Journal of the American College of Surgeons
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Randomized Controlled Trial Comparative Study Clinical Trial
Massage as adjuvant therapy in the management of acute postoperative pain: a preliminary study in men.
Opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and palliate postoperative distress. ⋯ Massage may be a useful adjuvant therapy for the management of acute postoperative pain. Its greatest effect appears to be on the affective component (ie, unpleasantness) of the pain.
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Randomized Controlled Trial Clinical Trial
Laparoscopic surgery for gastroesophageal reflux disease patients with impaired esophageal peristalsis: total or partial fundoplication?
It has been proposed that partial fundoplication is associated with less incidence of postoperative dysphagia and consequently is more suitable for patients with gastroesophageal reflux disease (GERD) and impaired esophageal body motility. The aim of this study was to assess whether outcomes of Toupet fundoplication (TF) are better than those of Nissen-Rossetti fundoplication (NF) in patients with GERD and low-amplitude esophageal peristalsis. ⋯ Both TF and NF efficiently control reflux in patients with GERD and low amplitude of esophageal peristalsis. Early in the postoperative period, TF is associated with fewer functional symptoms, although at 1 year after surgery those symptoms are reported at similar frequencies after either procedure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions.
The purpose of this study is to determine whether closure of laparoscopic port-site incisions using octylcyanoacrylate (OCA) is feasible, whether it is faster than traditional subcuticular suturing, whether the number and length of incisions impact on closure time, and to determine wound morbidity and patient satisfaction outcomes. ⋯ Closure of laparoscopic port-site incisions is feasible with OCA. Closure with OCA requires significantly less operative time than subcuticular suturing, particularly in cases when three or more port sites are used or when total incision length is greater than 4 cm. OCA appears to have equivalent adverse wound outcomes and patient acceptance rates as subcuticular suturing.
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Randomized Controlled Trial Clinical Trial
Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial.
Because of concerns about masking important physical findings, there is controversy surrounding whether it is safe to provide analgesia to patients with undifferentiated abdominal pain. The purpose of this study was to address the effects of analgesia on the physical examination and diagnostic accuracy for patients with abdominal pain. ⋯ Results of this study support a practice of early provision of analgesia to patients with undifferentiated abdominal pain.
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Randomized Controlled Trial Clinical Trial
When to remove a chest tube? A randomized study with subsequent prospective consecutive validation.
Operative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with wide variation among surgeons. Our objective was to evaluate the effectiveness and safety of establishing a volume of 200 mL/d of uninfected drainage as a threshold for removal of chest tube, as compared with more frequently used volumes of 100 and 150 mL/d. ⋯ Increasing the threshold of daily drainage to 200 mL before removing the chest tube did not markedly affect drainage, hospitalization time, or overall costs, nor did it increase the likelihood of major pleural fluid reaccumulation. This volume (200 mL/d) could be recommended for chest tube withdrawal decision for uninfected pleural fluid with no evidence of air leaks.