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Wound Pain (wound + pain)
Selected AbstractsPortless endoscopic adrenalectomy via a single minimal incision using a retroperitoneal approach: Experience with initial 30 casesINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2004YUKIO KAGEYAMA Abstract Aim: To assess the feasibility of portless endoscopic adrenalectomy via a single minimum incision that narrowly permits extraction of the specimen. Methods: For, 30 cases of adrenal tumor, portless endoscopic surgery through a single flank incision (3,9 cm; mean, 5.6 cm) was performed without gas inflation or trocar port placement. All of the instruments used during surgery were reusable. The cases included primary aldosteronism (12), Cushing's syndrome (6), preclinical Cushing's syndrome (3), pheochromocytoma (1), non-functioning cortical adenoma (6), adrenocortical carcinoma (1) and adrenocortical hemorrhage (1). Results: Resection of the tumor was successfully completed, without complications, in all of the cases. Operative time was between 83 and 240 min (mean, 147 min). Estimated blood loss was 5,470 mL (mean, 139 mL). None of the patients required blood transfusion. Postoperative course was uneventful. Wound pain was mild and walking and full oral feeding were resumed on the first and second postoperative day, respectively, in the majority of cases. Conclusions: Adrenal tumors are good candidates for portless endoscopic surgery, which is safe, cost-effective, minimally invasive and matches favorably with laparoscopic surgery. [source] Endoscopic minilaparotomy radical nephrectomy for chronic dialysis patientsINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2002Yukio Kageyama Abstract Background: To assess the feasibility of laparoscope-guided minilaparotomy (endoscopic minilaparotomy) for renal cell carcinoma in patients on chronic dialysis. Methods: Endoscopic retroperitoneal minilaparotomy using a 30° telescope was carried out through single skin incision (5,8 cm) in eight patients with renal cell carcinoma who were on chronic dialysis. Outcomes of the operations were compared to those in eight patients on chronic dialysis with renal cell carcinoma who underwent standard translumbar radical nephrectomy. Results: Resection of the tumor was successfully completed without complication and the postoperative course was uneventful in both of the treatment groups. No significant difference in mean operative time or mean blood loss was observed between the treatment groups. Wound pain was minimal and analgesics were generally not required in the minilaparotomy group. The endoscopic laparotomy group resumed full diet and began walking earlier than the group that underwent standard radical nephrectomy. Conclusions: Endoscopic minilaparotomy seems to be a valuable alternative treatment for renal cell carcinoma in patients on chronic dialysis. [source] Impact of topical anaesthesia on pain alleviation and wound healing in lambs after mulesingAUSTRALIAN VETERINARY JOURNAL, Issue 5 2008S Lomax Objective To investigate the impact of using the topical anaesthetic preparation Tri-Solfen® on pain alleviation and wound healing in lambs undergoing mulesing. Design Three separate trials, placebo controlled and/or randomised, were carried out over a 5 month period on three mobs of between 60 and 263 merino lambs undergoing routine mulesing. Procedure Wound pain was assessed using 10 and 75 g calibrated Von-Frey monofilaments to determine sensitivity to light touch and pain stimulation over a 4 to 8 h period. Pain-related behaviour was documented by trained, blinded observers using a numerical rating scale. Wound healing rates were determined using scaled digital photography and image analysis software to calculate contraction in wound surface area 2 and 4 weeks after mulesing. Results There was rapid (3 min) and prolonged (up to 8 h) wound analgesia as shown by pain response scores (P , 0.01), with absent or significantly diminished primary and secondary hyperalgesia (P , 0.01) and significant reduction in pain-related behaviour (P < 0.001) in treated versus untreated lambs. In addition there was improved wound healing in the treated lambs (P , 0.05). Conclusion Tri-Solfen® effects rapid and prolonged wound analgesia, reduction in pain-related behaviour and improved wound healing in lambs undergoing routine mulesing, providing effective alleviation of pain associated with routine mulesing in sheep. [source] Dressing-related pain in patients with chronic wounds: an international patient perspectiveINTERNATIONAL WOUND JOURNAL, Issue 2 2008Patricia E Price Abstract This cross-sectional international survey assessed patients' perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68·6 years (SD = 15·4) participated. The wounds were categorised into ten different types with a mean wound duration of 19·6 months (SD = 51·8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n= 605). Frequency of wound-related pain was reported as 32·2%, ,never' or ,rarely', 31·1%, ,quite often' and 36·6%, ,most' or ,all of the time', with venous and arterial ulcers associated with more frequent pain (P= 0·002). All patients reported that ,the wound itself' was the most painful location (n= 1840). When asked if they experienced dressing-related pain, 286 (14·7%) replied ,most of the time' and 334 (17·2%) reported pain ,all of the time'; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P < 0·001). Eight hundred and twelve (40·2%) patients reported that it took <1 hour for the pain to subside after a dressing change, for 449 (22·2%) it took 1,2 hours, for 192 (9·5%) it took 3,5 hours and for 154 (7·6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0,100) giving a mean score of 44·5 (SD = 30·5, n= 1981). Of the 1141 who reported that they generally took pain relief, 21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; ,pain' was given the highest mean score of 3·1 (n= 1898). In terms of different types of daily activities, ,overdoing things' was associated with the highest mean score (mean = 2·6, n= 1916). During the stages of the dressing change procedure; ,touching/handling the wound' was given the highest mean score of 2·9, followed by cleansing and dressing removal (n= 1944). One thousand four hundred and eighty-five (80·15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58·15%) responded that they were concerned about the long-term side-effects of medication, 790 (40·3%) of patient indicated that the pain at dressing change was the worst part of living with a wound. This study adds substantially to our knowledge of how patients experience wound pain and gives us the opportunity to explore cultural differences in more detail. [source] Uterine artery occlusion and myomectomy for treatment of pregnant women with uterine leiomyomas who are undergoing cesarean sectionJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2010Jui-Yu Lin Abstract Aim:, To evaluate the efficacy of uterine artery occlusion and myomectomy (UAO+M) for pregnant women with uterine leiomyomas who are undergoing cesarean section (CS). Methods:, Seventy-two women with uterine leiomyomas undergoing CS for obstetrical reasons were enrolled into this case,control study. Thirty-six patients underwent UAO+M during CS (UAO+M group), and 36 received CS alone (Control group). The UAO+M procedure was performed immediately after closure of the uterine incision wound. The outcome was measured by comparing surgical techniques, and future surgical intervention (myomectomy, uterine vessel occlusion or hysterectomy) for symptomatic leiomyoma. Results:, The average follow-up time was 63 months. General characteristics of the patients were similar in both groups. There were no statistical differences in intraoperative blood loss, postoperative recovery, complications, or wound pain between the two groups. The operative time was significantly longer in the UAO+M group compared with that in the Control group, but the further surgical intervention rate was significantly lower in the UAO+M group than in the Control group (2.8% vs 41.7%, P < 0.001). Seven patients (19%) in the UAO+M group and five (14%) in the Control group had a repeat CS during the follow-up period. Conclusion:, UAO+M could be considered for treating pregnant women with uterine leiomyomas who are undergoing CS, compared with observation, as this procedure can minimize the necessity for future surgery, with increased operative time for the UAO+M procedure, but without increased surgical morbidity. [source] Upper midline incision for living donor right hepatectomyLIVER TRANSPLANTATION, Issue 2 2009Seong Hoon Kim Innovations and refinements in the techniques of living donor right hepatectomy (LDRH) have been made over the past decades, but the type and size of abdominal incision have been at a standstill since its inception. We introduce herein the upper midline incision for LDRH using the standard open technique. A prospective case-matched study was conducted on 23 consecutive donors who underwent LDRH under a supraumbilical upper midline incision (I group) from February to May 2008. These donors were matched 1:1 to 23 right liver donors with a conventional J-shaped incision (J group) according to age, gender, and body mass index. Under the mean incision length of 13.5 cm, LDRH was successfully completed in all 23 donors without extension of the incision, with a mean operative time of 232.3 ± 29.2 minutes. No donors required blood transfusion during surgery. There were 2 cases of postoperative bleeding immediately controlled under the same incision and a case of pleural effusion. All donors fully recovered and returned to their previous activities. All grafts have been functioning well. Compared with the J group, the I group had a shorter operative time, a shorter period of analgesic use, and, after discharge, infrequent complaints of wound pain. This upper midline incision, even without laparoscopic assistance, can be used for LDRH with less pain and without impairing safety, reproducibility, or effectivity, allowing the seemingly insufficient incision to be recommended to the transplant centers that are practicing living donor liver transplantation. Liver Transpl 15:193,198, 2009. © 2009 AASLD. [source] QUADRAPOD MESH FOR POSTERIOR WALL RECONSTRUCTION IN ADULT INGUINAL HERNIASANZ JOURNAL OF SURGERY, Issue 3 2008Shih-Chung Wu Inguinal hernia repairs are the most frequently carried out operations worldwide, and open-mesh herniorrhaphies have gained wide acceptance for advantages of little tension, less pain and lower recurrence rates. Even so, potential drawbacks of original open-mesh repairs exist, and we accordingly make some modifications, suggesting a new ,quadrapod' marlex mesh as an alternative. From July 2002 to March 2004, we carried out 288 consecutive inguinal hernia repairs using quadrapod mesh in 273 patients, all of them were male and aged older than 35 years. Patient demographics, operative parameters, morbidity and outcomes were collected in detail. After surgery, patients were followed up every 6 months at one surgeon's clinic and any major abnormality was recorded. Mean age of the 273 patients was 58.7 years. Twenty-eight patients had recurrent hernias and 15 bilateral hernias. Mean surgical duration was 50.7 min. One patient suffered from major wound infection and needed prolonged hospitalization for parenteral antibiotics. Owing to old age and benign prostatic hyperplasia, 11 patients receiving spinal anaesthesia had temporary postoperative urine retention and needed short-term urinary catheter insertion. Most patients were discharged 1 day following surgery. Acute wound pain generally improved within days, and no patients complained of chronic pain or debility necessitating special interventions. With a mean follow up of 40.7 months, no case of recurrent herniation was detected to date. Open-mesh herniorrhaphy using quadrapod mesh provides a cheap, feasible and effective alternative choice in centres with limited resources. Preliminary results are encouraging, and a formal prospective study may be warranted. [source] GS27P TECHNIQUES FOR CLOSURE OF MIDLINE ABDOMINAL INCISIONSANZ JOURNAL OF SURGERY, Issue 2007A. Ali Background A recent meta-analysis of randomised controlled trials of abdominal fascial closures concluded that in order to reduce incisional hernia rates without increasing wound pain, or the rate of dehiscence slowly absorbable continuous sutures appear to achieve the best results in abdominal fascial closures. We surveyed the techniques for abdominal fascial closure among general surgeons in Canberra, Australia. Methodology 49 out of 80 surgeons responded to the survey by form. The information collected included the seniority of the surgeon, the frequency of laparotomy closure, surgical technique and suture material utilised in abdominal fascial closure. Results 34 (69%) of the surgeons surveyed preferred a non-absorbable monofilament suture material for abdominal fascial closure with nylon being the most popular. Most (38, 78%) also preferred a non-absorbable monofilament suture in emergency surgery. 12 (24%) surgeons preferred to use slowly absorbable suture. The majority of surgeons (37, 76%) preferred continuous suture technique, whilst only 2 (4%) used continuous followed by interrupted suture closures. Only 5 (10%) complied with the dual recommendation of continuous suture technique and slowly absorbable suture. Conclusion The majority of surgeons preferred non-absorbable monofilament suture rather than slowly absorbable suture. Only 1 in 10 surgeons complied with both components of evidence base, which supports the use of slowly absorbable suture material and a continuous technique in abdominal fascial closure. A definitive RCT would confirm this observation. [source] Renal autotransplantation for managing a short upper ureter or after ex vivo complex renovascular reconstructionBJU INTERNATIONAL, Issue 6 2005J. Christopher Webster Several topics related to the upper urinary tract are covered this month. Renal autotransplantation for managing a short upper ureter or after ex vivo complex renovascular reconstruction is described by authors from Florida. Percutaneous nephrolithotomy and various technical aspects associated with it are presented by authors from Germany and India. OBJECTIVE To report our contemporary experience with renal autotransplantation (AT), an established treatment for managing patients with a shortened ureter or renovascular disease, as despite its historical importance, AT remains an underused technique by urologists. PATIENTS AND METHODS All patients undergoing AT between 1997 and 2002 for a short ureter after ureteric injury and for renovascular disease were assessed by creatinine level and blood pressure before and after surgery, and antihypertensive drug use and complications. RESULTS Eleven patients had AT for renovascular disease and four for ureteric injury. There was no statistical difference in creatinine levels or blood pressure before and after surgery in either group. Eight patients treated with AT for renovascular disease required less antihypertensive medication after surgery. Minor complications occurred in both groups and included a suture abscess, chronic wound pain, and transient acute tubular necrosis. One patient in the ureteric injury group required a transplant nephrectomy after renal vein thrombosis, and one in the renovascular group died from multi-organ system failure. CONCLUSION AT remains a treatment option for patients with a short ureter after ureteric injury and in those with renovascular disease. Patients had stable renal function and blood pressure after surgery. Most patients treated for renovascular disease required less medication after AT. The procedure is associated with both minor and major complications, which must be considered before surgery. [source] | ||||||||||