International journal of surgery
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Randomized Controlled Trial
Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery.
Stoma formation delays discharge after colorectal surgery. Stoma education is widely recommended, but little data are available regarding whether educational interventions are effective. The aim of this prospective study was to investigate whether an enhanced recovery after surgery (ERAS) programme with dedicated ERAS and stoma nurse specialists focusing on counselling and stoma education can reduce the length of hospital stay, re-admission, and stoma-related complications and improve health-related quality of life (HRQoL) compared to current stoma education in a traditional standard care pathway. ⋯ Patients receiving a planned stoma can be included in an ERAS program. Pre-operative and postoperative stoma education in an enhanced recovery programme is associated with a significantly shorter hospital stay without any difference in re-admission rate or early stoma-related complications.
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Comparative Study
Comparison of short-segment pedicle fixation with versus without inclusion of the fracture level in the treatment of mild thoracolumbar burst fractures.
A review of the literature showed that posterior short-segment fixation including the fractured vertebra (PSFFV) has better outcomes in the treatment of thoracolumbar burst fractures(TBFs) than patients with short-segment pedicle screw fixation(SSPF) alone. However, its efficacy in mild TBFs with load-sharing scores of 3 and 4 points has not been specifically analyzed. The aim of this study was to compare the clinical, functional and radiologic results of PSFFV with SSPF for mild TBFs and to determine whether the screws in the fractured vetebra were necessary for these patients. ⋯ SSPF alone is a safe and effective surgical method for restoration and maintenance of vertebral column stability in treating mild TBFs. It gives excellent clinical and radiological results regardless of whether the fractured vertebra is included in the fixation or not.
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Epilepsy surgeries can be done under general anesthesia or with local anesthesia and sedation. Epilepsy surgery done under general anesthesia have similar goals as any other neurosurgical procedure, except in patients with temporal lobe epilepsy requiring cortical mapping or electrocorticography (ECoG) where depth of anesthesia has to be reduced. ⋯ It is comfortable for both the surgeon and the patient. For intraoperative ECoG or cortical mapping awake craniotomy is the preferred technique.
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A systematic review and meta-analysis of published randomized controlled trials was performed to update the present evidence about the safety and efficacy of dexamethasone combined with other antiemetics versus single antiemetics for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. ⋯ Dexamethasone combined with other antiemetics provided better prophylaxis than single antiemetics against postoperative nausea and vomiting after laparoscopic cholecystectomy. The underlying mechanism of dexamethasone action and its optimal dose should be further investigated.
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Review Meta Analysis
Liposomal bupivacaine infiltration versus femoral nerve block for pain control in total knee arthroplasty: A systematic review and meta-analysis.
Total knee arthroplasty (TKA) usually results in postoperative pain. The objective of this meta-analysis was to compare the effectiveness and safety of liposomal bupivacaine (LB) infiltration and femoral nerve block (FNB) for pain control in total knee arthroplasty. ⋯ Liposomal bupivacaine infiltration provides similar postoperative pain relief to femoral nerve block following total knee arthroplasty. In addition, liposomal bupivacaine infiltration could significantly reduce the consumption of morphine equivalents compared to femoral nerve block without an increased risk of adverse events.