Surgery, gynecology & obstetrics
-
Surg Gynecol Obstet · Dec 1991
Randomized Controlled Trial Clinical TrialThe use of bupivacaine in elective inguinal herniorrhaphy as a fast and safe technique for relief of postoperative pain.
The intraoperative use of local anesthetic agents to decrease postoperative pain has been used in many types of procedures. Most of these techniques involve needle injection of anesthetic and result in a low but troublesome incidence of complications. In this study, we evaluated the reliability, safety, and efficacy of a technique emphasizing bathing of tissues with anesthetic rather than needle injection for relieving postoperative pain. ⋯ Objectively, groups 1 and 2 required fewer total doses of pain medication and waited longer before requesting oral pain medication postoperatively compared with those in the control group. No complications occurred that could be attributed to the technique. The results of this study indicate that the bathing of wounds with 0.5 per cent bupivacaine with or without epinephrine 1:200,000 is a safe and effective method of decreasing postoperative pain for several hours in patients undergoing elective inguinal herniorrhaphy.(ABSTRACT TRUNCATED AT 400 WORDS)
-
Surg Gynecol Obstet · Nov 1991
Comparative StudyThe outcome of pregnancies complicated by bleeding during the second trimester.
Vaginal bleeding during the second trimester has historically been associated with high perinatal mortality rates (33 to 82 per cent). Because this topic has not been specifically studied since the advent of obstetric ultrasound and electronic fetal heart rate monitoring, we reviewed the experience at the University of Utah with second trimester vaginal bleeding from 1 January 1983 through 15 June 1989. The cause of the bleeding was found to fit into four general categories. ⋯ Midtrimester bleeding is still associated with a high perinatal mortality rate (22.3 per cent), being highest when associated with placental abruption (36.6 per cent) and lowest with placenta previa (7.4 per cent). For the entire series, pregnancies maintained into the third trimester were associated with a much lower perinatal mortality rate than those in which delivery occurred during the second trimester (7.1 versus 54.5 per cent). These relatively improved outcomes suggest that aggressive obstetric management is warranted in most instances.
-
Of 457 patients with multisystem injuries undergoing abdominal computed tomographic (CT) scan, 26 patients were found to have 31 pneumothoraces. None of these were apparent on prior roentgenograms of the chest. Each pneumothorax was quantified by measuring its maximal width in millimeters and the number of 10 millimeter CT sections on which it appeared. ⋯ The percentage of pneumothoraces in each group with positive pressure ventilation was 55 and 77 per cent, respectively. Our results suggest that such occult pneumothoraces may be managed with close observation if they measure less than 5 X 80 millimeters, whether or not the patient is to receive positive pressure ventilation. Larger pneumothoraces and those associated with more than two rib fractures may require early treatment.
-
Surg Gynecol Obstet · Oct 1991
Comparative StudyComputed tomography in the evaluation of blunt abdominal trauma.
The role of computed tomography (CT) in the evaluation of victims of blunt abdominal trauma remains controversial. This study was done to assess the reliability of CT in the evaluation of blunt abdominal trauma at our institution, to determine if the incidence of nontherapeutic laparotomy has decreased with the use of CT scan and to review the time necessary to complete the scans. Of the 325 patients studied, 37 per cent were found to have abdominal injury on CT scan. ⋯ Excluding transport time, abdominal CT scan required 55 +/- 20 minutes to complete. Abdominal CT was accurate when read by attending physicians (97.5 per cent). Major shortcomings included the commitment of time and personnel, transfer of the patient from a critical care area and reliance on experienced interpretation.
-
Surg Gynecol Obstet · Aug 1991
Continuous intercostal nerve block for postoperative analgesia after surgical treatment of the upper part of the abdomen.
Continuous intercostal nerve block can be used effectively for pain relief after abdominal operations. We have developed a greatly simplified technique instituted by the surgeon at operation using bupivacaine hydrochloride (Marcain, ASTRA). ⋯ In addition, no postoperative pulmonary complications or adverse reactions to bupivacaine hydrochloride or the procedure were encountered. This method proved to be a success in postoperative pain relief and we highly recommend that it be used routinely.