Simple Verbal Scale Research Articles

Evaluation of Postoperative Pain in Posterior Segment Surgery of the Eye at the CHU-IOTA

Postoperative pain is predictable and therefore preventable; its management should be a priority. Posterior segment surgery is an underestimated source of pain. The objective of this work is to highlight the intensity of postoperative pain in this type of surgery. This was a 6-month prospective descriptive longitudinal study. Involving 67 patients operated for a pathology of the posterior segment. The simple verbal scale was used to assess pain in the postoperative period at HO, H8, H16 and H24. During the period, posterior segment surgery accounted for 1.88% of the institute's surgical activities. Male predominates with 88%; The mean age was 45.7 years with extremes of 7 and 75 years, vitrectomy accounted for 71.6% and scleral cryoindentation 28.4%. Peribulbar anaesthesia combining bupivacaine and xylocaine was the most commonly used with 80.6%. Intravenous injection of morphine intraoperatively was associated with peribulbar anesthesia in 19.4% of cases of scleral cryoindentation. In the immediate postoperative period (H0), pain was intense in 37%, moderate in 52% and low in 11% of patients after cryoindentation while it was absent in 52% and low in 48% of patients after vitrectomy. At H8 and H16, severe pain was reported in 47% of cryoindentations; It was reported as weak to moderate after vitrectomy in 91.66%. At H24, after treatment, patients had moderate pain in 69%, and low pain in 31% after cryoindentation; It was low in 85.71% after vitrectomy. This work allowed us to highlight the feelings of patients operated on in the posterior segment and to propose a postoperative management protocol. Keywords: Pain, Posterior segment, Locoregional anesthesia, Verbal scale.

Clinical-radiological results of the tibial osteotomy of valgization by internal addition in Gonarthrosis.

In knee osteoarthritis, medial-opening tibial osteotomy remains a good surgical technique, and have been effective in stabilizing and even improving osteoarthritis, Our study is about 20 cases of gonarthrosis on genu varum, treated by opening wedge valgus high tibial osteotomyconducted within the orthopedic trauma department '' B'' of the University Hospital Mohamed VI of Marrakech, over a period of 4 years. The mean age of our patients was 49 years (39-60), with a sex ratio of 1M/4F. In 55% of cases (11 cases) thegonarthrosis was related to primitive genu varum, while 45% cases (9 cases) was secondary to trauma ormeniscectomy. Clinically the knee pain was the main symptom in all cases, with an intensity level 3 on the simple verbal scale. The imagery was designed to measure angular deviations and surgical correction and monitoring the evolution. Angular deviation adjusted mean was 10.3 ° (6 ° -16 °), stages II and III of Ahlback classification, represent the mostcases of tibiofemoral osteoarthritis (90%).The filling was done by autologous bone graft, and the average degree of varus correction was 9.6 °.The results evaluated by the IKS score were excellent or good in 60% of cases for the knee score and 73% for the function score.

EVALUATION OF THE QUALITY OF PAIN MANAGEMENT IN CANCER PATIENTS: STUDY OF 60 MOROCCAN PATIENTS AND LITERATURE REVIEW

Cancer is a chronic disease that affects patients quality of life, hence the need to evaluate the quality of care in its globality without forgetting cancer pain. This study aims to acknowledge the pain in cancer patients, evaluate it using international scales, and see to what extent this pain is managed in its totality. This is a prospective study to evaluate the quality of cancer pain management, 60 patients were included, 26 women and 34 men, with an average age of 52.2 years. The evaluation of pain concerned different cancer pathologies, according to the simple verbal scale and the visual analog scale, the majority of our patients (83.4%) had pain, 68.4% had moderate to severe pain, the use of level III analgesics occurred in 35% of patients. Among our sample 37% of cancer patients had negative pain management index scores, indicating inadequate analgesic treatment. This study shows that the management of cancer pain is still insufficient for reasons of organization and lack of information. This situation cannot be improved without the establishment of a global strategy for the management of cancer pain.

Effectiveness of the Suprainguinal Ultrasound-Guided Block for the Management of Postoperative Pain after Application of a Total Hip Prosthesis

Objective: To assess the effectiveness of ultrasound-guided supraginguinal block (SIB) in the management of pain after total hip replacement. Material and Methods: This was a prospective, randomized, single-blind controlled study carried out in the anesthesia-intensive care unit of the Donka National Hospital in Conakry, over a period of 06 months (01/01/2020 to 30/06/2020). It concerned 32 patients: 16 patients in the “ultrasound-guided SIB” group and 16 patients in the “standard analgesia” group. Results: The pain scores assessed by the simple verbal scale and collected at the different time intervals (6H, 12H, 24H, 36H, 48H) showed mean scores 3 in the standard analgesia group (P Conclusion: Our study demonstrated that echo-guided SIB provided better analgesia compared to standard analgesia for the management of postoperative pain after total hip replacement.

Management of Post-Operative Pain after Gyneco-Obstetrical Surgery: Practice of Transversus Abdominis Plane Bloc (Tap Block) Echoguide at the Ignace Deen National Hospital

Objectives: To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. Methods: This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. Results: In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38; at H12 of 1.15 ± 0.62; at H24 of 0.84 ± 0.51; at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61; at H24 of 1.53 ± 0.56; at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. Conclusion: Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.

Diagnostic Rigid Urethrocystoscopy: Indications, Results and Pain Assessment

Background: Over the last 50 years, endourology has revolutionized urological practices worldwide. This is not so in many urological centers in West Africa. Although, some centers have made progress in the level of urological services that they offer; many of such centers provide rigid urethrocystoscopy services. Rigid urethrocystoscopy is an endoscopic examination that explores the urethra, bladder and prostate in men. Aims: We report the indications, results and pain assessment of rigid urethrocystoscopy in our center. Patients and Methods: We carried out a retrospective, descriptive, monocentric study in our center between January 2016 and June 2018. The study included all patients who had a rigid urethrocystoscopy under local anaesthesia. We studied the following parameters: sex, age, indications for the examination, outcomes and the pain assessment. Results: Five hundred and forty-one patients were included. The sex-ratio was 1.49. The mean age was 49.47 ± 18.48 years (12 years and 91 years). Lower urinary tract symptoms (29%) and hematuria (28%) were the most common indications. The rigid urethrocystoscopy was normal in 26.8% of patients. Bladder tumors (21.2%) were the most frequent lesions. In men, prostate tumors were more common (21%) followed by bladder tumors (17.9%), while in women, bladder tumors (26.3%) were predominant followed by cystopathy lesions (12.4%).The mean Simple Verbal Scale (SVS) score was 1.25 in women and 2.1 in men. Conclusion: Rigid urethrocystoscopy was relatively well tolerated by our patients. Hematuria was the primary indication and the main etiologies were bladder and prostate tumors.

Comparison of psychometric properties between the Labin, a new electronic dynamometer, and the Jamar: Preliminary results in healthy subjects

Many instruments exist for measuring grip strength. The Jamar hydraulic hand dynamometer is currently the gold standard. The Labin is a prototype electronic dynamometer that can also measure maximum grip strength. The main objective was to compare the Labin dynamometer with the gold standard instrument, the Jamar, in a healthy population, and secondarily to compare discomfort during use. A single-center exploratory study was conducted. The subjects enrolled had to be aged between 20 and 60, be volunteers and give consent. The required number of subjects was 30. The subjects were positioned according to American Society of Hand Therapists recommendations. Maximum grip force was measured in kilograms using the mean of three successive trials. The first dynamometer used was chosen randomly. The handle's discomfort during use was rated on a simple verbal scale from 0 to 10. Thirty-four subjects were included. The concordance coefficient for peak torque between the Labin and Jamar dynamometers was 0.90 for the dominant hand and 0.83 for the non-dominant hand. The intraclass correlation coefficient for peak torque with the Labin was 0.81 [0.69; 0.89] for the dominant hand and 0.86 [0.76; 0.92] for the non-dominant hand. In our study, we have shown that the Labin prototype has acceptable validity and reproducibility. The Labin will need to be tested in pathological conditions next.

The usefulness of interpectoral block as an analgesic technique in breast cancer surgery

Abstract Objective To compare the analgesic efficacy of continuous interpectoral block (CIPB) compared to intravenous analgesia ( IV ) after breast surgery. Material and method A prospective, comparative and randomised study of women aged from 18 to 75 years, ASA I - III , operated for breast cancer. In group 1 (CIPB) after general anaesthetic, an ultrasound-guided interpectoral catheter was placed and 30 ml of 0.5% ropivacaine was administered through it. In the event of an increase in heart rate and blood pressure >15% after the surgical incision, intravenous fentanyl 1 μg kg−1 was administered, repeating the dose as necessary. In the postoperative period, perfusion of ropivacaine 0.2% 5 ml h−1; with PCA bolus 5 ml/30 min was administered through the catheter for 24 h and rescue analgesia prescribed with 5 mg subcutaneous morphine chloride. In group 2 ( IV ), after induction of general anaesthesia, intravenous fentanyl was administered in the same way as in the other group. The patients received metamizole 2 g with dexketoprofen 50 mg and ondansetron 4 mg postoperatively followed by perfusion of metamizole 4%, tramadol 0.2% and ondansetron 0.08% 2 ml h−1; with PCA bolus 2 ml/20 min for 24 h. The same rescue analgesia was prescribed. The principal variables recorded were pain at rest and during movement, according to a simple verbal scale (VAS 0–10) and the rescue analgesia required on discharge from recovery, at 12 and at 24 h. Results 137 patients were included: 81 in group 1 (59.12%) and 56 in group 2 (40.87%). No significant differences were observed in the analgesia between either group, but differences were observed in the dose of intraoperative fentanyl (p Conclusions Both techniques provided effective postoperative analgesia, but the CIPB group required significantly less intraoperative fentanyl.

Utilidad del bloqueo interpectoral continuo como técnica analgésica en cirugía oncológica de mama

ObjectiveTo compare the analgesic efficacy of continuous interpectoral block (CIPB) compared to intravenous analgesia (IV) after breast surgery. Material and methodA prospective, comparative and randomised study of women aged from 18-75years, ASAI-III, operated for breast cancer. In group1 (CIPB) after general anaesthetic, an ultrasound-guided interpectoral catheter was placed and 30mL of 0.5% ropivacaine was administered through it. In the event of an increase in heart rate and blood pressure >15% after the surgical incision, intravenous fentanyl 1μg·kg−1 was administered, repeating the dose as necessary. In the postoperative period, perfusion of ropivacaine 0.2% 5mL·h−1; with PCA bolus 5mL/30minutes was administered through the catheter for 24hours and rescue analgesia prescribed with 5mg subcutaneous morphine chloride. In group2 (IV), after induction of general anaesthesia, intravenous fentanyl was administered in the same way as in the other group. The patients received metamizole 2g with dexketoprofen 50mg and ondansetron 4mg postoperatively followed by perfusion of metamizole 4%, tramadol 0.2% and ondansetron 0.08% 2ml·h−1; with PCA bolus 2mL/20min for 24hours. The same rescue analgesia was prescribed. The principal variables recorded were pain at rest and during movement, according to a simple verbal scale (VAS 0-10) and the rescue analgesia required on discharge from recovery, at 12 and at 24hours. Results137 patients were included: 81 in group1 (59.12%) and 56 in group2 (40.87%). No significant differences were observed in the analgesia between either group, but differences were observed in the dose of intraoperative fentanyl (P<.05). Differences that were not significant were observed in the rescue analgesia required on recovery (10% fewer on group1). ConclusionsBoth techniques provided effective postoperative analgesia, but the CIPB group required significantly less intraoperative fentanyl.

Knee ankle foot orthoses in treatment of genu recurvatum: Evaluation of efficiency, users’ satisfaction and tolerance

The aim of this study is to evaluate the efficiency, users’ satisfaction and tolerance of the Knee Ankle Foot Orthosis (KAFO) in treatment of painful genu recurvatum (PGR). Epidemiologic retrospective monocentric study. Patients having a clinical PGR on stance phase confirmed by a practitioner. The main outcome was the pain before and after having the KAFO evaluated with the numerical verbal scale (NVS) of pain rated on 100 and the simple verbal scale (SVS) of pain. The secondary outcomes were the French version of the Quebec user evaluation of satisfaction with assistive technology (QUEBEC 2.0) and a numerical scale of satisfaction (NSS) rated on 100. Twenty-seven patients but 31 KAFO have been analyzed (4 patients had both KAFO): 25 free knee joints/6 locked knee joints. Before and after having the KAFO, the NVS of pain decreased from a mean of 80/100 to 26.9 ( P ≤ 0.001) and the SVS of pain from “extreme” to “weak” ( P ≤ 0.001). The French version of the QUEBEC 2.0 had a total of 4.04 and the NSS had a mean of 86/100. With this study, it was shown that treating a PGR with a KAFO is efficient on pain whatever the pathology from which the patient is suffering, and the patient satisfaction is good.

Estudio epidemiológico del dolor en los hospitales públicos andaluces

ObjectiveTo determine the prevalence of pain in medical and surgical patients admitted to reference hospitals in Andalusia, as well as their features and the most population groups most affected. Material and methodsA cross-sectional, multicenter epidemiological study was conducted simultaneously on the population admitted to 5 hospitals. Using a structured questionnaire the demographics, hospital area, presence of pain at the time of the interview, and pre- and post-variables related to the intensity of pain and its treatment at 24h were investigated. All patients over 18 years old were included, except those patients with difficulty in understanding the questionnaire, and psychiatric and obstetric patients. Pain intensity was assessed by simple verbal scale. ResultsOf the 1,236 patients included, 54.2% were male, with 51.1% of patients aged 65 years, and 69.17% were admitted to medical areas. Pain was observed in 52.9% of patients admitted to the surgical area compared to 29.4% in the medical area. Of the 19.4% who reported having had pain in the last 24h prior to the questionnaire, 57.7% of them were surgical patients and 32% were medical, P<.005), and of the 42.2% who had pain at the time of study, 52.7% were female. The incidence of pain on movement was higher than that observed at rest. The mean resting pain was 1.8 and 1.4 for the surgical and medical patients, respectively (P<.01). The mean pain on movement was 2.2 and 1.6 for the surgical and medical patients, respectively (P<.01). More than one quarter (25.8%) of surgical patients and 16.5% of medical patients had difficulty sleeping (P<.005). Some 12.8% of all patients had no analgesic regimen, and 66.2% and 85.6% of surgical and medical patients, respectively, did not request analgesics (P<.005). The main drugs were prescribed paracetamol analgesic and metamizole, and in 54.4% of patients. ConclusionsWe believe that the presence of pain in patients admitted to our study population is high and it is essential to encourage an improvement in the pain management of both acute and chronic pain processes.

Neuropathic Pain In HIV / AIDS Patients On Antiretroviral Therapy And Followed As Outpatients In Bamako, Mali

Introduction: Neuropathic pains induced by HIV/AIDS are frequent and able to negatively impact the life quality of patients and their observance of the treatment. Objective: We aimed to study the HIV-associated neuropathic pain in infected outdoor patients, followed-up in Bamako (MALI). Method: We conducted a traversal, prospective, descriptive and analytical study on a cohort of 600 patients. The diagnosis of neuropathic pain was made in patients presenting a sensitive, distal and symmetric neuropathy of legs (DN4 positive). Evaluation was conducted with a simple verbal scale (SVS); the impact on the quality of life was conducted with the following scales: HAD and the short survey on pains; scale of improvement (follow-up). Results: In this study of 120 patients, 20% had a positive DN4. The age group of [25 to 59] years was the most represented with extremes age of 18 and 75 years and modal age class 36-45 years. Females were predominant. The clinical signs were mainly burns, heaviness, and intense pains. The majority of patients reported moderate to intense pains. These pains had a negative impact on their quality of life (sleep, usual work, walk, humor) as well as treatment observance. Conclusion: Despite the efforts of international community to make available HAART, without intervention, neurological pains have the possibility to become a real public health problem. In order to reach the pinnacle of universal access to care for HIV/AIDS infected patients, the impact of treatments on patient well-being must be further elucidated.

Dolor, calidad de vida y estado anímico relacionados con la salud de pacientes ancianos hospitalizados

Objective . This descriptive, transverse study, attempts to establish the existent relation between the degree of perceived pain, anxiety, depression and quality of life of elderly hospitalized patients. Method . A stratified- random sample was used for this study. Using the Goldberg Anxiety and Depression Scale (GADS), the Nottingham Health Profile (NHP), and the Simple Verbal Scale (SVS), the patients’ reported anxiety and depression levels, as well as the intensity of their pain were measured. Results . It was observed that in general, as the patient’s pain increased, their depression and anxiety levels, and the quality of life areas evaluated using the NHP, worsened. Analyses are descriptive and inferential. Conclusion . In view of the deterioration of the quality of life and its relationship to the emotional responses associated with anxiety and depression, and the intensity of pain, interventions should be carried out at primary and secondary level to permit pain control, in order to reduce the impact on the mental health of older adults, based on pharmacological and psychological integrated strategies. Likewise, it is suggested that inpatient programs incorporating holistic therapies which, in turn, meet the emotional affective elderly needs of hospitalized patients, are created, with the aim of improving their quality of life.

El dolor y su impacto en la calidad de vida y estado anímico de pacientes hospitalizados

Mediante este estudio descriptivo transversal se pretendió conocer la relación entre la intensidad percibida del dolor, el estado de ánimo y la calidad de vida en pacientes hospitalizados. La muestra estuvo compuesta por 271 pacientes (133 hombres y 138 mujeres; edad M = 56.79) de un hospital de tercer nivel en Granada, España. Se administró el Perfil de Salud de Nottingham (PSN), la Escala de Ansiedad y Depresión de Goldberg (EADG) y la Escala Verbal Simple (EVS). Los resultados reflejan un empeoramiento en cada una de las áreas de la calidad de vida evaluada con el PSN, así como en la ansiedad y depresión medidas con la EADG, conforme la intensidad del dolor aumenta. Finalmente, se discuten algunas recomendaciones basadas en los resultados.

Estudio comparativo de la eficacia del bloqueo supraclavicular en la artroscopia de hombro

Objectives Our aim is to evaluate the efficacy of two anesthetic techniques for the treatment of the postoperative pain, as well as their influence on hospital stay, after surgery arthroscopic of shoulder. Materials and methods Retrospective study based on the collection of data from anesthesia histories and from of our postoperative acute pain unit, during a 6-months period. Cases of shoulder arthroscopies carried out during this period were selected and the patients were distributed in 2 groups depending on the anesthetic technique used: group I consisted of patients treated with locoregional anesthesia (interscalene and inter-sternocleidomastoid block) combined with general anesthesia. Group II was general anesthesia cases with intravenous analgesia. The recorded variables were the following: postoperative pain, both at rest and during exercise in the first 24 h, using a simple verbal scale (SVS); the presence of side effects, need of analgesic rescue and duration of hospital stay. In the cases where the patients were discharged from hospital in the first 24 h, a telephone consultation was carried out for the evaluation of the abovementioned variables. Statistical analysis: Student- t and Chi-square tests. A P<.05 was considered statistically significant. Results A total of 26 patients were included (14 cases in group I and 12 cases in group II). The analysis of the postoperative pain at rest in the first 24 h revealed that the SVS in group I was 1 for the percentile 75, whereas in group II it was 2. The pain on movement was 2.25 for group I, and 3 for group II, ( P<.05). There was only 1 case with need of rescue (7%) in the first group, compared to the 5 cases (41%) in the second group ( P<.05). There were no cases of postoperative nausea and vomiting in the combined anesthesia group, whereas in the group with general anesthesia there were 4 cases (33%), ( P<.05). The estimated surgical time for the first group was 125 min, compared to the estimated 116 min for group II ( p>.05). In the group of combined anesthesia the average duration of hospital stay was 36 h, compared to the 60 h average duration in the group of General Anesthesia. ( P<.05). Discussion The blockade of the brachial plexus over the clavicle combined with general anesthesia has shown greater efficacy in the control of perioperative pain, both at rest and during exercise than the general anesthesia with intravenous analgesia. In addition, the incidence of undesirable effects, the need of rescue and the duration of hospital stay were lower in the group of patients with the combined technique, without significant effects on the duration of operating room occupation.

Efecto de dosis bajas de ketamina en la analgesia postoperatoria y consumo de morfina tras cirugía de revascularización miocárdica

Objectives To assess the efficacy of ketamine in low doses by continuous infusion (8 μg/kg/min) given during surgery and the reduction in morphine use in the first 24 h after coronary bypass surgery with remifentanil based anaesthesia. Material and method Randomised, prospective, double blind study on 60 patients, ASA III–IV, scheduled to have off-pump myocardial revascularisation surgery. A standard anaesthetic technique with propofol and remifentanil between 0.5−1 μg/kg/min, after induction of anaesthesia, the ketamine (K) group (n=30) received a continuous infusion of 8 μg/kg/min and the propofol and remifentanil (P) group (n=30) received 0.9% physiological saline intravenously at the same infusion rate. Before the end of the surgery 0.15 mg/kg of morphine was given intravenously. Post-operative analgesia consisted of 3 mg of morphine every 5 min when the simple verbal scale was <1 (SVS<1). The intra-operative use of remifentanil–propofol was determined, as well as, the time to giving the first analgesic, pain intensity using the SVS and visual analogue scale (VAS), haemodynamic and respiratory parameters, level of sedation and adverse effects. Results No statistically significant differences were found between the demographic parameters, or in the mean use and infusions of remifentanil and propofol by both groups. The patients from the K group significantly delayed the time of requesting the first analgesic dose compared to the P group ( P<0.03). There were no significant differences between both study groups in the use of morphine in recovery and the total use in the first 24 h. The haemodynamic and respiratory parameters, and the sedation level remained stable during the whole period of the study, with no statistically significant differences between both groups. Post-operative pain control was adequate in both groups VAS<30, SVS<2), with no significant differences during the 24 h of the study. There no significant differences between groups, in the incidence of adverse effects. The incidence of nausea and post-operative vomiting was 20% in group K and 30% in group P. None of the patients had hallucinations or dysphoria. Conclusions Low doses of ketamine in continuous infusion during the intra-operative period of coronary surgery prolongs the time of demanding the first morphine dose, without reducing the use of intra-operative remifentanil, or the total use of morphine in the first 24 h after surgery.

The analgesic efficacy of continuous elastomeric pump ropivacaine wound instillation after appendectomy

Study Objective To evaluate the analgesic efficacy and safety of ropivacaine 0.2% when administered continuously via elastomeric pump after appendectomy. Design Prospective, randomized, double-blinded study. Setting Surgical ward of a university hospital. Patients 96 ASA physical status I and II patients of at least 14 years of age, undergoing appendectomy through a McBurney incision. Interventions Patients were randomly assigned into two groups: 500 mg of ropivacaine in 48 hours (10 mL of 0.2% ropivacaine 20 mg, starter dose plus 5 mL/h continuous wound infusion via elastomeric pump device; n = 48) in the experimental group and 250 mL of normal saline, as placebo, in the control group. Measurements Postappendectomy pain, measured either with a simple verbal scale or with a visual analog scale, parenteral analgesic consumption, and global satisfaction were all measured. Main Results A reduction in postoperative pain was observed in the ropivacaine group. Degree of pain, with a simple verbal scale measurement of severe and unbearable, was significantly lower in the ropivacaine group than in the normal saline group from time 0 to 24 hours at rest and from time 0 to 36 hours on coughing. A significant lower pain intensity (visual analog scale) was found in the ropivacaine group both at rest and on coughing, beginning at three hours and continuing to 36 hours postoperatively. The mean number of rescue analgesic doses was significantly lower in the ropivacaine group. There were no statistically significant differences in the frequency of adverse events between the two groups. Conclusions Wound instillation with ropivacaine 0.2% is a useful, practical, and safe method for management of postoperative pain after appendectomy.

FROM PROSTHETIC HERNIOPLASTY TO XENOGRAFT FOR TISSUE ENGINEERING IN INGUINAL HERNIA REPAIR: A PROSPECTIVE RANDOMIZED, DOUBLE-BLIND, CONTROLLED TRIAL COMPARING LICHTENSTEIN’S REPAIR WITH POLYPROPYLENE MESH VERSUS SURGISIS IHM.

A253 Aims: Although polypropylene (PP) mesh is the preferred material for tension-free hernioplasty, because has reduced the recurrence rate below 1%, some problems with its use are still to be addressed (postoperative pain, long-term discomfort, infections, intestinal obstruction and fistulization). In order to answer to these disadvantages, a new absorbable collagen-based material for xenograft (the porcine small intestinal submucosa mesh), has recently been developed for hernia repair. Aim of our study is to evaluate the safety and efficacy of the Lichtenstein’s hernioplasty using Surgisis IHM 8x13cm, 4 plies (SIHM, Cook Surgical Inc.), as a mesh, and to compare it with the traditional Lichtenstein procedure performed with PP. Methods: A prospective, randomised, double-blinded comparison of Lichtenstein’s repair with PP mesh versus SIHM was carried out at the Department of Emergency Surgery of St Orsola-Malpighi University Hospital with the participation of 2 surgeons who accepted to standardise the Lichtenstein’s procedures with the two different types of meshes. Results: From july 2002 up to now 55 male patients submitted to Lichtenstein’s repair of inguinal hernia with a 6 month minimum follow-up were enrolled. 28 subjects were treated with SIHM mesh, while 27 with PP mesh. The post-hernioplasty pain/discomfort (tested with visual analogue scale and simple verbal scale) and parenteral/oral analgesic consumption were statistically significant lower in SIHM group. Conclusions: Lichtenstein’s hernioplasty using the SIHM has a promising safety and efficacy.

A Comparison of Two Constant-Dose Continuous Infusions of Remifentanil for Severe Postoperative Pain

We evaluated the analgesic efficacy and safety of two continuous constant-dose infusions of IV remifentanil, without infusion rate increments or the addition of boluses, in patients with severe postoperative pain during the first 4 h after general anesthesia with IV propofol-remifentanil. Thirty patients were randomly assigned to two groups of 15 subjects each according to the remifentanil dose administered: 0.1 μg · kg−1 · min−1 IV (Group A) or 0.05 μg · kg−1 · min−1 IV (Group B). Rescue analgesia was provided with meperidine (0.5 mg/kg IV) when pain intensity on the simple verbal scale (SVS) ≥2. The criteria for adequate analgesia (SVS 0–1, respiratory frequency >8/min. and Spo2 >90%) after 4 h were met by 78% and 75% of the patients in Groups A and B, respectively (P = ns). “Meperidine rescue” analgesia was significantly more in Group B (26%) than in Group A (6%) (P < 0.05). There were no cases of respiratory depression, and nausea and emesis occurred in one patient in each group (6.5%). We conclude that IV remifentanil is an effective and safe opioid for the treatment of postoperative pain at a constant dose of 0.1 μg · kg−1 · min−1 with a need for rescue analgesia 4 times less than a constant dose of 0.05 μg · kg−1 · min−1.