International journal of surgery
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Randomized Controlled Trial
Early experience with lidocaine patch for postoperative pain control after laparoscopic ventral hernia repair.
Reduced postoperative pain is one of the many factors that have driven the growing emphasis on the role of laparoscopic surgery for surgical management. Several studies have documented the advantages of the laparoscopic repair of ventral hernias compared to the open ventral herniorraphy. However, the laparoscopic approach may be associated with more postoperative pain initially. In this preliminary study, we present data from our early experience with the use of a lidocaine patch for pain control in the immediate postoperative period following laparoscopic ventral hernia repair (LVH). ⋯ In this preliminary study, the use of a lidocaine patch in the management of postoperative pain following laparoscopic ventral herniorraphy is a safe and promising modality to consider in the management of postoperative pain control.
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Sildenafil may lead an improvement in anastomotic healing of ischemic left colon anastomosis. ⋯ Our results showed that 10mg/kg sildenafil decreased the adverse effects of ischemia on the healing of ischemic left colon anastomosis. Additional investigations are needed to confirm the effects of phosphodiesterase-5 inhibitors in ischemic colon anastomosis models.
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Multimodal care or Enhanced Recovery after Surgery (ERAS) protocols are gaining popularity in order to modify surgical stress responses after colonic resection. However, these protocols are not straightforward to implement as peri-operative care is varied. We aimed to identify areas that may need attention in order to successfully change practice. ⋯ Implementing evidence-based peri-operative care into practice is challenging. Barriers to multimodal recovery pathways should be addressed.
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Venous thromboembolism (VTE) is the most common preventable cause of hospital-related mortality. There are major inadequacies internationally in administering appropriate prophylaxis. Our initial aim was to show whether our local effectiveness of administration was equally poor. With local inadequacy confirmed, our second aim was to design, implement and evaluate the efficacy of a new VTE protocol nested within a surgical clerking proforma. ⋯ Implementation of a VTE protocol as part of a clerking proforma for acute surgical admissions is a simple and effective way of ensuring that surgical patients receive appropriate thromboprophylaxis. A similar strategy could be employed to broaden the scope of the National Institute of Clinical Excellence (NICE) guidelines to address VTE prevention in all hospitalised patients.
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In response to the recommendations of the National Confidential Enquiries into Perioperative Deaths many UK hospitals have introduced a half day (morning or afternoon) planned list for emergencies. We have compared two district general hospitals (DGH A and DGH B) within the same Trust with an afternoon and a morning list, respectively, and examine whether there is any effect on the emergency and urgent laparotomy workload. ⋯ Less than one-third of laparotomies were performed on the emergency list, suggesting underutilisation. The seniority of the surgeon and the level of supervision were similar at both sites. Neither morning nor afternoon proved better in terms of service provision or training opportunities. By accommodating laparotomies onto an elective list DGH A reduced the number of laparotomies performed in the evening.