Arch Surg Chicago
-
Randomized Controlled Trial Clinical Trial
Intraoperative wound infiltration with bupivacaine in patients undergoing elective cholecystectomy.
In a double-blind randomized trial, 50 patients scheduled for elective cholecystectomy received 50 mL of either 0.25% bupivacaine hydrochloride or physiologic saline by wound perfusion at the end of the operation before wound closure. The duration of incisional infiltration, total amount of postoperative analgesics administered, and total hospital stay were recorded. Pulmonary function tests were performed the day before surgery and 1 day after surgery. ⋯ Both groups also had similar decrements in forced vital capacity and forced expiratory volume on the first postoperative day. We conclude that wound infiltration with 0.25% bupivacaine after elective cholecystectomy is not effective in reducing postoperative pain. Lung function disturbances cannot be prevented.
-
Skin grafts can be used effectively to inhibit wound contraction. A critical element of this inhibition is the adherence of the graft to the wound bed. Fibrin glue has been shown to increase the adherence of skin grafts to wound beds. ⋯ Graft sites treated with fibrin glue contracted less than the controls from the ninth postgraft day to the completion of the study. The mechanism by which fibrin glue inhibits wound contraction may be related to increased adherence of grafts to the underlying wound bed. As an adjunct in skin grafting, fibrin glue may offer certain advantages that are not achieved by suturing alone.
-
The relation of (multiple) organ failure (OF) to the release of inflammatory mediators and the incidence of infection and sepsis was studied prospectively in 100 patients with multiple trauma (injury severity score = 37). Sixteen patients died of OF, 47 patients survived OF, and 37 patients had no OF. Fifteen (24%) of the patients with OF showed no signs of infection. ⋯ These data indicate that infection might not play a crucial role in the pathogenesis of posttraumatic OF in a substantial portion of patients with trauma. Early OF, especially, seems to be mainly influenced by the direct sequelae of tissue damage and shock (eg, the release of inflammatory mediators). Since infection and sepsis did not lead to an augmented release of mediators in patients with trauma, the role of both entities remains unclear.