The use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study
|
|
- Logan Sutton
- 6 years ago
- Views:
Transcription
1 Kasr El Aini Journal of Surgery VOL., 10, NO 3 September The use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study Sherif Adly and Mohamed Abd El Aziz Departments of Surgery and Anesthesia Misr University for Science & Technology ABSTRACT Hemorrhoidectomy operation is usually associated with intense postoperative pain. Trials to improve surgical techniques failed to decrease postoperative pain significantly. The use of regional anesthesia although it gives a reasonable postoperative pain relief yet this is short lived and is sometimes associated with postoperative urinary retention. Finding a way of a more sustained postoperative pain relief with no added risk of urinary retention would be beneficial. This is a prospective double blind placebo controlled clinical trail.sixty patients scheduled for herorrhoidectomy operation in our hospital were recruited in this study and were randomized into three groups. Group A received general anesthesia only, group B received general anesthesia and bilateral Pudendal nerve block and group c received general anesthesia and bilateral placebo pudendal block. This trial showed a significant pain relief in group B in the night of surgery and in the first postoperative day when compared with groups A and C. It showed that the addition of pudendal nerve block to general anesthesia does not add any risk of postoperative urinary retention. In conclusion we recommend the addition of pudendal nerve block to general anesthesia in hemorrhoidectomy operation. Key words: Hemorrhoidectomy, pudendal nerve block. INTRODUCTION Hemorrhoidectomy is frequently associated with significant postoperative pain of variable duration. The pain is usually accompanied by substantial consumption of analgesics both opioid and non-opioid (1). Despite numerous attempts to modify both surgical and anesthetic regimens this problem remains clinically important (2). Pudendal nerve block has been used in many centers to decrease the postoperative pain after hemorrhoidectomy operations (3). The aim of the current study is to detect if there is any benefit to the addition of Pudendal nerve block to general anesthesia and the primary outcome variables were postoperative pain calculated by pain score, the need for opioid analgesics and the duration of hospital stay. All patients recruited in this study signed a written informed consent. The study was approved by the ethical committee in our hospital. PATIENTS & METHODS Sixty patients admitted to our hospital from February 2007 to February 2009 with the diagnosis of hemorrhoids scheduled for surgery because of their symptoms and their unsuitability for band ligation therapy were recruited in this study. Patients on oral anticoagulants, patients with American Society of Anesthesia ASA 4 or 5 and pregnant women were all excluded from the study. Those sixty patients were randomly divided into three groups. Randomization was done by the sealed opaque envelope technique. Group A is the general anesthesia only group, group B is the general anesthesia plus bilateral Pudendal nerve block group and finally group C is the general anesthesia plus bilateral placebo nerve block. Surgical technique Open hemorrhoidectomy was done in the usual fashion where skin flaps were raised next to the mucocutaneous junction to the dentate line, hemorrhoid pedicle was transfixed and hemorrhoids were excised.
2 Kasr El Aini Journal of Surgery VOL., 10, NO 3 September Protocol for general anesthesia All patients were given preoperative sedation (Midazolam 0.15 mg/kg). Induction of general anesthesia was by intravenous Fentanyl (1.5micogram/kg) and Thiopental (3-5 mg/kg) followed by endotracheal intubation facilitated by Atracuruim (0.5/kg). Anesthesia was subsequently maintained with Isoflurane 1-3% and Oxygen 30%. The Isoflurane concentration was adjusted with intension of keeping heart rate and blood pressure about plus or minus 25% of pre-induction values. Pudendal nerve block technique This technique was done for both group B and group C. For group B patients a mixture of (2% Lidocaine, 5% Bupivacaine, Fentanyl and Clonidine) was used and patients were given a total volume of injection 0.7 ml/kg (4). Patients in group C were given similar volume but of normal saline only. While the patient is in lithotomy position, four injection sites were used two anterior and two posterior. The skin of the chosen injection sites was infiltrated with 1 ml of 1% Lidocaine after aseptic skin preparation. The posterior injections were at four and eight o`clock positions five centimeters from the anal verge. A 22-gauge 10 centimeter nerve stimulator was advanced approximately 7 to 10 centimeters depending on patient size perpendicular to the skin in all planes using a stimulating current of ma and 1 Hz. Appropriate stimulation of the nerve was detected by the contraction of the posterior fibers of the internal anal sphincter. Then the injection was performed. A similar procedure was done for the anterior injections at two and ten o`clock two and a half centimeters from the anal verge and at these locations the needle was advanced to only 4 to 5 centimeters. The response of Pudendal nerve stimulation at those sites is the contraction of the anterior fibers of the internal anal sphincter (4). The time needed for the performance of Pudendal nerve block was ten to twenty minutes Data collection Data were collected as regards patient`s characteristics including age, sex, body mass index (BMI) and the grade of hemorrhoid. Data were also collected as regards postoperative nausea and vomiting, urinary retention, pain score in the night of operation and in the first postoperative day. The need for opiod analgesia and the duration of hospital stay were registered. Pain score was explained to each patient as a score from zero to ten where zero means no pain and ten means unbearable pain. Pharmacological management of postoperative pain All patients were given Diclofenac potassium but opiod analgesics were given only on demand. RESULTS All the studied groups were similar as regards sex, age, Body Mass Index and hemorroidal grade. Table (1) shows no statistically significant difference between the three studied groups as regards patient`s age and BMI. Table (2) shows that patients in group B needed less opiod analgesics and had less pain in the night of surgery and in the first postoperative day when compared to patients in group A and C and this difference was found statistically significant. Also hospital stay was less in patients of group B compared to patients in group A and C and this difference is statistically significant. But as regards postoperative nausea, vomiting and urinary retention there was no significant difference between the three studied groups.
3 Kasr El Aini Journal of Surgery VOL., 10, NO 3 September Table (1): Comparison between the three studied groups as regards patient`s Age and Body Mass Index (BMI). NS is not significant, SD is standard deviation. Group Number Mean SD T P Significance Age A Age B NS BMI A BMI B NS Age A Age C NS BMI A BMI C NS Age B Age C NS BMI B BMI C NS Table (2): Comparison between the 3 studied groups as regards clinical parameters. Parameter Item Group A Group B Group C Sig. Sex Females Males 8 (40%) 12 (60%) 11 (55%) 11 (55%) A& C (NS) Nausea Vomiting Urinary Retention Needs for opioids Pain at night of surgery Pain at first postoperative day Hospital stay Hemorrhoid Grade (75%) 18 (90%) 2 (10%) 8 (40%) 12 (60%) 13 (65%) 10 (50%) 16 (80%) 18 (90%) 2 (10%) 20 (100%) 20 (100%) 15 (75%) 17 (85%) 3 (15%) 13 (65%) 18 (90%) 2 (10%) 16 (80%) 0(0%) 16 (80%) 1 (5%) 13 (65%) 8 (40%) A& B (NS) B& C (NS) A& C (NS) A& C (NS) B& C (HS) B & C (HS) B & C (HS) B & C (HS)
4 Kasr El Aini Journal of Surgery VOL., 10, NO 3 September DISCUSSION Pain after hemorrhoidectomy operations is usually very intense (5) leading to excessive consumption of narcotic analgesia and prolonged hospital stay (6). Attempts to improve surgical techniques have been disappointing (2). A good postoperative analgesia can be achieved with regional anesthesia as Caudal or spinal anesthesia but the postoperative analgesia is short lived and is frequently associated with some side effects like retention of urine (7). Finding a method that can provide a relatively prolonged pain relief with no increase risk of urinary retention would be beneficial. This prospective double blind placebo controlled clinical trial showed that general anesthesia GA combined with Pudendal Nerve Block PNB was associated with a statistically significant pain control at the night of surgery and in the first postoperative day, significant reduction in the use of opioid analgesia and in hospital stay. This is when compared with GA alone and GA combined with placebo Pudendal block. This study also showed that the addition of PNB to GA did not increase the incidence of urinary retention. The results of this study collaborate well with the results obtained by Naja Z et al, (3) and also with Luck et al (8), who in a prospective randomized clinical trial, found the combination of GA and ischiorectal fossa block using plain local anesthetics producing improved analgesia in the first 24 hours following hemorrhoidectomy compared to GA alone. Another benefit in adding PNB to GA is that in this study pain relief was longer than would be expected if we were using plain local anesthetics only. But the addition of clonidine and Fentanyl extended the period of analgesia to more than 48 hours. This sustained pain relief can be explained with the reduction in the nociceptive plasticity within the central nervous system (9). Another factor could have been the local effect at the level of the injured perianal nerves. Giannoni et al, described a potent effects of peripheral administration of a mixture of local anesthetics and clonidine when injected close to injured nerves or nerve endings (10). Opiod medications added to the local anesthetics have also been capable of prolonging the duration of peripheral nerve block (11). Conclusion This study proved that the addition of Pudendal nerve block to general anesthesia in hemorrhoidectomy operation leads to significant pain relief in the night of surgery and in the first postoperative day leading to a shorter hospital stay. The addition of pudendal nerve block to general anesthesia does not increase the incidence of postoperative urinary retention. REFERENCES 1. Read TE, Henry SE, Hovis RM, et al. Prospective evaluation of anesthetic technique for anorectal surgery. Dis Colon Rectum 2002; 45: Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 2000; 355: Naja Z, Ziade MF, Lönnqvist PA. Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain. Can J Anesth 2005; 52: Pybus DA, D Bras BE, Goulding G, Liberman H, Torda TA. Postoperative analgesia for haemorrhoid surgery. Anaesth Intensive Care 1983; 11: Beattie GC, Wilson RG, Loudon MA. The contemporary management of haemorrhoids. Colorectal Dis 2002; 4: Gabrielli F, Cioffi U, Chiarelli M, Guttadauro A, De Simone M. Hemorrhoidectomy with posterior perineal block. Experience with 400 cases. Dis Colon Rectum 2000; 43: Petros JG, Bradley TM. Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg 1990; 159: Luck AJ, Hewett PJ. Ischiorectal fossa block decreases posthemorrhoidectomy pain. Randomized, prospective, double blind clinical trial. Dis Colon Rectum 2000; 43:
5 Kasr El Aini Journal of Surgery VOL., 10, NO 3 September Aida S. The challenge of preemptive analgesia. PAIN Clinical Updates 2005; 13: Giannoni C, White S, Enneking FK, Morey T. Ropivacaine with or without clonidine improves pediatric tonsillectomy pain. Arch Otolaryngol Head Neck Surg 2001; 127: Mays KS, Lipman JJ, Schnapp M. Local analgesia without anesthesia using peripheral perineural morphine injections. Anesth Analg 1987; 66:
6 Kasr El Aini Journal of Surgery VOL., 10, NO 3 September
Raed Aldabbas MD*, Moath Kreshan MD** ABSTRACT
Comparison between Anesthetic Approaches with Pudendal Nerve Block on Postoperative Pain Profile after Anorectal Surgery: Our Experience at King Hussein Medical Centre Raed Aldabbas MD*, Moath Kreshan
More informationIschiorectal Block with Bupivacaine for Post Hemorrhoidectomy Pain
Original Article Korean J Pain 2012 April; Vol. 25, No. 2: 89-93 pissn 2005-9159 eissn 2093-0569 http://dx.doi.org/10.3344/kjp.2012.25.2.89 Ischiorectal Block with Bupivacaine for Post Hemorrhoidectomy
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationNerve stimulator guided pudendal nerve block versus general anesthesia for hemorrhoidectomy
REGIONAL ANESTHESIA AND PAIN 579 Nerve stimulator guided pudendal nerve block versus general anesthesia for hemorrhoidectomy [Le bloc du nerf honteux guidé par un neurostimulateur versus l anesthésie générale
More informationNerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain
62 Regional Anesthesia and Pain Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain [Le bloc du nerf honteux guidé par neurostimulation diminue la douleur posthémorroïdectomie]
More informationNerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS
Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV
More informationSingle Dose Preemptive Thoracic Paravertebral Block For Postoperative Pain Relief After Cholecystectomy
10 Single Dose Preemptive Thoracic Paravertebral Block For Postoperative Pain Relief After Cholecystectomy Tarek Atef Tawfic *, MD; Mohamed Medhat Khalil *, MD *Lecturer of anaesthesia, faculty of medicine,
More information*Corresponding Author: Mahadevappa Gudi
Int. J. Pharm. Med. & Bio. Sc. 2014 Mahadevappa Gudi and Shiddalingesh Salimath, 2014 Research Paper ISSN 2278 5221 www.ijpmbs.com Vol. 3, No. 4, October 2014 2014 IJPMBS. All Rights Reserved A SINGLE
More informationSenior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view
Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view 1st Geneva International SCIENTIFIC DAY February 3 rd 2010 E. Schiffer Dept APSI, HUG 1 Fast-Track in colorectal
More informationDORIS DUKE MEDICAL STUDENTS JOURNAL Volume V,
Continuous Femoral Perineural Infusion (CFPI) Using Ropivacaine after Total Knee Arthroplasty and its Effect on Postoperative Pain and Early Functional Outcomes Eric Lloyd Scientific abstract Total Knee
More informationRole and safety of epidural analgesia
Anaesthesia for Liver Resection Surgery The Association of Anaesthetists Seminars 21 Portland Place, London Thursday 15 th December 2005 Role and safety of epidural analgesia Lennart Christiansson MD,
More informationWITH ISOBARIC BUPIVACAINE (5 MG/ML)
, 49, 2013, 3 63 (5 MG/ML) (5 MG/ML).,.,.,..,..,, SPINAL ANESTHESIA: COMPARISON OF ISOBARIC ROPIVACAINE (5 MG/ML) WITH ISOBARIC BUPIVACAINE (5 MG/ML) D. Tzoneva, Vl. Miladinov, Al. Todorov, M. P. Atanasova,
More informationComparison of Electrotherapy, Rubber Band Ligation and Hemorrhoidectomy in the Treatment of Hemorrhoids: A Clinical and Manometric Study
Original Article 9 Comparison of Electrotherapy, Rubber Band Ligation and Hemorrhoidectomy in the Treatment of Hemorrhoids: A Clinical and Manometric Study A Izadpanah 1*, SV Hosseini 2, M Mahjoob 1 1.
More informationMr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government
Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia
More informationGeneral anesthetics. Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine
General anesthetics Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine Rationale General anesthesia is essential to surgical practice, because it renders patients analgesic,
More informationUltrasound Guided Thoracic Paravertebral Block versus Blind Landmark Technique for Breast Surgery. Does it Really Different?
Med. J. Cairo Univ., Vol. 84, No. 3, December: 235-24, 216 www.medicaljournalofcairouniversity.net Ultrasound Guided Thoracic Paravertebral Block versus Blind Landmark Technique for Breast Surgery. Does
More informationComparison Of 0.5%Bupivacaine And 0.5% Bupivacaine Plus Buprenorphine in Brachial Plexus Block
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 1 Ver. VIII (Jan. 2016), PP 01-08 www.iosrjournals.org Comparison Of 0.5%Bupivacaine And 0.5%
More informationEFFECTS OF INTRAOPERATIVE-INTRATHECAL SUFENTANIL INJECTION ON POSTOPERATIVE PAIN MANAGEMENT AFTER SINGLE LEVEL LUMBAR DISCECTOMY
EFFECTS OF INTRAOPERATIVE-INTRATHECAL SUFENTANIL INJECTION ON POSTOPERATIVE PAIN MANAGEMENT AFTER SINGLE LEVEL LUMBAR DISCECTOMY Saeid Abrishamkar *, Mohammadhossein Karimi **, Mohammadreza Safavi ***,
More informationLOCAL ANESTHETIC NERVE BLOCKS and ANALGESIA. Carolyn Cartwright, RVT, VTS (Anesthesia/Analgesia)
LOCAL ANESTHETIC NERVE BLOCKS and ANALGESIA Carolyn Cartwright, RVT, VTS (Anesthesia/Analgesia) Effective approach for optimum pain management requires a practical multimodal anesthesia and analgesia protocol.
More informationTAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial
TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial Kim Gorissen Frederic Ris Martijn Gosselink Ian Lindsey Dept of Colorectal Surgery Dept of
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationFast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus
More informationControlled Trial of Wound Infiltration with Bupivacaine for Post Operative Pain Relief after Caesarean Section
Bahrain Medical Bulletin, Vol.23, No.2, June 2001 Controlled Trial of Wound Infiltration with Bupivacaine for Post Operative Pain Relief after Caesarean Section Omar Momani, MD, MBBS, JBA* Objective: The
More informationNeostigmine as an adjunct to Bupivacaine, for caudal block in burned children, undergoing skin grafting of the lower extremities
Neostigmine as an adjunct to Bupivacaine, for caudal block in burned children, undergoing skin grafting of the lower extremities Dr. Pramod Gupta, Dr Amy Grace MD Department of Anaesthesiology and Critical
More informationComparison of Bolus Bupivacaine, Fentanyl, and Mixture of Bupivacaine with Fentanyl in Thoracic Epidural Analgesia for Upper Abdominal Surgery
Original Article DOI: 10.17354/ijss/2016/156 Comparison of Bolus Bupivacaine, Fentanyl, and Mixture of Bupivacaine with Fentanyl in Thoracic Epidural Analgesia for Upper Abdominal Surgery Sachin Gajbhiye
More informationCAESAREAN SECTION Brian Fredman
CHAPTER 3 GYNAECOLOGICAL SURGERY CAESAREAN SECTION Brian Fredman Review of evidence: surgical site infusion Of the seven studies on surgical site local anaesthetic infusion after Caesarean section performed
More informationPost Tonsillectomy Pain Presented by: Dr.Z.Sarafraz Otolaryngologist
Post Tonsillectomy Pain Presented by: Dr.Z.Sarafraz Otolaryngologist Tonsillectomy is a common surgery in children Post tonsillectomy pain is an important concern. Duration &severity of pain depend on:
More informationLocal anesthetic infiltration is not effective in decreasing post- Cesarean section skin pain severity. Iman Fayez Anees
Rawal Medical Journal An official publication of Pakistan Medical Association Rawalpindi Islamabad branch Established 1975 Volume 36 Number 2 March- June 2011 Original Article Local anesthetic infiltration
More informationMaterials and Methods
Anesthesiology 2000; 93:1225 30 2000 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Comparison of the Costs and Recovery Profiles of Three Anesthetic Techniques for Ambulatory
More informationTarek M Sarhan, Assistant professor of Anesthesiology, Faculty of Medicine, Alexandria University
7 ANALGESIA FOR TRACHEOESOPHAGEAL FISTULA REPAIR IN NEONATES : A COMPARISON OF SINGLE SHOT THORACIC PARAVERTEBRAL BLOCK AND EPIDURAL BLOCK WITH ROPIVACAINE Tarek M Sarhan, Assistant professor of Anesthesiology,
More informationInternational Journal of Drug Delivery 5 (2013) Original Research Article
International Journal of Drug Delivery 5 (2013) 239-244 http://www.arjournals.org/index.php/ijdd/index Original Research Article ISSN: 0975-0215 Comparative study of duration of analgesia with epidural
More informationIshrat Rashid 1, Khairat Mohammad 2, Mohamad Ommid 3, Mubasher Ahmad 4, Sheikh Irshad 5,Velayat Nabi 6
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 9, Issue 2 (Jul.- Aug. 2013), PP 42-48 A prospective randomized double blind Study of the effects of
More informationEvaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study
Original article: Evaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study RajulSubhash Karmakar 1, ShishirRamachandra Sonkusale 1* 1Associate Professor,
More informationIntra-articular Adjuvant Analgesics Following Knee Arthroscopy: Comparison between Dexmedetomidine and Fentanyl
Intra-articular Adjuvant Analgesics Following Knee Arthroscopy: Comparison between Dexmedetomidine and Fentanyl 1 Mostafa El-Hamamsy, 2 Mohsen Dorgham 1 Anaesthesia Dept., Faculty of Medicine, El-Fayoum
More informationR Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,
More informationJames J. Mooney * and Ashley McDonell ** Introduction
Opioid Administration as Predictor of Pediatric Epidural Failure James J. Mooney * and Ashley McDonell ** Background: Increasing use of regional analgesia in pediatric populations requires a better understanding
More informationAs laparoscopic surgeries are gaining popularity, Original Article. Maharjan SK 1, Shrestha S 2 1. Introduction
, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 Original Article Maharjan SK 1, Shrestha S 2 1 Associate Professor, 2 Assistant Professor, Department of Anaesthesiology and Intensive Care Kathmandu Medical College,
More informationRegional Anaesthesia for Children
Regional Anaesthesia for Children Indispensable! but also safe? PD Dr. med. Jacqueline Mauch Outline Significance of regional anaesthesia in paediatric surgery Risks and complications of regional anaesthesia
More informationType of intervention Anaesthesia. Economic study type Cost-effectiveness analysis.
Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery Li S T, Coloma M, White P F, Watcha M F, Chiu J W, Li H, Huber P J Record Status This is a
More informationMETA-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY
META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY RESIDENT RESEARCH EXCHANGE DAY MAY 30 TH, 2014 SUPERVISOR: DR. JAMES PAUL SUSAN JO PGY4 SUZANNE LAMBERT PGY4 ADA HINDLE PGY4 INTRODUCTION
More informationResearch and Reviews: Journal of Medical and Health Sciences
Research and Reviews: Journal of Medical and Health Sciences Evaluation of Epidural Clonidine for Postoperative Pain Relief. Mukesh I Shukla, Ajay Rathod, Swathi N*, Jayesh Kamat, Pramod Sarwa, and Vishal
More informationOB Div News March 2009
OB Div News March 2009 Several articles in this month s review have come from Canadian institutions. In spite of my pride in being Canadian, which was enhanced during the Olympics, this is purely coincidental.
More informationPerioperative Pain Management
Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists
More informationIntravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC
Intravenous lidocaine infusions Dr Ian McConachie FRCA FRCPC Thank the organisers for inviting me. No conflicts or disclosures Lidocaine 1 st amide local anesthetic Synthesized in 1943 by Lofgren in Sweden.
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency
More informationA comparison Between the Transversus Abdominis Plane (TAP) Block Versus Traditional Parentral Analgesia Post Caesarian Section
TRANSVERSUS THE IRAQI POSTGRADUATE ABDOMINIS MEDICAL PARENTRAL JOURNAL ANALGESIA A comparison Between the Transversus Abdominis Plane (TAP) Block Versus Traditional Parentral Analgesia Post Caesarian Section
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationHemorrhoids. Carlos R. Alvarez-Allende PGY-III Colorectal Surgery
Hemorrhoids Carlos R. Alvarez-Allende PGY-III Colorectal Surgery Overview Anatomy Classification Etiology Incidence Symptoms Differential Diagnosis Medical Management Surgical Management Anatomy Anal canal
More informationComparison of Open Hemorrhoidectomy under Local and Spinal Anesthesia and its Practical Feasibility at a Tertiary Care Institute
DOI: 10.17354/SUR/2016/18 Original Article Comparison of Open Hemorrhoidectomy under Local and Spinal Anesthesia and its Practical Feasibility at a Tertiary Care Institute Praveen Singh Baghel 1, Maneesh
More informationRegional anaesthesia in paediatric day case surgery. PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden
Regional anaesthesia in paediatric day case surgery PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden Ambulatory surgery in children Out-patient surgery in children did
More informationEfficacy of Transversus Abdominis Plane Block versus Epidural Analgesia in Pain Management Following Lower Abdominal Surgery
Med. J. Cairo Univ., Vol. 85, No. 6, September: 2231-2235, 2017 www.medicaljournalofcairouniversity.net Efficacy of Transversus Abdominis Plane Block versus Epidural Analgesia in Pain Management Following
More informationStapled Hemorrhoidopexy Versus Classical Hemorrhoidectomy A Prospective Comparative Study with 3 Years Follow-up
IJCRR Section: Healthcare Sci. Journal Impact Factor 4.016 ICV: 71.54 Research Article Stapled Hemorrhoidopexy Versus Classical Hemorrhoidectomy A Prospective Comparative Study with 3 Years Follow-up Kasibhatla
More informationStapled Hemorrhoidopexy: The Mayo Hospital Experience
ORIGINAL ARTICLE Stapled Hemorrhoidopexy: The Mayo Hospital Experience MUHAMMAD RAFAIH IQBAL, YASEEN RAFI, SAAD JAVED, KHALID JAVED ABID ABSTRACT Objective: To evaluate clinical outcome after Stapled Hemorrhoidopexy.
More informationRoutine Internal Sphincterotomy with Hemorrhoidectomy: A Prospective Study
Original Article DOI:./ijss// Routine Internal Hemorrhoidectomy: A Prospective Study S Harish, R Raxith Sringeri, G Ajay Associate Professor, Department of Surgery, JSS University, Mysore, Karnataka, India,
More informationPostoperative Analgesia for Circumcision in Children: A Comparative Study of Caudal Block versus High Dose Rectal Acetaminophen or EMLA Cream
Postoperative Analgesia for Circumcision in Children: A Comparative Study of Caudal Block versus High Dose Rectal Acetaminophen or EMLA Cream Jehan Ahmed Sayed 1 and Mohamed Amir Fathy 2 1 Department of
More informationA Comparative Study of Open Haemorrhoidectomy with Minimally Invasive Procedure For Haemorrhoids (M.I.P.H)
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 1 Ver. VIII (January. 2017), PP 51-56 www.iosrjournals.org A Comparative Study of Open Haemorrhoidectomy
More informationComparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block
Original Research Article Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block S. Arul Rajan 1, N. Sathyan 2*, T. Murugan 3 1 Assistant
More informationThe Effect of Preemptive Analgesia in Postoperative Pain Relief A Prospective Double-Blind Randomized Study
PAIN MEDICINE Volume 10 Number 1 2009 The Effect of Preemptive Analgesia in Postoperative Pain Relief A Prospective Double-Blind Randomized Study Seetharaman Hariharan, MD, Harley Moseley, FFARCS, Areti
More informationThe Influence of Bilateral Superficial Cervical Plexuses Block (BSCBs) as Pre-emptive Analgesia on Patient Satisfaction after Thyroid Surgery
11 The Influence of Bilateral Superficial Cervical Plexuses Block (BSCBs) as Pre-emptive Analgesia on Patient Satisfaction after Thyroid Surgery Hisham Negmi MD*, Ashraf Moustafa MD*, Mohamed Rabie MD*,
More informationAssistant Professor, Anaesthesia Department, Govt. General Hospital / Guntur Medical College, Guntur, Andhra Pradesh, India.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 8 Ver. I (August. 2016), PP 87-91 www.iosrjournals.org A Comparative Study of 0.25% Ropivacaine
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. COMPARATIVE STUDY OF CENTRAL VENOUS CANNULATION USING ULTRASOUND GUIDANCE VERSUS LANDMARK TECHNIQUE IN PAEDIATRIC CARDIAC PATIENT. 2. TO EVALUATE THE ABILITY OF SVV OBTAINED BY VIGILEO-FLO TRAC
More informationComparative Study of Effects of Dexmedetomidine as Adjuvant to Bupivacaine and Bupivacaine Alone in Epidural Anesthesia
DOI: 1.17354/SUR//13 Original Article Comparative Study of Effects of Dexmedetomidine as Adjuvant to Bupivacaine and Bupivacaine Alone in Epidural Anesthesia Vishwadeep Singh 1, Geeta Singh, Priyank Srivastava
More informationContinuous Wound Infusion and Postoperative Pain Current status?
Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe
More informationMalaysian Orthopaedic Journal 2008 Vol 2 No 2
Randomized Clinical Trial of Periarticular Drug Injection used in combination Patient-Controlled Analgesia versus Patient-Controlled Analgesia Alone in Total Knee Arthroplasty MN Sabran, MBBS, AJM Talha*,
More informationComparison of Bier's Block and Systemic Analgesia for Upper Extremity Procedures: A Randomized Clinical Trial
J Arch Mil Med. 1 August; (3): e1977. Published online 1 August 3. DOI: 1.81/jamm.1977 Research Article Comparison of Bier's Block and Systemic Analgesia for Upper Extremity Procedures: A Randomized Clinical
More informationORIGINAL ARTICLE. Comparison of Spinal vs General Anesthesia via Laryngeal Mask Airway in Inguinal Hernia Repair
ORIGINAL ARTICLE Comparison of Spinal vs General Anesthesia via Laryngeal Mask Airway in Inguinal Hernia Repair Richard E. Burney, MD; Mythili A. Prabhu, MD; Mary Lou V. H. Greenfield, MPH, MS; Amy Shanks,
More informationEffects of analgesia methods on serum IL-6 and IL-10 levels after cesarean delivery
Effects of analgesia methods on serum IL-6 and IL-10 levels after cesarean delivery Z.-M. Xing*, Z.-Q. Zhang*, W.-S. Zhang and Y.-F. Liu Anesthesia Department, No. 1 People s Hospital of Shunde, Foshan,
More informationStapled haemorrhoidectomy in Chinese patients: a prospective randomised control study!"#$%&'()*+,-./
Key words: Hemorrhoids; Pain, postoperative; Surgical stapling; Manometry!!"#!" PYY Lau WCS Meng AWC Yip Hong Kong Med J 2004;10:373-7 Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon,
More informationInternationally Indexed Journal
Internationally Indexed Journal Indexed in Chemical Abstract Services(USA),Index Coppernicus,Ulrichs Directory of Periodicals,Google scholar,cabi,doaj,psoar, EBSCO,SCOPUS, EMBASE etc. Rapid Publishing
More informationCOBISS.SR-ID EFFECTIVNESS OF DEXAMETASONE VS. MAGNESIUM SULPHATE IN POSTOPERA- TIVE ANALGESIA (DEXAMETASONE VS. MAGNESIUM SULPHATE)
COBISS.SR-ID 222299404 616-089.5-06:616.33-008.3 615.243.6 Original article EFFECTIVNESS OF DEXAMETASONE VS. MAGNESIUM SULPHATE IN POSTOPERA- TIVE ANALGESIA (DEXAMETASONE VS. MAGNESIUM SULPHATE) Brikena
More informationISSN X (Print) Research Article. *Corresponding author Dr. Ajay Gandhi
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2015; 3(2G):1000-1004 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationIs There an Ideal Regimen for CPNB?
Is There an Ideal Regimen for CPNB? Dr Eric Albrecht, MD, DESA Department of Anesthesiology, CHUV 2nd SARA Annual Symposium June 2013 Manuel pratique d ALR échoguidé, Elsevier Masson, Paris, 2013 Albrecht
More informationCombination of Ultra-low Dose Bupivacaine and Fentanyl for Spinal Anaesthesia in Out-patient Anorectal Surgery
The Journal of International Medical Research 2008; 36: 964 970 Combination of Ultra-low Dose Bupivacaine and Fentanyl for Spinal Anaesthesia in Out-patient Anorectal Surgery A GURBET, G TURKER, NK GIRGIN,
More informationEffect of Preoperative Intravenous Oxycodone After Transurethral Resection of Prostate Under General Anesthesia
Int Surg 2017;102:377 381 DOI: 10.9738/INTSURG-D-15-00087.1 Effect of Preoperative Intravenous Oxycodone After Transurethral Resection of Prostate Under General Anesthesia Jinguo Wang 1, Yaowen Fu 1, Haichun
More informationPostoperative pain is the principal cause of morbidity
The Effects of Glossopharyngeal Nerve Block on Postoperative Pain Relief After Tonsillectomy: The Importance of the Extent of Obtunded Gag Reflex as a Clinical Indicator Hee-Pyoung Park, MD* Jung-won Hwang,
More informationEffect of preoperative oral amantadine on intraoperative anesthetic and analgesic requirements in female patients during abdominoplasty
Egyptian Journal of Anaesthesia (2013) 29, 7 11 Egyptian Society of Anesthesiologists Egyptian Journal of Anaesthesia www.elsevier.com/locate/egja www.sciencedirect.com Research Article Effect of preoperative
More informationHTX-011, a Proprietary, Unique, Long-Acting Local Anesthetic, Reduces Acute Postoperative Pain Intensity and Opioid Consumption Following Bunionectomy
HTX-011, a Proprietary, Unique, Long-Acting Local Anesthetic, Reduces Acute Postoperative Pain Intensity and Opioid Consumption Following Bunionectomy Eugene Viscusi, 1 Oscar DeLeon-Casasola, 2 TJ Gan,
More informationHussein M. 1*, Youssef K. 2 and Hassan M. 2.
Comparative Study between Continuous Transversus Abdominis Plane Block and ON- Q Anesthetic Pump for Postoperative Analgesia Following Caesarean Section Hussein M. 1*, Youssef K. 2 and Hassan M. 2 1 Department
More informationCombined Subfascial and Subcutaneous Bupivacaine Instillation for Inguinal Hernia Wounds
Original Article Combined Subfascial and Subcutaneous Bupivacaine Instillation for Inguinal Hernia Wounds Khaled Mohammed El-Radaideh, Mohammed Ahmed Al-Ghazo 1 and Kamal Eddin Bani-Hani, 2 Departments
More informationAnaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation
Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee
More informationProphylactic use of dexamethasone in tonsillectomy among children
Prophylactic use of dexamethasone in tonsillectomy among children Author(s): Ali Maeed Al-Shehri Vol. 11, No. 1 (2007-10 - 2007-12) Curr Pediatr Res 2007; 11 (1 & 2): 3-7 Ali Maeed Al-Shehri Department
More informationGastrointestinal and urinary complications in the postoperative period
The 13 th Annual Perioperative Medicine Summit Fort Lauderdale, Florida Gastrointestinal and urinary complications in the postoperative period Dan Hunt, MD Professor of Medicine Director, Division of Hospital
More informationCOMPARISON OF FENTANYL AND MORPHINE IN INTRAVENOUS PATIENT-CONTROLLED ANALGESIA AFTER OPEN GASTRECTOMY SURGERY
COMPARISON OF FENTANYL AND MORPHINE IN INTRAVENOUS PATIENT-CONTROLLED ANALGESIA AFTER OPEN GASTRECTOMY SURGERY Nguyen Toan Thang, Nguyen Huu Tu Department of Anesthesia Critical Care, Hanoi Medical University
More informationPOSTOPERATIVE URINARY RETENTION IN ABDOMINAL SURGERY. Marta Alves Servicio de Urología
POSTOPERATIVE URINARY RETENTION IN ABDOMINAL SURGERY Marta Alves Servicio de Urología Introduction Incidence Mechanism of micturition Risk factors Prevention Diagnosis Complications/Adverse effects associated
More informationINTRAVENOUS LIDOCAINE INFUSIONS AND INTRALIPID RESCUE
INTRAVENOUS LIDOCAINE INFUSIONS AND INTRALIPID RESCUE Acute Pain Service-LHSC VH and UH sites HISTORY Lidocaine and procaine used by IV infusion in the 1950s and 1960s for general analgesia Often continued
More informationThe Effect of Adding Magnesium Sulphate to Epidural Anesthesia for Lower Urinary Tract Surgeries
Med. J. Cairo Univ., Vol. 83, No. 1, March: 267-273, 2015 www.medicaljournalofcairouniversity.net The Effect of Adding Sulphate to Epidural Anesthesia for Lower Urinary Tract Surgeries MANAR M. EL-KHOLY,
More informationEnhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid
More informationEfficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia
ISPUB.COM The Internet Journal of Anesthesiology Volume 33 Number 1 Efficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia S Gautam, S Singh, R Verma, S Kumar,
More information* id of corresponding author- Received: 12/12/2016 Revised: 15/02/2017 Accepted: 21/02/2017 ABSTRACT
International Journal of Medical Science and Education An official Publication of Association for Scientific and Medical Education (ASME) Original research Article ROPIVACAINE AND ROPIVACAINE WITH CLONIDINE
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationAdjuvants for peripheral nerve blocks. Daan Bringmans
Adjuvants for peripheral nerve blocks Daan Bringmans Why adjuvants in peripheral nerve blocks? increase speed of onset increase duration of action increase density or quality of block decrease toxicity
More informationTcases as 'day care' is increasing by the
Review Article Choice of Anaesthesia for Day Care Surgery Shagufta Choudhary*, M.M. Begani**, Dheeraj Mulchandani*** Abstract Aims and Objectives: To review choice of anaesthesia and anaesthetic management
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 2 2013 Article 7 Delayed Bleeding Following LigaSure Hemorrhoidectomy Alexander Becker, MD Yakov Khromov, MD Joel Sayfan,MD, FACS Department of Surgery
More informationANESTHESIA EXAM (four week rotation)
SPARROW HEALTH SYSTEM ANESTHESIA SERVICES ANESTHESIA EXAM (four week rotation) Circle the best answer 1. During spontaneous breathing, volatile anesthetics A. Increase tidal volume and decrease respiratory
More informationA comparison of nerve stimulator guided paravertebral block and ilio-inguinal nerve block for analgesia after inguinal herniorrhaphy in children
doi:./j.6-.6.8.x A comparison of nerve stimulator guided paravertebral block and ilio-inguinal nerve block for analgesia after inguinal herniorrhaphy in children Z. M. Naja, M. Raf, M. El Rajab, N. Daoud,
More informationResearch Article ABSTRACT INTRODUCTION. S. Parthasarathy, R. Sripriya, VR Hemanthkumar
Research Article Comparative evaluation of addition of polygeline to bupivacaine in ilioinguinal-iliohypogastric nerve blocks in patients undergoing hernioraphy a randomized, double-blind, controlled trial
More informationSeries 2 dexmedetomidine, tramadol, fentanyl, intellectually disabled patients:
Series 2 dexmedetomidine, tramadol, fentanyl, intellectually disabled patients: Read the following published scientific articles and answer the questions at the end: Abstract We get a substantial number
More informationDexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy
Original Research Article Dexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy T. Uma Maheswara Rao * Associate Professor, Department of Surgery, Konaseema Institute
More informationINTRA-ARTICULAR ANALGESIA WITH KETAMINE AND TRAMADOL; THE EFFECT OF THE TYPE OF SURGERY.
61 INTRA-ARTICULAR ANALGESIA WITH KETAMINE AND TRAMADOL; THE EFFECT OF THE TYPE OF SURGERY. Ashraf A Hassan, MD*, Mohamed M Khalil, MD** *Assistant professor, ** Lecturer, Anaesthesia and surgical intensive
More information