The British journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain and pulmonary complications: comparison of three analgesic regimens.
In a prospective study, patients undergoing cholecystectomy were randomly allocated to receive (a) intermittent intramuscular morphine (n = 25), (b) continuous intravenous morphine infusion (n = 25) or (c) epidural bupivacaine (n = 25) for postoperative pain relief. Morphine by intravenous infusion provided comparable pain relief to intermittent intramuscular morphine; there was no significant difference in the incidence of postoperative pulmonary complications. ⋯ Arterial oxygen tensions were also significantly higher in the epidural group for the first three postoperative days (P less than 0.05). Epidural analgesia was associated with a significant reduction in the incidence of pulmonary complications (P less than 0.01) and chest infection (P less than 0.05).
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Randomized Controlled Trial Clinical Trial
Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial.
The operative mortality for biliary tract obstruction due to malignancy is high. In 1981 a controlled clinical trial of pre-operative percutaneous drainage was started at the Royal Postgraduate Medical School. At the time of percutaneous transhepatic cholangiography patients were randomized either to laparotomy or to pre-operative percutaneous transhepatic biliary drainage ( PTBD ) followed by laparotomy. ⋯ Five patients required early surgery for complications of PTBD and two died within 30 days of surgery. The mortality for laparotomy was 19 per cent (6/31) compared with 32 per cent (11/34) for drainage plus laparotomy. This trial highlights the hazards of PTBD in high risk patients and has failed to demonstrate a reduction in mortality with the use of pre-operative PTBD .
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Randomized Controlled Trial Comparative Study Clinical Trial
A physiological appraisal of polyethylene glycol and a balanced electrolyte solution as bowel preparation.
Seventy-seven patients undergoing bowel preparation with either sennosides and rectal washout (S + RWO; n = 26) or polyethylene glycol and a balanced electrolyte solution (PEG + E) given orally (n = 25) or by nasogastric infusion (n = 26) have been studied. PEG + E was not associated with significant physiological change in electrolytes or blood gases. ⋯ It is therefore a safe, quick and efficient bowel preparation and provides a safer alternative to mannitol. The solution (PEG + E) man be used orally or by nasogastric infusion and does not require an accompanying intravenous infusion.
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Randomized Controlled Trial Clinical Trial
The effect of topical povidone iodine on wound infection following abdominal surgery.
The effect of povidone iodine on wound sepsis following gastrointestinal surgery was studied in a trial involving 153 patients of whom 72 had their wounds sprayed with povidone iodine dry powder (Disadine DP) and 81 acted as a control group. The infection rate of 9.9 per cent in the patients treated with povidone iodine was significantly lower than that of 24.4 per cent in the control group (P less than 0.05). ⋯ However, spraying of contaminated wounds with povidone iodine reduced the infection rate to the significantly lower level of 11 per cent (P less than 0.05). We conclude that povidone iodine is a safe and effective means of reducing wound sepsis following gastrointestinal surgery.
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Randomized Controlled Trial Clinical Trial
The effect of topical povidone-iodine on the incidence of infection in surgical wounds.
A randomized stratified clinical trial of topical povidone-iodine in 627 patients undergoing abdominal procedures demonstrated a reduction in postoperative wound sepsis in female patients, in patients receiving subcutaneous low dose heparin and during the first quarter of the trial when the infection rate in control subjects was high. Overall, there was no significant reduction in wound sepsis after administration of povidone-iodine due mainly to a high infection rate in povidone-iodine treated male appendix operations where, by chance, there was an increased incidence of contamination with Bacteroides fragilis. Postoperative stay in those developing wound infection was significantly reduced in the povidone-iodine group. This is considered as indirect evidence for a decrease in severity of wound infection.