The American surgeon
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The American surgeon · Jun 2007
Randomized Controlled Trial Comparative StudyProspective, double-blinded, randomized, placebo-controlled comparison of local anesthetic and nonsteroidal anti-inflammatory drugs for postoperative pain management after laparoscopic surgery.
Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. ⋯ The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.
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The American surgeon · Aug 2006
Randomized Controlled TrialImpedance cardiography: can it replace thermodilution and the pulmonary artery catheter?
Clinical assessment of cardiac output (CO) is inaccurate, yet the use of the pulmonary artery catheter (PAC) for thermodilution (TD) measurement of CO (CO(TD)) has declined significantly. Can noninvasive impedance cardiography (ICG) now be used to measure CO (CO(ICG)) in place of CO(TD)? A literature review of recent CO(ICG) correlations with CO(TD) (r = 0.73-0.92) were similar to ours, r = 0.81. A search for conditions interfering with CO(ICG) revealed no serious problems with patient position, cardiac or pulmonary assist devices, "wet lungs," body mass index > or = 30, or age > or = 70 years. ⋯ Data from ICG was revealed only in the study group, resulting in a 49 per cent change in treatment compared with 29 per cent in the control group. Length of stay was shorter in the study than the control group in the intensive care unit (2.4 +/- 8.8 vs 3.3 +/- 7.3 days) and on the floor (9.8 +/- 10.6 vs 15.7 +/- 19.0 days). In conclusion, ICG is comparable with TD, is easily, accurately, and safely performed, enhances clinical assessment of CO, and improves care in hemodynamically compromised patients.
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The American surgeon · May 2006
Randomized Controlled TrialA prospective, randomized trial of cognitive intervention for postoperative pain.
A single-blind, randomized prospective trial was performed at a university hospital to determine if preoperative relaxation training will decrease pain and narcotic demand postoperatively. A convenience sample of 49 patients undergoing lumbar and cervical spine surgery was randomized to receive instruction on relaxation techniques or routine preoperative information before surgery. ⋯ The differences were significant for narcotic demand (P = 0.01) but not for pain (P = 0.94). In conclusion, our results could not support the use of relaxation training for reducing postoperative pain and narcotic demand in this selected surgical population.
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The American surgeon · Oct 2005
Randomized Controlled TrialPreoperative oral rofecoxib and postoperative pain in patients after laparoscopic cholecystectomy: a prospective, randomized, double-blinded, placebo-controlled trial.
Cyclooxygenase-2 (COX-2) inhibitors are a class of drugs that may avoid some of the side effects of narcotics and nonsteroidal anti-inflammatory drugs (NSAIDs). We performed a randomized, double-blinded, placebo-controlled trial giving a single oral dose of the COX-2 inhibitor rofecoxib 25 mg or placebo preoperatively to determine the impact upon postoperative pain, complications, narcotic use, and hospital stay after laparoscopic cholecystectomy. Investigators and patients were blinded. ⋯ Pain was recorded at 1 hour, 4.03 +/- 1.93 in the rofecoxib group versus 4.38 +/- 1.34 in the placebo group (P = 0.36); at 6 hours, 3.00 +/- 1.12 in the rofecoxib group versus 2.78 +/- 0.78 in the placebo group (P = 0.42); and at 24 hours, 1.64 +/- 0.67 in the rofecoxib group versus 2.68 +/- 1.90 in the placebo group (P = 0.17). The amount of pain medication received and lengths of hospital stay was not significantly different between the two groups. Our data demonstrate no significant benefit of preoperative oral rofecoxib in patients undergoing laparoscopic cholecystectomy.
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The American surgeon · Mar 2005
Randomized Controlled Trial Comparative Study Clinical TrialSplanchnic hypoperfusion-directed therapies in trauma: a prospective, randomized trial.
Splanchnic hypoperfusion as reflected by gastric intramucosal acidosis has been recognized as an important determinant of outcome in shock. A comprehensive splanchnic hypoperfusion-ischemia reperfusion (IRP) protocol was evaluated against conventional shock management protocols in critical trauma patients. The study was a prospective randomized trial comparing three therapeutic approaches to hypoperfusion after severe trauma in 151 trauma patients admitted to the intensive care unit. ⋯ The three groups were similar based on age, Injury Severity Score, and Acute Physiology and Chronic Health Evaluation II Scores. There were no statistically significant differences in mortality rates, organ dysfunction, ventilator days, or length of stay between any of the interventions. Techniques of optimization of splanchnic perfusion and minimization of oxidant-mediated reperfusion injury evaluated in this study were not advantageous relative to standard resuscitation measures guided by conventional or tonometric measures of hypoperfusion in the therapy of occult and clinical shock in trauma patients.