Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Case Reports
[Neuralgia of the genitofemoral nerve after hernioplasty. Therapy by peripheral nerve stimulation].
The peripheral nerve stimulation (PNS) is an established therapy in the management of neuropathic pain. Here, we describe a case of successful epifascial stimulation in the proximity of the genitofemoral nerve, which was injured during an endoscopic hernioplasty. ⋯ There were no adverse events until now. In conclusion, PNS is a promising procedure in the treatment of neuralgia after hernioplasty.
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In general and visceral surgery fast-track rehabilitation means a procedure-specific, evidence-based, multimodal, interdisciplinary and patient-focussed clinical pathway in perioperative therapy. The primary goals of fast-track rehabilitation are to maintain patient autonomy and homeostasis, minimization of postoperative organ dysfunction and prevention of postoperative general morbidity (i.e. cardiopulmonary complications, nosocomial infections). At the same time, postoperative recovery is accelerated and early discharge from hospital after surgery becomes possible. ⋯ Therefore, implementation of fast-track programs should be accompanied by intensive education and collaboration of all professional groups concerned with perioperative patient care. So far, visceral surgeons have been leading the field of fast-track rehabilitation and fast-track could be a way for surgeons to recapture lost ground in perioperative medicine. Therefore, intensive experimental and clinical research in fast-track rehabilitation is strongly recommended for visceral surgeons to maintain competence in scientific discussions with other medical specialists.
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Recent evidence has documented that a combination of single-modality evidence-based care principles into a multimodal effort to enhance postoperative recovery (the fast track methodology) has led to enhanced recovery with reduced medical morbidity, need for hospitalisation and convalescence. Nevertheless, general implementation of fast track surgery has been relatively slow despite concomitant economic benefits. Further improvement in postoperative outcome may be obtained by developments within each care principle with a specific focus on minimally invasive surgery, effective multimodal, non-opioid analgesia and pharmacological stress reduction.
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Interactive Tutorial
[Local and regional anaesthesia. Principles and techniques].
Local and regional anaesthesia procedures are common in most surgical practices. Continuous regional anaesthesia techniques may improve the outcome and significantly reduce postoperative pain. Epidural anaesthesia is recommended for abdominal and thoracic surgery, whereas continuous peripheral regional anaesthesia via a catheter is advantageous for limb surgery. Although these techniques are very safe, emergency treatment of life-threatening complications must be available.