Articles: postoperative.
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Multicenter Study
Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up.
To investigate the role of peripheral neuropathy in the development of neuropathic postsurgical persistent pain (N-PSPP) after surgery, this French multicentric prospective cohort study recruited 3,112 patients prior to elective cesarean, inguinal herniorrhaphy (open mesh/laparoscopic), breast cancer surgery, cholecystectomy, saphenectomy, sternotomy, thoracotomy, or knee arthroscopy. Besides perioperative data collection, postoperative postal questionnaires built to assess the existence, intensity, and neuropathic features (with the Douleur Neuropathique 4 Questions [DN4]) of pain at the site of surgery were sent at the third and sixth months after surgery. In the 2,397 patients who completed follow-up, the cumulative risk of N-PSPP within the 6 months ranged from 3.2% (laparoscopic herniorrhaphy) to 37.1% (breast cancer surgery). Pain intensity was greater if DN4 was positive and decreased with time since surgery; it depended on the type of surgery. In pain-reporting patients, the response to the DN4 changed from time to time in about 1:4 of the cases. Older age and a low anxiety score were independent protective factors of N-PSPP, whereas a recent negative event, a low preoperative quality of life, and previous history of peripheral neuropathy were risk factors. The type of anesthesia had no influence on the occurrence of N-PSPP.
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Delirium is known to be a predictor of adverse outcomes. In a prospective study Abelha and colleagues showed that postoperative delirium was an independent risk factor for deterioration in functional capacity following discharge. ⋯ Early mobilisation of ICU patients has been demonstrated to decrease delirium and improve functional outcomes. Resources should be directed to appropriate, progressive mobilisation of all critically ill patients as a priority.
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Review
Pre-operative co-morbidity and postoperative survival in the elderly: beyond one lunar orbit.
Mortality is a good measure of killing, but it is a poor measure of cure, palliation or the maintenance of function. Nevertheless, it has remained the primary metric of hospital care for 200 years. ⋯ This article discusses how disparate factors can usefully combine to generate an 'elderly' group with a monthly mortality in excess of 1% and a median life expectancy less than 3.5 years. A downloadable spreadsheet is provided that combines risk factors to generate mortality risks and their associated survival curves, emphasising the importance of looking beyond one postoperative month.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialParecoxib and paracetamol for pain relief following minor day-stay gynaecological surgery.
Paracetamol and non-steroidal anti-inflammatory drugs are often administered for postoperative analgesia. Dilatation and curettage, with or without hysteroscopy, is a common day-stay procedure that is associated with pain that is partly mediated by prostaglandins. This study aimed to investigate the analgesic efficacy of adjunctive paracetamol and parecoxib in this setting. ⋯ There were no significant differences in patient satisfaction or recovery. We conclude that paracetamol or parecoxib does not produce a clinically important reduction in pain in this setting. Women having uterine curettage and receiving intravenous fentanyl do not appear to benefit from administration of these non-opioid analgesics.
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Frontiers in pharmacology · Jan 2014
ReviewThe effect of transdermal scopolamine for the prevention of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) is one of the most common and undesirable complaints recorded in as many as 70-80% of high-risk surgical patients. The current prophylactic therapy recommendations for PONV management stated in the Society of Ambulatory Anesthesia (SAMBA) guidelines should start with monotherapy and patients at moderate to high risk, a combination of antiemetic medication should be considered. Consequently, if rescue medication is required, the antiemetic drug chosen should be from a different therapeutic class and administration mode than the drug used for prophylaxis. ⋯ Clinical trials with transdermal scopolamine have consistently demonstrated its safety and efficacy in PONV. Thus, scopolamine is a promising candidate for the management of PONV in adults as a first line monotherapy or in combination with other drugs. In addition, transdermal scopolamine might be helpful in preventing postoperative discharge nausea and vomiting owing to its long-lasting clinical effects.