Journal of investigative surgery : the official journal of the Academy of Surgical Research
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Laparoscopic cholecystectomy causes moderate to severe pain despite its minimally invasive nature. This study was performed to compare the efficacy of the bilateral erector spinae plane block (ESPB) and the subcostal transversus abdominis plane block (STAPB) under ultrasound guidance. ⋯ Bilateral ultrasound-guided ESPB provides superior analgesia after laparoscopic cholecystectomy surgery compared to STAPB and further reduces unaided walking time and hospital stay.
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Background: There is a relative shortage of studies directly addressing the postoperative rectal cancer patients' evacuatory dysfunction, as estimated by the low anterior resection syndrome (LARS) score at repeated assessment time-points. The aim of the present study was to prospectively evaluate the incidence of LARS at predefined time intervals during the first 3 years after sphincter preserving rectal cancer surgery and to enlighten the effect of identified risk factors. Materials and methods: Seventy-eight patients, who remained alive and recurrence-free 2 years after (ultra-) low anterior resection were prospectively assessed at 6, 12, 18, 24, 30 and 36 months postoperatively, using the LARS score as bowel dysfunction outcome measure. ⋯ Most patients (90%) after radiotherapy showed a high LARS score in the first semester, but improved afterwards. Conclusion: Overall, the LARS score improves in the majority of patients after 18 months, with low tumor height and radiation adversely affecting them. Our results may be useful in more accurately define the postoperative "functional course" of rectal cancer patients and in aiding their consultation on expected functional outcome.
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Platypnoea-Orthodeoxia Syndrome is an uncommon phenomenon characterized by dyspnea/arterial desaturation in the standing position, resolving in recumbency. Some patients present with Platypnoea-Orthodeoxia Syndrome in the early-or-late post-operative period after major lung resection (lobectomy/pneumonectomy). The main cause of Platypnoea-Orthodeoxia Syndrome is an intracardiac anomaly (Patent Foramen Ovalis/Atrial Septal Defect) leading to right-to-left shunt. ⋯ Platypnoea-Orthodeoxia Syndrome after lobectomy is a rare cause of post-operative dyspnea/hypoxia. It is the result of right-to-left shunt via an interatrial communication. Mediastinal relocation, stretching of the atrial septum and aortic root dilatation are among the functional elements necessary for the Platypnoea-Orthodeoxia Syndrome manifestation.
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Objective: Recently, there has been an increasing interest in combined adductor canal block (ACB) with periarticular anesthetic injection (PAI) as a technique to control postoperative pain in total knee arthroplasty (TKA). This study evaluated the analgesic efficacy and safety of the combined therapy for early postoperative pain treatment after TKA. Methods: From the inception to July 2018, two independent investigators used the following electronic databases to search existing literature: PubMed, Embase, Medline, and Web of Science. ⋯ Similarly, there were no significant differences between groups in opioid-related adverse effects, and LOS. Conclusions: There is evidence that combined therapy is more effective than single therapy within 48 h following primary TKA. Applying combined therapy appears to be an effective and safe method for pain control.
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The impact of COVID-19 in healthcare systems globally was unprecedented leading to cancelations of most planned surgical activities. Surgical trainees were redeployed to Intensive Care and Emergency units supporting urgent and unplanned care on COVID-19 patients. Theater exposure, crucial part of surgical training, was reduced to minimal since elective cases were postponed, and emergency operating was carried out by consultants only. Surgical research has also been severely hit with most of the clinical trials been postponed. Teaching activities as well as national and international congresses and surgical courses important tools for continuous professional development were canceled. ⋯ The "new" era forced the educational boards to reexamine training curriculums. Innovation strategies and cooperation on the part of surgical residency programs is crucial. Strong leadership is needed, on the part of the education bodies with restructuring of the surgical programmes to accommodate alternative ways of training is necessary to maintain rigorous standards of education and training.