Articles: postoperative.
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Case Reports
Stercoral Ulcer Presenting in a Patient with Cauda Equina Syndrome Secondary to Postoperative Epidural Hematoma.
Chronic constipation can lead to fecal impaction in the large bowel, which can cause pressure necrosis followed by perforation, known as a stercoral ulcer. In extensive posterior thoracolumbar surgery, a long operation time, large blood loss, and perioperative narcotic use may aggravate constipation. Moreover, sacral root palsy due to cauda equina syndrome (CES) can lead to the deterioration of fecal impaction. ⋯ Chronic constipation, a common clinical problem, can sometimes cause relatively obscure but potentially life-threatening complications such as stercoral ulceration. Possible factors including advanced age, extensive spinal surgeries, prolonged operation time, significant blood loss, perioperative narcotic use, and the presence of spinal cord injury might contribute to the development of this condition. It highlights the importance of recognizing the potential development of stercoral ulcers in patients with CES and emphasizes the need for prompt diagnosis and management to avert catastrophic complications.
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Minerva anestesiologica · Jul 2023
The effect of off-hours hip surgery on patients' outcomes: a RECORD-compliant retrospective, propensity score-matched cohort study.
Off-hours working may have negative impacts on the performance of clinicians, leading to possible adverse outcomes of patients. We aimed to explore the impact of off-hours hip surgery on early postoperative outcomes. ⋯ Off-hours hip surgery was associated with adverse early postoperative prognosis, suggesting that more attention should be paid to off-hours hip surgery.
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Minerva anestesiologica · Jul 2023
Randomized Controlled TrialProlonged continuous wound infusion of local anesthetic and steroid after major abdominal surgery to reduce opioid consumption: a randomized, double-blind trial.
Continuous wound infusion (CWI) is effective for post-operative pain management, but the effect of prolonged infusions and the use of steroids in the infused mixture have never been addressed. We investigate the effect of prolonged CWI with ropivacaine 0.2% (R) over seven days and methylprednisolone (Mp) 1 mg/kg infused in the wound in the first 24 hours. ⋯ Prolonged infusion with R-Mp is safe and effective but did not reduce opioid consumption in the seven days after surgery or PPSP prevalence.
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Randomized Controlled Trial
Long-term Efficacy of Pectoserratus Plane Block for Prevention of Post-mastectomy Pain Syndrome: Extended Follow-up From a Randomised Controlled Trial.
Pectoserratus plane block (PSPB) leads to lower postoperative pain intensity. We examined whether PSPB could also reduce the incidence of post-mastectomy pain syndrome (PMPS) in women undergoing breast cancer surgery. ⋯ The results suggest that, in the long term, PSPB-treated participants were associated with a statistically significantly lower risk of PMPS than those who received standard general anesthesia.
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Surgery is often advised when conservative treatment fails in musculoskeletal pain conditions, but a substantial proportion still suffers chronic pain after surgery. Somatosensory processing system (SPS) signs were previously studied as potential predictors for chronic postsurgical pain, but results are inconsistent. Therefore, studying the evolution of SPS signs could be of added value. ⋯ On the other hand, dynamic QST mostly improved after surgery. Worthfully mentioning is that worsening of SPS signs was only seen at a follow-up of <3 months after surgery, that conclusions are stronger when evaluating dynamic QST with a follow-up of ≥3 months after surgery, and that pain improvement postsurgery was an important predictor. Future high-quality research should focus on the evolution of SPS signs after nociceptive targeted surgery, accounting for pain improvement groups and focusing on preoperative, perioperative, and postoperative predictors of this evolution.