World journal of surgery
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Choice of anesthesia for inguinal hernia repair remains a controversial topic. Local anesthesia has been described in the literature as the optimal technique, however general and spinal anesthesia are commonly used in practice despite well-known complications and side effects. The regional technique of paravertebral block has been successfully used at our institution for the operative treatment of breast cancer. ⋯ D. for 4 days regardless of pain; supplemental oral narcotic use during the 48 hours following surgery averaged 3.5 tablets, with 6 patients not requiring any narcotic. ninety-six percent of patients scheduled for ambulatory surgery were discharged from the postanesthesia care unit, with an average stay of 2.5 hours. Employed patients returned to work on day 5.5 (range 3-10 days); patients who were not employed returned to regular activities in 5.8 days (range 1-14 days). Eighty-two percent of patients reported being "very satisfied" with the anesthetic technique.
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Major trauma presents a time-critical medical emergency. Successful and expeditious management with early definitive treatment is required to prevent secondary injury. The resources in the prehospital setting, at the hospital of first treatment, and at the tertiary referral (major trauma) center all have an impact on the ability of an integrated trauma system to deliver optimal care to a patient. ⋯ Potentially preventable morbidity and mortality has been identified and is specifically related to the time between injury and definitive care and the efficiency of the retrieval and hospital transfer processes. These problems are being addressed with a further sophistication of integrated trauma systems. Regional trauma committees, unified and sophisticated ambulance services, good communication lines, adequate resources at major trauma services, and well developed surgical services are all essential for the appropriate and expeditious management of major trauma patients injured at a distance from tertiary referral (major trauma) centers.