BACKGROUND: Orofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. PATIENTS/METHODS: Overall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. RESULTS: Data from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. CONCLUSIONS: Regional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. GOV IDENTIFIER: NCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.
- MeSH
- lidé MeSH
- nervová blokáda * metody MeSH
- novorozenec MeSH
- opioidní analgetika * terapeutické užití MeSH
- pooperační bolest farmakoterapie prevence a kontrola MeSH
- retrospektivní studie MeSH
- rozštěp patra * chirurgie MeSH
- rozštěp rtu * chirurgie MeSH
- svodná anestezie * metody MeSH
- zákroky plastické chirurgie metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Previous studies have assessed different aspects concerning the applications of i-PRF in the oral cavity. However, nothing is known regarding patients' perceptions of the injection of autologous platelet-rich fibrin (i-PRF). OBJECTIVES: To investigate patients' perceptions after injecting platelet-rich fibrin (i-PRF) in the course of retracting upper canines. METHODS: Twenty-one patients, whose treatments required extractions of both upper first premolars, were recruited. Extraction side was randomly allocated to the intervention or control sides. After the alignment phase, i-PRF was injected twice with a one-month interval on the buccal and palatal aspects of the extraction sites (intervention side). Patients' perceptions were evaluated with two questionnaires: the first was used to assess the level of pain, discomfort, swelling, eating and swallowing difficulties as well as jaw movement restriction after 1 h (T1), 2 h (T2), 6 h (T3), 24 h (T4) and 48 h (T5) of the second injection; the second questionnaire was used to assess the acceptance of the i-PRF injection and overall satisfaction with this technique at the end of canine retraction phase. Visual Analogue Scale (VAS) was adopted for this purpose. Wilcoxon Signed Rank Test was used to compare between both sides at all time points while Friedman's Test was the selected test for detecting variables' changes over time. Post-hoc Wilcoxon Matched-Pairs Signed-Rank Tests were applied when any of the results were significant. As to the multiplicity of tests, Bonferroni Correction was implemented. RESULTS: Pain and swelling levels were significantly higher on the experimental compared to the control sides at T1, T2, and T3 (P < 0.05), whereas they declined sharply and went back to almost normal values at T4 (after 24 h). At T5 they were 0. Discomfort and difficulty in mastication on intervention sides were significant only at T1 and T2. Pain, swelling, and chewing difficulties were significant (P < 0.001) during the 4 assessed time points. The increase was insignificant regarding swallowing difficulties and jaw movement limitations at all time intervals. CONCLUSIONS: Injecting autologous (i-PRF) during orthodontic canine retraction is a well-perceived and well-tolerated method due to the limited discomfort which significantly diminishes 24 h afterwards. TRIAL'S REGISTRATION: ClinicalTrials.gov (Identifier Number: NCT03399422. 16/01/2018).
Předkládanou kazuistikou si dovolujeme seznámit odbornou veřejnost s příběhem ženy, která v raném pooperačním období prodělala recidivující poruchu vědomí s nekonstantními myoklonickými záškuby trupu se samovolně obnoveným vědomím. Příběh ženy, který vyvolal otazníky, na které nebyly nalezeny jednoznačné odpovědi. Příběh ženy, který nás zdravotníky pracující v intenzivní medicíně donutil pomýšlet nejen na samotnou existenci disociativních stavů, ale také na jejich různé klinické projevy a diferenciální diagnózu. Naše pracovní zaměření v intenzivní medicíně, jsme‐li svědky poruchy stavu vědomí u pacienta, nás nutí primárně se zaměřit na přísně somatické a diagnosticky průkazné příčiny stavu. Předloženým a popsaným případem si zkusíme odpovědět, zda pooperační bolest nasedající na predisponující psychické traumatizující události může tím být hledaným procesem, který spustí narušení integrace vědomí. Zda existuje vztah mezi stresorem a začátkem poruchy stavu vědomí.
With the presented case report we would like to acquaint the professional public with the story of a woman who experienced a recurrent disturbance of consciousness with non-constant myoclonic twitches of the trunk followed by spontaneous recovery of consciousness in the early postoperative period. The story that raised questions to which no definite answers were found. The story that forced us, health care workers in intensive care, not only to think about the very existence of dissociative states, but also about their various clinical manifestations and differential diagnosis. When we witness a patient with impaired state of consciousness, our focus in intensive care medicine forces us to concentrate primarily on strictly somatic and diagnostically proven causes of the condition. With the presented and described case, we will try to answer whether postoperative pain superimposed on predisposing psychological traumatizing events can be the sought-after process that triggers the disruption of the integration of consciousness. And whether there is a relationship between the stressor and the onset of consciousness impairment.
This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.
- MeSH
- bolest etiologie MeSH
- dospělí MeSH
- extrakce zubů škodlivé účinky MeSH
- hypestezie etiologie MeSH
- lidé MeSH
- mandibula chirurgie MeSH
- molár třetí * chirurgie MeSH
- percepce MeSH
- pooperační bolest etiologie MeSH
- prospektivní studie MeSH
- zaklíněný zub * chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.
- MeSH
- dislokace kloubu * MeSH
- hmat MeSH
- karpometakarpální klouby * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- osteoartróza * chirurgie MeSH
- palec ruky chirurgie MeSH
- pooperační bolest MeSH
- protézy a implantáty MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Cieľ: Zamerali sme sa na anestéziu a jej vplyv na psychické rozpoloženie pacientov. Dizajn: Sledovali sme vzťah medzi výskytom nepríjemných zážitkov pacientov počas anestézie a demografickými údajmi. Metódy: Súbor tvorilo 219 pacientov po anestézii. Pre interpretáciu výsledkov sme vypočítali jednoduché frekvencie, percentuálne hodnotenie súboru, aritmetický priemer, medián a modus. Dotazníky sme pacientom administrovali v Univerzitnej nemocnici Bratislava od novembra 2010 do marca 2011. Výsledky: Najdôležitejšími výsledkami je zistenie vzťahu medzi jednotlivými nepríjemnými zážitkami a vekom pacientov, kde sme štatistickú významnosť zistili u nepríjemných zážitkov, ako je spomienka bez bolesti (p = 0,015), vracanie (p = 0,029), svalová slabosť (p = 0,048) a bolesť hlavy (p = 0,015); a pri hodnotení vzťahu medzi výskytom nepríjemných zážitkov a pohlavím, kde sme zistili štatisticky významný vzťah vo výskyte nevoľnosti (p = 0,000), problémov s dýchaním (p = 0,048), vracaním (p = 0,015), bolesti v operačnej rane (p = 0,001) a svalovej slabosti (p = 0,003). Záver: Výsledky potvrdzujú vzťah medzi výskytom nepríjemných zážitkov pacientov počas anestézie a ich demografickými údajmi. Na základe našich zistení navrhujeme vytvorenie protokolov predoperačnej prípravy so zameraním sa na identifikáciu najčastejších nepríjemných zážitkov u pacientov súvisiacich s anestéziou.
Purpose: We focused on anaesthesia and its impact on patients' mental mood. Design: We followed the relationship between the occurrence of unpleasant experiences of patients during anaesthesia and demographic data. Methods: The group consisted of 219 patients after anaesthesia. We administered questionnaires to patients at the University Hospital Bratislava between November 2010 and March 2011. Results: The most important results are the subsequent investigation of the relationship between individual unpleasant experiences and the age of the patients, where we found statistical significance in unpleasant experiences such as recall without pain (p = 0.015), vomiting (p = 0.029), muscle weakness (p = 0.048), and headache (p = 0.015); and when evaluating the relationship between the incidence of unpleasant experiences and sex, we found a statistically significant relationship in the incidence of nausea (p = 0.000), breathing problems (p = 0.048), vomiting (p = 0.015), pain in the surgical wound (p = 0.001), and muscle weakness (p = 0.003). Conclusion: Results confirm the relationship between the occurrence of unpleasant experiences of patients during anaesthesia and their demographic data. Based on our findings, we propose creating protocols for preoperative preparation, focusing on identifying the most common unpleasant experiences in patients related to anaesthesia.
- MeSH
- anestezie MeSH
- lidé MeSH
- pooperační bolest farmakoterapie patofyziologie MeSH
- pooperační delirium MeSH
- pooperační péče * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Výkony v dutině břišní jsou spojeny obvykle s intenzivní pooperační bolestí. Kvalitní analgezie zkracuje hospitalizaci pacienta, snižuje náklady na léčbu i redukuje pooperační komplikace. V průběhu operačních výkonů je metodou volby kontinuální epidurální analgezie se směsí lokálního anestetika a opioidu. Pokud tato není možná, je indikována multimodální analgezie s kombinací silného opioidu, neopioidních analgetik a případně nitrožilní infuze lidokainu. V pooperačním období je opět vhodnou metodou kontinuální epidurální analgezie, i pacientem řízená. Ostatní možnosti zahrnují nitrožilní pacientem řízenou analgezii se silnými opioidy, kombinaci opioidů a neopioidních analgetik a multimodální neopioidní analgezii, kde se uplatňují paracetamol, metamizol, nesteroidní antiflogistika a selektivní inhibitory cyklooxygenázy 2. Systémová analgezie může být suplementována i technikami regionálních blokád břišní stěny, jako jsou rectus sheath blok, transversus abdominis plane blok, erector spinae blok nebo kontinuální infiltrace podkoží.
Surgical procedures inside the abdominal cavity are usually associated with intensive postoperative pain. Good-quality analgesia shortens the length of hospital stay, decreases the costs of treatment, and reduces postoperative complications. Continuous epidural analgesia with the mixture of local anesthetics and opioids remains the method of choice during surgical procedures. If this method is not feasible, multimodal analgesia with a combination of strong opioids, non-opioid analgesics, and eventually intravenous infusion of lidocaine is indicated. During the postoperative period, continuous epidural analgesia, even patient-controlled is a suitable method of pain relief. Other options include intravenous patient-controlled analgesia with strong opioids, a combination of opioids and non-opioid analgesics, or multimodal non-opioid analgesia, where paracetamol, metamizole, nonsteroidal anti-inflammatory drugs, and selective inhibitors of cyclooxygenase 2 may be employed. Systemic analgesia may be supplemented also with the techniques of abdominal wall regional blockades, such as rectus sheath block, transversus abdominis plane block, erector spinae block, or continuous wound infiltration.
- Klíčová slova
- protokol ERAS, protokol PROSPECT,
- MeSH
- analgetika aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- analgezie metody MeSH
- anestetika lokální aplikace a dávkování terapeutické užití MeSH
- břišní stěna inervace MeSH
- inhibitory cyklooxygenasy 2 terapeutické užití MeSH
- kolorektální chirurgie rehabilitace MeSH
- lidé MeSH
- pooperační bolest * farmakoterapie MeSH
- protokoly protinádorové léčby MeSH
- synergismus léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Cíl: Zjistit, zda je nová metoda úspěšná při blokádě obou ilioinguinálních nervů pro zmírnění pooperační bolesti po císařském řezu. Materiály a metody: Mezi lednem 2022 a lednem 2023 bylo do této studie zařazeno 300 pacientek na Porodnicko-gynekologickém oddělení Lékařské fakulty Univerzity Al-Azhar. 150 z těchto pacientů dostalo infiltraci bupivakainu na obě strany blízko přední páteře kyčelní a 150 dostalo normální injekci fyziologického roztoku do stejných míst. Výsledky: Studie porovnávala obě skupiny a objevila významné rozdíly v načasování žádostí o analgetika, intervalu před první ambulancí pacienta, délce pobytu v nemocnici, skóre pooperační bolesti a incidenci pooperační nevolnosti a zvracení, přičemž skupina A na tom byla lépe. Závěr: Po císařském řezu je účinným způsobem, jak zmírnit pooperační nepohodlí a použití analgetik, lokální anestetikum injekce „bupivakainu” k bilaterální blokádě ilioinguinálních nervů.
Aim: To determine whether the novel method is successful in blocking both ilioinguinal nerves to lessen postoperative pain following caesarean surgery. Materials and methods: Between January 2022 and January 2023, 300 patients were enrolled in this study at the Obstetrics and Gynaecology Departments of the Faculty of Medicine at Al-Azhar University. About 150 of these patients received bupivacaine infiltration on both sides close to the anterior superior iliac spine, and 150 received a normal saline injection at the same locations. Results: The study compared the two groups and discovered significant differences in the timing of analgesic requests, interval before the patient’s first ambulation, length of hospital stay, postoperative pain score, and incidence of postoperative nausea and vomiting, with group A performing better. Conclusion: After a caesarean section, the local anaesthetic “bupivacaine” injection used to block the ilioinguinal nerves bilaterally is an efficient way to lessen postoperative discomfort and analgesic use.
