Journal of the American College of Surgeons
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Randomized Controlled Trial
Partial matrix excision or orthonyxia for ingrowing toenails.
We wanted to evaluate whether partial matrix excision and orthonyxia are equally effective in the treatment of ingrown toenails of the hallux. ⋯ Partial matrix excision and orthonyxia are equally effective treatments for ingrown toenails. But the orthonyxia procedure showed better results, with less postoperative morbidity, shorter time to complete recovery, fewer postoperative symptoms, and greater patient satisfaction.
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Randomized Controlled Trial Multicenter Study Comparative Study
A phase 3, randomized, double-blind comparative study of the efficacy and safety of topical recombinant human thrombin and bovine thrombin in surgical hemostasis.
Plasma-derived bovine thrombin is used as a topical agent to improve surgical hemostasis, but development of antibodies to bovine hemostatic proteins has been associated with increased bleeding and thrombotic complications. Recombinant human thrombin could reduce the risk of these complications. ⋯ Results of this trial suggest that rhThrombin has comparable efficacy, a similar safety profile, and is considerably less immunogenic than bovine thrombin when used for surgical hemostasis.
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Randomized Controlled Trial Multicenter Study
Postoperative ileus-related morbidity profile in patients treated with alvimopan after bowel resection.
Postoperative ileus (POI), an interruption of coordinated bowel motility after operation, is exacerbated by opioids used to manage pain. Alvimopan, a peripherally acting mu-opioid receptor antagonist, accelerated gastrointestinal (GI) recovery after bowel resection in randomized, double-blind, placebo-controlled, multicenter phase III POI trials. The effect of alvimopan on POI-related morbidity for patients who underwent bowel resection was evaluated in a post-hoc analysis. ⋯ Alvimopan 12 mg was associated with reduced POI-related morbidity compared with placebo, without compromising opioid-based analgesia in patients undergoing bowel resection. Relatively low NNTs are clinically meaningful and reinforce the potential benefits of alvimopan for the patient and health care system.
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Randomized Controlled Trial
A double-blinded, prospective randomized controlled trial of intraperitoneal bupivacaine in laparoscopic Roux-en-Y gastric bypass.
Intraperitoneal local anesthetics have been investigated in several laparoscopic procedures that demonstrate improved postoperative pain control and reduced length of hospital stay. No published studies to date address the effectiveness of IP local anesthetics in laparoscopic gastric bypass patients (LRYGB). ⋯ IPB use during LRYGB revealed a statistically significant difference only in postoperative oral narcotic use. Possibly, the IPB can limit or prevent peritoneal irritation and reduce the need for longer narcotic use. Clinical significance was not demonstrated by our outcomes variables.
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Randomized Controlled Trial Comparative Study
An Apgar score for surgery.
Surgical teams have not had a routine, reliable measure of patient condition at the end of an operation. We aimed to develop an Apgar score for the field of surgery, an outcomes score that teams could calculate at the end of any general or vascular surgical procedure to accurately grade a patient's condition and chances of major complications or death. ⋯ A simple score based on blood loss, heart rate, and blood pressure can be useful in rating the condition of patients after general or vascular operations.