ANZ journal of surgery
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ANZ journal of surgery · Sep 2005
Fate of the infrapatellar branch of the saphenous nerve post total knee arthroplasty.
The infrapatellar branch of the saphenous nerve is a known cause of morbidity following knee surgery. The incidence of sensory changes following total knee arthroplasty, and its effect on patient satisfaction with arthroplasty surgery remain undocumented. Our aim was to document the incidence of infrapatellar nerve palsy following total knee arthroplasty and its effect on patient satisfaction. ⋯ Sensory changes due to damage to the infrapatellar branch of the saphenous nerve during total knee joint arthroplasty is a common occurrence and can interfere with patient satisfaction. Patients should be informed of this risk in the preoperative discussion.
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ANZ journal of surgery · Sep 2005
Comparative StudyImprovement in the emergency splinting of fractures after a simple educational exercise.
Splinting long bone fractures in the early stages of their management reduces pain, facilitates transport and helps prevent further soft tissue injury; but experience suggests that the rate of splinting is low. This study set out to quantify this rate and determine whether it could be improved with simple educational intervention. ⋯ The rate of splinting of long bone fractures in the early stages of their management is low, and junior doctors do not regard this as a priority. We have shown that a simple teaching session significantly improves this rate and suggest that similar training should be provided to all emergency staff.
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The aim of this project was to increase rates of day surgery, reduce elective surgical waiting lists, give patients a guaranteed date of surgery and improve operating theatre utilization. The guiding principle behind the project was to treat the administration of elective surgery as a separate business unit, distinct from emergency surgery. ⋯ During the project period, the number of the selected surgical procedures performed doubled. Fifty-seven per cent of patients were discharged on the day of surgery. Surgeons took less time to perform procedures. By the end of the trial period, waiting lists for the selected procedures were eliminated. Operating costs as evaluated by the Centre for Health Economics Research and Evaluation were reduced by 25%. The administrative changes to surgical admissions resulted in improved cost and patient throughput for elective surgical admissions with no adverse patient outcomes.
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ANZ journal of surgery · Aug 2005
Randomized Controlled Trial Comparative StudyRandomized, prospective comparison of postoperative pain in low- versus high-pressure pneumoperitoneum.
Reduced postoperative pain after laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC) may be able to be further optimized. To reduce pain, focus should be directed on the effects of individual components of pain. ⋯ There was no correlation between high- and low-pressure laparoscopy and postoperative pain after LC. Peritoneal stretching may be more responsible for shoulder pain but has less effect on intensity of abdominal pain or incisional pain. On the basis of these negative findings, routine use of low-pressure pneumoperitoneum for alleviation of postoperative pain following LC is not recommended.
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ANZ journal of surgery · Aug 2005
Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain.
Splanchnic nerve block is a useful alternative to coeliac plexus block in the management of patients with chronic upper abdominal pain. The predictable relationship of the splanchnic nerves to other structures allows for accurate needle placement and hence a low risk of iatrogenic damage. Radiofrequency ablation (RFA) uses a high frequency alternating current to heat tissues leading to thermal coagulation. It produces predictable and accurate lesions and hence is useful alternative to more conventional phenol and alcohol neurolytic methods. ⋯ Although preliminary data regarding RFA ablation of splanchnic nerves are encouraging, further trials are also needed comparing percutaneous splanchnic nerve ablation with opioid analgesia and coeliac plexus blockade.