Terms Of Postoperative Pain Research Articles

Random clinical study about application value of oxycodone in radiofrequency ablation of hepatocellular carcinoma

Objective: To evaluate the clinical effect and safety of oxycodone hydrochloride in the anesthesia for percutaneous radiofrequency ablation (PRFA) in hepatocellular carcinoma. Methods: Between March and December 2015, 60 cases of hepatocellular carcinoma patients undergoing percutaneous radiofrequency ablation surgery in Peking University Cancer Hospital were randomly divided into three groups: oxycodone group (group Q), fentanyl group (group F) and dezocine group (group D), 20 cases in each group. Respectively intravenously injection oxycodone 0.1 mg/kg, fentanyl 0.001 mg/kg, dezocine 0.1 mg/kg before surgery. After the surgeon completed puncture administer propofol to maintain anesthesia. Recorded mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2) changes in each group at entrance, beginning of radiofrequency ablation (T1), radiofrequency ablation began after 10 minutes (T2), the end of the surgical and awake. Observe the analgesia effect, respiratory depression, nausea, vomit and other complications. Postoperative pain scores were recorded.Using ANOVA, repeated measure variance analysis, SNK test, χ2 test and other tests to evaluate the anesthetic effect indexes. Results: The observation completed in all patients. Patients of three groups had no significant differences in general information. No significant difference between MAP, HR and SpO2 at each time points among the three groups. At the T1 time point (group Q: (11.7±1.6)/min, group D: (12.1±1.7)/min, group F: (10.3±2.3)/min, F=5.068, P=0.009) and T2 time point (group Q: (11.9±1.3)/min, group D: (12.2±1.4)/min, group F: (10.7±1.3)/min, F=7.024, P=0.002), RR in group F were lower than in group Q and group D. Pain visual analogue scores after waking (group Q: 0.2±0.7, group D: 0.3±0.7, group F: 1.7±1.5, F=12.981, P=0.000) and postoperative pain score of 1 hour (group Q: 2.0±0.9, group D: 1.8±0.8, group F: 4.3±0.9, F=42.362, P=0.000) in the group Q and group D were significantly lower than in group F. The body movements in group Q and group D were significantly less than in group F (3 cases, 3 cases, 9 cases, χ2=6.400, P=0.041 ). Intraoperative respiratory depression in group Q and group D were lower than group F (3 cases, 2 cases, 9 cases, χ2=8.012, P=0.018). Conclusions: Oxycodone hydrochloride can be used safely and effectively for radiofrequency ablation. It has favorable hemodynamic stability, lower incidence of respiratory depression, and advantage in terms of postoperative pain.

Single incision laparoscopic cholecystectomy in geriatric patients

BackgroundLaparoscopy is a surgical approach recommended for the treatment of gall bladder disease. It is recommended also in geriatric patients. Recently Single Incision Laparoscopic Cholecystectomy (SILC) has been proposed to minimize surgical trauma, recovery and hospitalization time. However, the results and advantages of SILC in the geriatric population have received minimal attention. This case series review is focused on the results of SILC in the geriatric population. MethodsThe records of 355 patients who had undergone SILC were reviewed. This report identifies, in the entire cohort, 40 patients aged 65 years or older at the time of surgery who will be the object of this study (geriatric series). Clinical outcomes and results were evaluated. Moreover, post-operative pain of the geriatric cohort was compared to that of the entire series. ResultsSILC was successfully completed for 347 out of 355 patients of the entire series, with no mortality reported. In total SILC was converted to standard laparoscopy in 10 patients (2.2%) but never to open procedure. No significant difference was found between the total cohort and the geriatric series in terms of median time of operation (61.20 min vs 68.38 min). Post-operative pain was significantly lower in geriatric patients. ConclusionSILC is an effective and safe procedure for the treatment of gallbladder disease of elderly, also in terms of post-operative pain and it represents an alternative to the standard laparoscopic approach on a routine basis.

Thumb Basal Joint Arthroplasty: Prospective Comparison of Perioperative Analgesia and Opioid Consumption: Level 2 Evidence

There is no financial information to disclose. Trapeziectomy alone or in combination with a suspensionoplasty technique is a common surgical treatment for symptomatic basal joint arthritis, but is considered one of the more painful procedures of the hand. Various modalities for perioperative pain control are employed in the endeavor to manage postoperative pain, including peripheral nerve blocks and the infiltration of local anesthetics into the surgical site. We undertook a prospective comparative study with the hypothesis that peripheral nerve blocks would provide better pain control than local anesthesia with Marcaine or Exparel with respect to pain scores and opioid pill consumption. All consecutive patients undergoing thumb basilar joint arthroplasty were prospectively enrolled and allocated to one of three perioperative anesthesia groups: (1) peripheral nerve block, (2) local anesthesia with Marcaine and (3) local anesthesia with Exparel. Total opioid pill consumption and visual analog scale (VAS) pain scores were reported and collected for the first 5 postoperative days (POD). Seventy-eight patients were enrolled in the study with 27, 23, and 28 patients assigned to the peripheral nerve block (Group 1), Marcaine (Group 2) and Exparel (Group 3) groups, respectively. All groups experienced an increase in both opioid pill consumption and VAS scores from POD 0 to POD 1 (P < 0.05). Postoperative VAS was lowest in Group 3 from POD 0 to 2, although not statistically significant. During the same period, except for POD 0, average VAS scores were highest in Group 1 (Peripheral block). However, after POD 2, VAS scores normalized between all Groups and decreased uniformly thereafter. Total opioid consumption was lowest in Group 3 (11 pills) compared to Group 1 (17 pills) and Group 2 (19 pills), (P = 0.06). •There was a trend in all groups towards increase postoperative pain and opioid consumption between POD 0 and 1. After POD 2, pain decreased uniformly in all groups.•Total opioid consumption was found to be least in Group 3 (Exparel). Similarly, there was a trend towards better postoperative VAS in the Exparel group, but the trend was not statistically significant and did not continue beyond POD 2.•Peripheral nerve blocks were not found to be superior in terms of postoperative pain beyond POD 0. Moreover, peripheral nerve blocks and Marcaine alone had higher pain scores and opioid consumption after POD 0.•The effectiveness of each modality, as well as their potential risks and costs, should be considered when determining the optimal strategy.

Laparoscopic transabdominal preperitoneal versus open mesh lichtenstein repair of inguinal hernia: a comparative analysi

Background: Inguinal hernia repair is a commonly performed surgery usually managed by open surgical mesh repair. Nowadays many patients are demanding laparoscopic hernia repair. Laparoscopic hernioplasty has a shorter rehabilitation, but it is a technically difficult procedure. It is unclear if it has advantages over open tension-free mesh repair. Methodology: This prospective study of 80 patients is done at Jawaharlal Nehru Medical College Hospital, A.M.U., Aligarh from January 2012 to November, 2014. 50 patients underwent Lichtenstein tension free mesh repair while on 30 patients TAPP was performed. Results: Out of 80 patients 7 patients were lost to follow up at 2 weeks. 47 patients in Lichtenstein group and 26 patients in TAPP group were followed for 6 months. Average operation time was 39.3±16.4 minutes for the Lichtenstein group and 51.4±15.8 minutes for the TAPP group. Postoperatively, pain score was 6.5±3.5 in lichtenstein group as compared to 5.8±1.5 in TAPP group. Because of lesser postoperative pain, the TAPP patients got significantly fewer analgesics than the Lichtenstein patients (2.4 ± 1.0) versus (3.5 ± 1.3) doses. TAPP patients needed significantly fewer admission days than Lichtenstein patients (2.5±0.6 versus 1.8±0.5 days, respectively). TAPP patients returned to work earlier as compared to Lichtenstein group (11.7±4.9 days versus 14.8±4.2 days respectively). Short term and long complications were similar in both groups. Conclusion: Laparoscopic hernioplasty (TAPP) is superior to Lichtenstein tension-free hernioplasty in terms of postoperative pain, hospital stay and return to daily activity.

Surgical techniques for the treatment of tongue tie in children: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ankyloglossia is another name for tongue tie which in mild form is characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth. It can affect feeding, speech, and oral hygiene as well as have mechanical/social effects. Ankyloglossia can also prevent the tongue from contacting the anterior palate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study aimed to find out best possible surgical modality of frenectomy by comparing scalpel, electro-cautery and CO&lt;sub&gt;2&lt;/sub&gt; laser in the treatment of tongue tie. This is a prospective randomized clinical trial conducted in the department of ENT, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra. All patients were categorized in to three groups randomly as group A, group B and group C. Each group contains 18 patients and among group A, B and C, frenectomy was done by conventional scalpel technique, by bipolar cautery and CO&lt;sub&gt;2&lt;/sub&gt; laser respectively. Then patients were assessed on post op day 1 for symptomatology and inflammatory signs, on post op day 7 for wound healing and any complications and also after 1 month post-op for scar and contracture of wound. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, about 61% of population is of male child and female child were remaining 39% (ratio 1.6:1) which is matching with the previous studies. Amongst all patients most common age group is between 1-4 years of age group. Most of the patients were in Kotlow’s class III having severe ankyloglossia (3‑7 mm) followed by class I having Mild ankyloglossia (12‑16 mm).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Laser and electro-cautery treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique.&lt;/p&gt;

Outcome of Surgical Treatment of Degenerative Lumbar Spinal Stenosis.

Introduction: Spinal stenosis mostly occur in lumbar spine and causes back pain, leg pain &amp; neurogenic claudication. Although conservative treatment is mainstay, decompression with or without fusion (with or without instrumentation) can be considered in non-responsive cases. However, long term outcome of the surgery is controversial. The aim of our study was to analyze the outcome of surgery in lumbar spinal stenosis in terms of post-operative pain and claudication distance.Methods: A prospective analysis of patients who underwent decompression or decompression with fusion (with or without instrumentation), after failure of 3-6 months conservative treatment, for lumbar spinal stenosis were conducted. Only those who were operated and followed up for at least two years were included.Their preop and postop VAS score and walking distance compared.Results: Of 22 cases enrolled in this study, VAS score was improved in 21 patients and walking distance increased. Only one patient complained of increase in pain score at 24 months.Conclusion: Operative management is a good option for selected patients, 21 out of 22 have improved VAS and claudication distance in our study

Effects of preoperative ultrasound-guided transversus abdominis plane block on pain after laparoscopic surgery for colorectal cancer: a double-blind randomized controlled trial.

Although laparoscopic colorectal surgery decreases postoperative pain and facilitates a speedier recovery compared with laparotomy, postoperative pain at trocar insertion sites remains a clinical concern. The objective of this study was to assess the effects of a preoperative ultrasound-guided transversus abdominis plane (TAP) block on pain after laparoscopic surgery for colorectal cancer. In total, 58 patients scheduled to undergo laparoscopic surgery following a diagnosis of colorectal cancer were included in this study. The patients were randomized into TAP and control groups; the TAP group patients received a preoperative ultrasound-guided bilateral TAP block with 0.5mL/kg of 0.25% bupivacaine, while the control patients received the block with an equal amount of saline. Pain on coughing and at rest was assessed during postanesthetic recovery (PAR; 1h after surgery) and on postoperative days (PODs) 1 (24h), 2 (48h), and 3 (72h) by an investigator blinded to group allocations using the numeric rating scale (NRS). The primary outcome was pain on coughing on postoperative day (POD) 1. Fifty-five patients were included in the final analysis, including 28 in the TAP and 27 in the control groups. The pain intensity on coughing and at rest during PAR and on PODs 1, 2, and 3 showed no significant differences between groups. Furthermore, there was no significant difference in postoperative opioid consumption, sedation scores, nausea scores at the four time points, complication rates, and length of hospital stay between groups. In colorectal cancer patients undergoing laparoscopic colorectal surgery, a TAP block did not offer enough benefit for clinical efficacy in terms of postoperative pain or analgesic consumption.

What's good for the goose is not always good for the gander-are conclusions from a clinical trial always universally exportable?

Minimally invasive approaches have revolutionized how surgery is performed and as technology and instrumentation continue to improve, the use of minimally invasive surgery (MIS) will be successfully applied to more complex surgical procedures. When considering a MIS approach, the first question a surgeon must ask is whether MIS provides at least equivalence in terms of short- and long-term outcomes compared to its open counterpart. As an example, the use of MIS approach for appendectomy approaches clinical equipoise compared to the open procedure, and only when applied to certain subset of patients do we see superiority of the MIS approach (1). On the other hand, the use of robotics for thyroidectomy [using the amusingly appropriate acronym, robotic assisted thyroid surgery (RATS)] remains, at best, controversial. Although still championed by a small number of surgeons, the robotic approach converts a straightforward, low complication, open surgery, to a complex and potentially morbid MIS procedure. The disadvantages (including longer operative time, and increased cost compared to conventional open thyroidectomy, as well as potential injuries to the brachial plexus, skin flap, esophagus, and trachea) must be weighed against the effort to compensate for minor cosmetic improvements (2). For the most part however, the literature suggests that MIS for a variety of surgical procedures does provide equivalence, if not improvement over open surgery, especially in terms of postoperative pain, length of stay and return to the patient’s baseline activities of daily living. Cholecystectomy is an early and prime example.

Comparative study of stapled haemorrhoidectomy under local anaesthesia versus spinal anaesthesia

Background The aim of this study is to compare and evaluate the results of stapled haemorrhoidectomy performed under local anaesthesia against those performed under spinal anaesthesia in terms of postoperative pain, bleeding per rectum, the time needed for return to normal bowel habits and resumption of normal physical activities (within one week of surgery), incidence of recurrence and stenosis (within three months of surgery).

Surgical Techniques for the Treatment of Tongue Tie in Children: A Comparative Study

Background: Ankyloglossia is another name for tongue tie which in mild form is characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth. It can affect feeding, speech, and oral hygiene as well as have mechanical/social effects. Ankyloglossia can also prevent the tongue from contacting the anterior palate. Methods: The study aimed to find out best possible surgical modality of frenectomy by comparing scalpel, electro-cautery and CO 2 laser in the treatment of tongue tie. This is a prospective randomized clinical trial conducted in the department of ENT, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra. All patients were categorized in to three groups randomly as group A, group B and group C. Each group contains 18 patients and among group A, B and C, frenectomy was done by conventional scalpel technique, by bipolar cautery and CO 2 laser respectively. Then patients were assessed on post op day 1 for symptomatology and inflammatory signs, on post op day 7 for wound healing and any complications and also after 1 month post-op for scar and contracture of wound. Results: In our study, about 61% of population is of male child and female child were remaining 39% (ratio 1.6:1) which is matching with the previous studies. Amongst all patients most common age group is between 1-4 years of age group. Most of the patients were in Kotlow’s class III having severe ankyloglossia (3‑7 mm) followed by class I having Mild ankyloglossia (12‑16 mm). Conclusions: Laser and electro-cautery treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique.

Have Any Changes in Pain Been Noted After a Hemorrhoidectomy Since the Establishment of the Milligan-Morgan Hemorrhoidectomy?

See Article on Page 111-116 Postoperative pain is the major drawback of a hemorrhoidectomy. Researchers have sought solutions to this problem by looking at surgical techniques, topical medications, and surgical devices. First, surgical techniques have drawn attention since the basic techniques of a hemorrhoidectomy were established. Which technique is ideal or more suitable for a hemorrhoidectomy has long been a subject of debate. Because of enthusiasm to find an ideal technique, numerous techniques have been introduced into practice. However, no solid evidence exists for one technique having an absolute advantage over other techniques in terms of postoperative pain [1]. Thus, one can draw the conclusion that no drastic change in terms of pain after a hemorrhoidectomy can be achieved only by modifying or changing the surgical technique. Another attempt to alleviate pain after a hemorrhoidectomy has been attempts to find topical agents that might facilitate wound healing and alleviate pain by decreasing the internal sphincter tone [2]. Although sporadic reports of improved results have been published, most topical agents are regarded as supplementary measures that provide little improvement in pain management. With the development of energy devices for use in a wide variety of surgeries, studies have been conducted to confirm that these devices can, indeed, reduce pain after a hemorrhoidectomy [3,4]. These devices are presumed to have an advantage in terms of pain because their use seems to result in less thermal damage. Despite several reports suggesting that the new energy devices may cause less pain after a hemorrhoidectomy, the advantage is thought not to be sufficient to bring about a fundamental change in the surgical practice for treating hemorrhoids. Although many attempts have been made to deal with pain after a hemorrhoidectomy, none, except the stapled hemorrhoidopexy, seems to have been successful. The stapled hemorrhoidopexy is a completely different approach from a hemorrhoidectomy [5]. Because it is performed in a less pain-sensitive region, it seems, apart from an increased risk of recurrence, to have an advantage over a conventional hemorrhoidectomy in terms of postoperative pain. However, from a technical point of view, that surgical approach is not a hemorrhoidectomy, but rather a hemorrhoidopexy. Therefore, one may conclude that no significant reductions in pain after a hemorrhoidectomy have been achieved as of yet, even though changes in and modifications of the surgical technique, as well as the introduction and use of new surgical devices, may bring about some changes in the postoperative outcomes of a hemorrhoidectomy.

Reduced port laparoscopic surgery for colon cancer is safe and feasible in terms of short-term outcomes: comparative study with conventional multiport laparoscopic surgery.

PurposeLaparoscopic surgery was previously accepted as an alternative surgical option in treatment for colorectal cancer. Nowadays, single-port laparoscopic surgery (SPLS) is introduced as a method to maximize advantages of minimally invasive surgery. However, SPLS has several limitations compared to conventional multiport laparoscopic surgery (CMLS). To overcome those limitations of SPLS, reduced port laparoscopic surgery (RPLS) was introduced. This study aimed at evaluating the short-term outcomes of RPLS.MethodsPatients who underwent CMLS and RPLS of colon cancer between August 2011 and December 2013 were included in this study. Short-term clinical and pathological outcome were compared between the 2 groups.ResultsThirty-two patients underwent RPLS and 217 patients underwent CMLS. Shorter operation time, less blood loss, and faster bowel movement were shown in RPLS group in this study. In terms of postoperative pain, numeric rating scale (NRS) of RPLS was lower than that of CMLS. Significant differences were shown in terms of tumor size, harvested lymph node, perineural invasion, and pathological stage. No significant differences were confirmed in terms of other surgical outcomes.ConclusionIn this study, RPLS was technically feasible and safe. Especially in terms of postoperative pain, RPLS was comparable to CMLS. RPLS may be a feasible alternative option in selected patients with colon cancer.

Comparative study between open (milligan morgan) haemorrhoidectomy and stapled haemorrhoidectomy

Background: Haemorrhoids are one of the commonest afflictions of mankind from times immemorial. It is said that 40 percent of population have symptoms due to haemorrhoids at some time of their lives, a price possibly man has had to pay following the evolution of his erect posture. Conventional haemorrhoidectomy is a commonly performed operation for haemorrhoids, it has good results but is a painful procedure resulting in a hospital stay for variable days and time off work for two to six weeks. Stapled haemorrhoidectomy has come up as a new and promising procedure causing minimal post-operative pain, early discharge and quick return to work. Methods: In all 50 patients were included in the study - 25 underwent open and 25 underwent stapled haemorrhoidectomy. Computerised analysis of the data was done with the help of software computer programme MS Excel and Statistical 1984-1999. Significance levels were determined by using averages, standard deviation, unpaired student t test, Mann Whitney U test (for non-parametric skewed distribution) and Fischer exact test. If p value < 0.01 or < 0.001, the difference is highly significant. If p value < 0.05, the difference is significant Results: the stapled procedure for haemorrhoids is superior to Milligan Morgan haemorrhoidectomy in terms of post-operative pain, operative time and return to normal activities. It is straightforward and easy to learn. Early functional and symptomatic outcomes have been satisfactory and appear to be similar or better than those achieved using conventional technique. However, long term follow up with respect to these factors is necessary. Conclusions: Stappled haemorrhoidectomy is superior to open haemorrhoidectomy in terms of less intraoperative blood loss,less time for surgery,less pain in postoperative period, less stay in hospital,less post operative complications and early return to work.

Use of leukocyte and platelet-rich fibrin (L-PRF) in periodontally accelerated osteogenic orthodontics (PAOO): Clinical effects on edema and pain.

BackgroundDemand for shorter treatment time is common in orthodontic patients. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a somewhat new surgical procedure which allows faster tooth movement via combining orthodontic forces with corticotomy and grafting of alveolar bone plates. Leukocyte and Platelet-Rich Fibrin (L-PRF) possess hard- and soft-tissue healing properties. Further, evidence of pain-inhibitory and anti-inflammatory potential is growing. Therefore, this study explores the feasibility, intra- and post-operative effects of using L-PRF in PAOO in terms of post-operative pain, inflammation, infection and post-orthodontic stability.Material and MethodsA pilot prospective observational study involving a cohort of 11 patients was carried out. A Wilcko’s modified PAOO technique with L-PRF (incorporated into the graft and as covering membrane) was performed with informed consent. Post-surgical pain, inflammation and infection were recorded for 10 days post-operatively, while the overall orthodontic treatment and post-treatment stability were followed up to 2 years.ResultsAccelerated wound healing with no signs of infection or adverse reactions was evident. Post-surgical pain was either “mild” (45.5%) or “moderate” (54.5%). Immediate post-surgical inflammation was either “mild” (89.9%) or “moderate” (9.1%). Resolution began on day 4 where most patients experienced either “mild” or no inflammation (72.7% and 9.1%, respectively). Complete resolution was achieved in all patients by day 8. The average orthodontic treatment time was 9.3 months. All cases were deemed stable for 2 years.ConclusionsL-PRF is simple and safe to use in PAOO. Combination with traditional bone grafts potentially accelerates wound healing and reduces post-surgical pain, inflammation, infection without interfering with tooth movement and/or post-orthodontic stability, over a 2 years period; thus alleviating the need for analgesics and anti-inflammatory medications. Key words:Periodontally accelerated osteogenic orthodontics, leukocyte and platelet-rich fibrin, corticotomy, osteogenesis, grafts.

To compare single incision laparoscopic cholecystectomy with standard laparoscopic cholecystectomy for treatment of symptomatic cholelithiasis: a prospective randomized study

Background: SILC can best be described as a procedure in evolution. There is no consensus on surgical technique and exclusion criteria for SILC and conflicting reports regarding the merits and demerits of this procedure are present in literature. Efforts to improve outcomes of laparoscopic cholecystectomy heralded the advent of single incision laparoscopic cholecystectomy. The objective of this study was to evaluate and compares single incision laparoscopic cholecystectomy (SILC) with standard four port laparoscopic cholecystectomy (SLC). Methods: All the 80 patients were operated by the same surgeon, all adult patients (>18years of age) with symptomatic cholelithiasis were included and were randomized to two groups, group A consisting of 40 patients undergoing SILC and group B consisting of 40 patients undergoing SLC. Patients with acute cholecystitis, empyema gall bladder, obstructive jaundice, choledocholithiasis, H/O ERCP or pancreatitis, previous abdominal surgery, pregnancy and major comorbidity were excluded. Results were compared with those of standard laparoscopic cholecystectomy (SLC). Results: The mean operating time was 58.73 minutes as compared to 45.10 mins in SLC. Conversion to SLC was required in 4 patients with SILC and 4 patients’ required one extra port. Mean VAS pain scores at 1hours (6.18 versus 6.53, p=0.206), at 6 hours (5.6 versus 6.12, p=0.112), and next morning (4.85 versus 4.75, p=0.772). Mean VAS score (9.27 versus 6.67, p=0.05) and mean VCS score (1.25 versus 4.05, p=0.04) for cosmesis. Additional analgesic was required in 32.5% versus 45% (p= 0.251). Significance was calculated by student t test. A p value less than .05 was considered significant. Conclusions: Transumblical SILC is a superior alternative when cosmesis is considered and is comparable to SLC in terms of post-operative pain, hospital stay but the operative time is significantly more.

Transepithelial Photorefractive Keratectomy for Low to Moderate Myopia in Comparison with Conventional Photorefractive Keratectomy.

Purpose:To compare the effectiveness, safety and stability of the results of transepithelial photorefractive keratectomy (tPRK) with conventional photorefractive keratectomy (PRK) for low to moderate myopia.Methods:In this prospective non-randomized case-control study, patients with low to moderate myopia were assigned to the tPRK group (cases) or the PRK group (controls). In the tPRK group, eyes were treated using the Amaris excimer laser (SCHWIND eye-tech-solutions GmbH and Co. KG, Germany). Outcome measures included postoperative pain using McGill Pain Questionnaire, epithelial healing time, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, and safety and efficacy indexes which were compared between the study groups.Results:Three hundred forty eyes of 170 patients were enrolled in this study. Each study group comprised of 170 eyes of 85 patients. There was a significant difference between the two groups regarding the postoperative pain scores in favor of the tPRK group (P = 0.04). The tPRK group had a shorter epithelial healing time than the conventional PRK group postoperatively (P = 0.01). Mean UCVA was significantly better in the case group than in the control group at the postoperative month 2 (P = 0.01). Regarding the safety and efficacy indexes, the tPRK group had better results than the conventional PRK group (P < 0.01 for both comparisons).Conclusion:Transepithelial PRK seems to be superior to conventional PRK for treatment of low to moderate myopia in terms of postoperative pain, epithelial healing time, visual recovery and safety and efficacy indexes.

Modified Flap Design for Lower Third Molar Surgery: A Short Patient-based Outcome Comparative Study

Objectives: to compare the influence of a newly suggest modified flap design on pain and swelling with the traditional two sided flap.&#x0D; Materials and Methods: Patients were divided into two groups: conventional approach (control) group (n=42) and modified approach (experimental) group (n=41). Pain and swelling were evaluated for the first three postoperative days using 10 cm visual analogue scales. Presence of dry socket was documented in the 7th postoperative day.&#x0D; Results: There was statistically significant difference on the third postoperative day (p &lt;0.05) in the mean pain score between the two surgical groups. The mean score of swelling in conventional group&#x0D; was slightly higher than the modified approach (p&lt;0.05) in the first and the third post operative days. The incidence of dry socket in the modified approach was significantly less than conventional approach group (p &lt;0.001).&#x0D; Conclusions: The modified flap design has a relative advantage over the conventional two sided buccal approach in terms of postoperative pain, swelling and dry socket incidence.

Minimally Invasive Anal Fistula Treatment—a True Minimal Invasive Surgical Procedure

A surgical procedure comprises of two aspects—the surgical access and surgery on the target organ. For decades, general surgeons focussed their minds to propel development in the latter, i.e., surgery on the target organ. Trauma due to surgical access was considered inevitable. Patient discomfort, debility, and disfigurement were considered to be a small price the patients were paying in the larger interest of surgical cure. The advent of minimal access surgery revolutionized the concept of surgical practice. The approach placed the patient at the center of all surgical decisions. It was for the first time that the comfort and needs of the patient were given paramount importance. Through minimal access surgery, the trauma of surgical access has been dramatically minimized, with shorter hospital stay and greater patient satisfaction. Today, minimal access surgery is firmly established in the armamentarium of surgeons worldwide. The early postoperative sequelae following management of anal fistulae in terms of postoperative pain, need for dressings, and time taken off work has not been reported much in literature. Mostly, long-term outcomes in terms of recurrence and incontinence have been addressed in studies reported so far. Traditional techniques including fistulectomy and use of cutting seton have been associated with incontinence, especially in patients who have had previous surgery. Mucosal advancement flaps are technically challenging and are associated with high recurrence rates and high rates of incontinence postoperatively. Although surgical field has undergone significant evolution over the past few decades, the surgical management of the perianal anomalies is yet to witness a technological breakthrough. Apart from treatment of hemorrhoids, there have not been many surgical innovations for perianal infective pathologies. The newer treatment options include use of fibrin glue, bio-prosthetic plugs, and ligation of intersphincteric fistula tract (LIFT) and video-assisted anal fistula treatment (VAAFT). LIFT procedure has been associated with good healing rates. The early results with the use of VAAFT have been encouraging so far. The video-assisted anal fistula treatment (VAAFT) was developed by Professor P. Meinero in 2006 [1]. However, we strongly feel and advocate the terminology of minimally invasive anal fistula treatment (MAFT), which is much more appropriate and is the correct description of the procedure. MAFT qualifies as a trueminimal invasive surgical procedure. There are no iatrogenic incisions for access on the patient. Surgical access is obtained from a pre-existing pathological opening of the fistula. The technique comprises identification and secure internal closure of the internal fistula opening and visualization with cauterization of the fistulous tract using a specially designed fistuloscope. The MAFT is based on the same principles as other procedures for closing the internal opening and obliterating the tract with the innovation that allows precise identification of the fistula anatomy and the internal opening by fistuloscopy and fulguration of the tract walls under direct vision. This approach allows the identification and treatment of all the secondary tracts and the abscess cavities connected to the main track. In our opinion, the adoption of fistuloscope-aided exploration along with effective closure of the internal opening and reinforcing the closure of the opening from the inner side of the staple/suture line is the most effective way of achieving a high healing rate for complex anal fistulas with preservation of the anal sphincter. We adopted the MAFT technique in April 2011 in an effort to reduce early postoperative morbidity and offer patients * P. K. Chowbey pradeepchowbey@gmail.com

Timely thoracoscopic decortication promotes the recovery of paediatric parapneumonic empyema.

Parapneumonic empyema is one of the most commonly encountered yet difficult to manage paediatric thoracic conditions. Conservative treatment with chest tube drainage and fibrinolytic agents had been proposed but operative decortication remains the gold standard for refractory cases. Thoracoscopic decortication has been advocated in recent years due to its superiority in terms of post-operative pain, cosmesis and other long-term results. However, few studies investigated the effect of timing on peri-operative outcomes. This study aims to explore the benefits of early decortication. Retrospective study of all patients who underwent thoracoscopic decortication between 1999 and 2013 at a tertiary referral centre was performed. Data were extracted from respective medical records. Patients' demographics, peri-operative outcomes, length of hospitalization and post-operative complications were analysed. A total of 28 patients were identified, 12 males and 16 females. Average age of patients was 4.5 years (range 12 months-14 years). Right-sided empyema was involved in 14 of the patients. Patients who underwent operation within 2 weeks from symptom onset (n = 16) showed significant shorter post-operative hospital stay (mean 9.5 vs 20.4 days, p = 0.003) and total hospitalization duration (mean 19.3 vs 38.8 days, p < 0.001). Correlation study demonstrated a strong relation between delay in operation and prolonged hospitalization (r = 0.63, p = 0.001). The peri-operative and post-operative outcomes were similar. No major post-operative complication was encountered except one patient who required a second decortication for residual empyema. Thoracoscopic decortication is a safe and feasible procedure for parapneumonic empyema. Timely surgery is recommended as it promotes early recovery and shorter hospitalization.

Dilatation of the cervix at non-labour caesarean section: Does it improve the patients’ perception of pain post-operatively?

Our aim was to determine the effect of cervical dilatation at non-labour caesarean section on post-operative pain and maternal morbidity. This prospective, randomised, single-blinded trial was conducted from March 2013 to February 2014. In all, 199 patients were enrolled in the study: 102 in non-dilated group and 97 in cervical dilatation group. Based on Visual Analogue Scale, there were no significant differences between the two groups on post-operative 8th, 24th and 48th hour pain scores. We observed thinner endometrial cavity thickness, shorter operation time and shorter hospitalisation duration in cervical dilatation group. However, change in haemoglobin concentrations and puerperal fever rates were found to be comparable between the groups. In conclusion, intra-operative cervical dilatation does not seem to benefit in terms of post-operative pain, change in haemoglobin concentrations or puerperal fever.