test were used to assess the significance of differences.ConclusionsInjection of 8 mg dexamethasone into the pterygomandibular space effectively reduced the postoperative pain and other postoperative sequalae.

C-reactive protein in drainage fluid as a predictor of anastomotic leakage after elective colorectal resection.

C-reactive protein (CRP) is considered to be an indicator of postoperative complications in. abdominal surgery. The aim of this study was to determine the significance of serial measurement of CRP in drainage fluid in the detection of anastomotic leakage (AL) in patients with colorectal resection. CRP values in serum and drainage fluid, respectively, were measured on the first, third, fifth, and seventh postoperative day (POD) in 150 patients with colorectal resection and primary anastomosis. The values obtained were compared between the groups of patient without complications of surgical treatment and those with AL. Clinically evident AL was observed in 15 patients--in two (4.2%) patients with left colonic surgery, and 13 (12.6%) patients with colorectal anastomosis. Mean values of CRP were higher in the patients with AL than in the patients without complications, both in serum and drainage fluid, with the most significant differences recorded on the PODs 5 and 7 (p < 0.001). Correlation analysis showed a positive correlation between serum and drainage fluid CRP levels in both groups of patients. Serum and drainage fluid CRP values on the PODs 5 and 7 are most important in the detection of AL. In 80% of patients with CRP values in the drainage fluid of 53 mg/L for the POD 5 and 42 mg/L for the POD 7 AL was observed. The method specificity was 77% for the POD 5, and 83% for the POD 7. All the patients with CRP values in drainage fluid above 108 mg/L on the POD 5 and 93 mg/L on the POD 7 had AL. Serial measurement of CRP in drainage fluid can reliably be used in the detection of AL in patients with colorectal resection. The most significant values obtained on the PODs 5 and 7 were positively correlated with the values registered in

Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol.

Background:Muscle atrophy and prolonged inactivity are associated with an increased sensation of fatigue and reduced functional capacity in the postoperative period in patients undergoing coronary artery bypass grafting. Cardiac rehabilitation after hospital discharge is highly recommended and contributes to improvement in functional capacity and quality of life. However, few studies have evaluated the effectiveness of early mobilization protocols during hospitalization on the patterns of physical activity and functional capacity after coronary artery bypass grafting.Objective:To investigate the effectiveness of an early mobilization program on the functional capacity of patients undergoing coronary artery bypass grafting in the short and long term.Methods:This is a prospective, randomized, controlled, single-blind trial protocol that will evaluate 66 consecutive patients undergoing coronary artery bypass grafting. Patients will be randomized into two training groups: the control group (N = 33), which will perform breathing exercises and the intervention group (N = 33), which will perform breathing exercises and aerobic exercises. The groups will receive treatment from first to the seventh postoperative day, twice daily. In the preoperative period, the following outcomes will be assessed: physical activity level (Baecke Questionnaire), Functional Independence Measure, and functional capacity (6-min walking test). Functional capacity will be reassessed after the 7th and 60th postoperative day. Pulmonary complications and length of hospital stay will also be evaluated. Statistical analysis will be calculated using linear mixed models and will be based on intention-to-treat. The level of significance will be set at α = 5%.

Spontaneous Arachnoid Cyst Rupture with Subdural Hygroma in a Child.

Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. A case of a nine-year-old boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days. Examination showed a young, fully conscious oriented boy with positive Cushing's reflex and papilledema of left eye. MRI (magnetic resonance imaging) of the brain showed left temporal extra-axial cystic lesion of 5.40 × 4.10 cm in size, representing arachnoid cyst, with bilateral frontoparietal subdural hygromas. Cyst was partially drained through left temporal craniectomy and subdural hygromas were drained through bilateral frontal burr holes. Postoperatively the child recovered uneventfully and was discharged on the seventh postoperative day. Histopathology proves it to be arachnoid cyst of the brain with subdural CSF (cerebrospinal fluid) collection or hygroma.

The Effects of Using Hyaluronic Acid on the Extraction Sockets

Aims: The aim of this study is to evaluate the effectiveness of using Hyaluronic Acid (HA) clinically in extraction sockets related to the incidence of dry socket and the severity of post extraction pain. Methods: This randomized clinical trial included 98 extraction sockets. Combination of HA with Gelfoam scaffolds were applied to (28) sockets. Gelfoam scaffolds without HA were placed in another (21) sockets. No intervention was done for the remaining (49) sockets. The occurrence of dry socket and patients’ pain levels (VAS) were assessed at the first, second and seventh postoperative days. Results: Pain score was highest on the operation day according to VAS scores and decreased gradually in all groups on the 2nd and 7th postoperative days. There were no statistically significant differences in VAS scores between the three groups on the three postoperative days. A total of 5 patients had dry socket (5.1%). Also, there was no statistically significant difference in terms of dry socket formation (P = 0.891) between the extraction sites of the three groups during the three postoperative days. Conclusions: The results showed that HA administration did not decrease either the incidence of dry socket formation nor postoperative pain.

Left Lung Torsion: Complication of Lobar Resection for an Early Stage Lung Adenocarcinoma.

Lobar torsion is a fatal but fortunately rare occurrence following lung resection. Early clinical signs and radiographic features may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further parenchymal necrosis and deadly gangrene. We report a case of left lower lobe torsion in a 76-year-old female following elective upper lobectomy for underlying lung adenocarcinoma. Diagnosis was made following highly suggestive radiographic findings prompting bronchoscopy and revision thoracotomy. An emergency detorsion failed to restore lung viability and was followed by completion pneumonectomy. The patient recovered and was discharged on the seventh postoperative day.

Experimental models of renal dysfunction in female rats. Functional and histological aspects after unilateral nephrectomy or ligation of right renal vein with kidney preservation.

To compare renal dysfunction after right nephrectomy and ligation of the right renal vein with preservation of kidney. Animals' weight, pH, density, protein in urine and histological samples of the kidneys were evaluated. Fifteen female rats (Wistar) were divided into three groups. In the control group, right renal vein dissections were performed. In the second group, the right nephrectomy was performed. In the third group, the right renal vein was ligated and the kidney was preserved. Urine samples were taken before, three and seven days after the procedure. On the seventh postoperative day the kidneys were removed to histopathological study. Analysis by Student's t test was performed. weight loss, alterations of urine pH (p<0.05), in specific gravity, proteinuria (p<0.05) were found in groups 2 and 3; hemorrhagic infarction and edema were found after ligation of the right renal vein; changes in the left kidney were also observed on the seventh day.

Vestibular-evoked myogenic potentials before and after dental implant surgery.

This study aims to examine the effects of dental implant surgery on vestibular-evoked myogenic potential (VEMP) responses. Between October 2012 and October 2014, a total of 60 consecutive patients undergoing dental implant surgery at Başkent University Hospital, Department of Otorhinolaryngology were included in the study. The control group consisted of 40 healthy subjects undergoing routine clinical examination. The VEMP response was evaluated at baseline, second and seventh days. Positional tests and Dix-Hallpike testing for vertigo were performed at baseline, second and seventh days. Hundred-eight dental implants were placed in 60 patients. There was no significant difference in the p1 and n1 latencies in the control group at baseline, second day, and seventh day (p>0.05). However, there was a significant increase at the second day for p1 latencies in the study group, compared to the baseline and seventh day (p=0.038). There was a significant increase at the second day for n1 compared to the baseline (p=0.016) and seventh day in the study group (p=0.005). There was a significant increase at the seventh day for n1 compared to the baseline in the study group (p=0.016). The present study revealed a significant difference in the cervical VEMP response on the second postoperative day for p1 and n1 latencies compared to the baseline and seventh postoperative day in dental implantation patients. Dental implant patients should be informed of such possible temporary problems as dizziness and vestibular problems.

The Influence of Chronic Pain on Postoperative Pain and Function After Hip Surgery: A Prospective Observational Cohort Study

Pre-existing or chronic pain is an established risk factor for severe postoperative pain. In this prospective observational cohort study, we investigated whether a history of chronic pain, beyond the presence of hip-related pain, affected other postoperative factors including early mobilization, function, and psychological distress after hip surgery. Patients who underwent total hip replacement surgery were observed from the preoperative day until the seventh postoperative day. Before surgery, they were characterized by their pain history, pain intensity, function, and psychological characteristics. Postoperatively, pain intensity was evaluated on day 1, 3, 5, and 7 and the analgesic consumption was recorded for each of these days. Measures of function (functional questionnaire, ability to mobilize and to climb stairs, and range of hip motion) and psychological distress were re-evaluated on day 7. A history of chronic pain was associated with slower postoperative mobilization, poorer physical function, and greater psychological distress in addition to increased postoperative pain intensity. The comorbidity of a chronic pain disorder resulted in greater pain intensity after surgery, and also impeded postoperative rehabilitation. Identification of patients with a chronic pain disorder is necessary preoperatively so that appropriate pain management and rehabilitation can be planned to facilitate recovery. PerspectiveChronic pain, beyond the presence of hip-related pain, is associated with slower postoperative mobilization, poorer physical function, and greater psychological distress after total hip replacement surgery. Identification of patients with chronic pain and establishment of multiprofessional perioperative management might improve postoperative rehabilitation of patients with chronic pain.

Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation.

BackgroundElderly patients are reportedly at higher risk of postoperative cognitive dysfunction (POCD) after inhalational anesthesia with sevoflurane. We hypothesized that the incidence of POCD would be higher in elderly patients undergoing major surgery under inhalational rather than intravenous anesthesia. We also measured plasma S-100β protein concentration as a biomarker of central nervous system injury, and plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-α concentrations to judge the contribution of systemic inflammation to POCD.MethodsNinety patients aged 65–75 years scheduled for resection of an esophageal carcinoma were randomly assigned to one of three groups (n = 30) as follows: a group receiving sevoflurane anesthesia (Group S); a group receiving preoperative methylprednisolone before sevoflurane anesthesia (Group S + MP); and a control group maintained with intravenous propofol (Group C). The mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were used to measure patients’ cognitive function the day before surgery, and on the first, third and seventh postoperative days. The plasma concentrations of TNF-α, IL-6 and S-100β protein were measured 10 min before anesthesia, and on the first, third and seventh postoperative days.ResultsThere were no significant differences in the demographic or clinical characteristics, or perioperative hemodynamic status, of the three groups. The MMSE and MoCA scores were significantly lower in Group S than in the propofol control (Group C) and Group S + MP on the first, third and seventh postoperative days (P <0.05). Throughout the first postoperative week the plasma concentrations of TNF-α, IL-6, and S-100β protein were significantly elevated in Group S compared with Group C (P <0.05), but were significantly lower in Group S + MP than Group S (P <0.05).ConclusionsThe incidence of POCD was higher in elderly patients undergoing major surgery under inhalational anesthesia with sevoflurane than those maintained on intravenous propofol, and lower in elderly patients pro-treating with methylprednisolone. Furthermore, we found elevated plasma concentrations of S-100β protein, TNF-α and IL-6 in those receiving sevoflurane anesthesia.Trial registrationChiCTR-IOR-15007007 (02-09-2015).