International journal of surgery
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Serratiopeptidase is a proteolytic enzyme prescribed in various specialities like surgery, orthopaedics, otorhinolaryngology, gynaecology and dentistry for its anti-inflammatory, anti-edemic and analgesic effects. Some anecdotal reports suggest it to possess anti-atherosclerotic effects also, due to its fibrinolytic and caseinolytic properties. Despite being widely used there are few published studies regarding its efficacy. Thus, evidence regarding its clinical utility is needed. ⋯ Serratiopeptidase is being used in many clinical specialities for its anti-inflammatory, anti-edemic and analgesic effects. It is even being promoted as a health supplement to prevent cardiovascular morbidity. The existing scientific evidence for Serratiopeptidase is insufficient to support its use as an analgesic and health supplement. The data on long-term safety of this enzyme is lacking. Evidence based recommendations on the analgesic, anti-atherosclerotic efficacy, safety and tolerability of Serratiopeptidase are needed.
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Chronic pelvic pain (CPP), a common gynaecological presentation, may be due to bladder pain syndrome (BPS) or the co-existence of BPS and endometriosis, known as the 'evil twins syndrome'. ⋯ Almost two thirds of women presenting with CPP have BPS. Large variations in prevalence may be due to variable study selection and quality. Clinicians need to actively investigate patients for BPS, a condition that appears to co-exist with endometriosis.
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Delirium is highly prevalent, occurring in 20% of acute hospital inpatients and up to 62% of surgical patients. It is a significant predictor of poor outcomes including mortality and institutionalisation, however it is often viewed as simply a marker of underlying illness and is frequently overlooked in older adults. Although delirium is commonly comorbid with dementia, it represents a more urgent diagnosis, requiring prompt intervention. ⋯ Appropriate treatment of delirium requires thorough investigation, management of the underlying illness, avoidance of complications and simplification of the care environment. Studies suggest a role for pharmacological prophylaxis, particularly in relation to anaesthetic and sedative agents used intra- and post-operatively. Furthermore, gathering evidence suggests that judicious use of antipsychotic medications may be helpful in delirium prevention and treatment.
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Bedside ultrasound is increasingly commonly used by surgeons in their everyday practice. Little is known on the practical implications of bedside ultrasound, its efficacy and safety. ⋯ Evidence exists for the routine use of certain types of bedside ultrasound in surgical practice, especially in hepatobiliary and head and neck scanning. Further study is needed to determine its utility in vascular, hernia and breast ultrasound.
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A best evidence topic was written according to a structured protocol. The question addressed whether local anaesthetic infiltration of the transversus abdominis plane (TAP block) during a laparoscopic cholecystectomy improves pain control. Ten papers were found using the reported search, of which four represented the best evidence to answer the clinical question. ⋯ Three of the randomised controlled trials demonstrated a reduction in analgesic requirements associated with TAP blocks following laparoscopic cholecystectomy as compared to placebo. The remaining randomised study compared TAP blocks with local anaesthetic infiltration of laparoscopic port sites and showed no significant difference in clinical outcomes between these two techniques. We conclude that there is good evidence that TAP block in laparoscopic cholecystectomy leads to a reduction in pain scores and analgesic requirement, however there is no significant difference when compared to local anaesthetic infiltration of trocar insertion sites.