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L.h. Oliveira - One of the best experts on this subject based on the ideXlab platform.
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High macro rubber band ligature
Journal of Coloproctology, 2013Co-Authors: José A. Reis Neto, Jose Alfredo Reis Junior, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, L.h. OliveiraAbstract:PURPOSE: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. METHODS: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the pectinate line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). RESULTS: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for Parenteral Analgesia) in 1.6 %, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. CONCLUSIONS: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief.
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High macro rubber band ligature
Elsevier, 2013Co-Authors: José Reis A. Neto, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, José A. Reis, L.h. OliveiraAbstract:Purpose: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. Methods: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the pectinate line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). Results: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for Parenteral Analgesia) in 1.6%, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. Conclusions: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief. Resumo: Objetivo: o objetivo de uma ligadura com banda de borracha é promover a fibrose da submucosa com subsequente fixação do epitélio ao esfíncter anal subjacente. Seguindo esse princípio, uma nova técnica de ligadura foi desenvolvida baseada em dois aspectos: 1. macro bandas: para obter uma melhor fibrose e fixação ao atingir um volume maior de mucosa e 2. ligadura alta: para obter essa fixação na origem do deslocamento do coxim hemorroidal. Métodos: 1634 pacientes com doença hemorroidária interna de grau II ou III foram tratados pela técnica de macro ligadura elástica alta. Não houve distinção de idade, sexo ou etnia. Para executar essa técnica, um novo dispositivo hemorroidário foi especialmente projetado com um diâmetro maior e uma maior capacidade de aspiração de volume da mucosa. Recomenda-se utilizar um anoscópio mais longo e largo para obter uma melhor vista do canal anal, o que facilitará a injeção da submucosa a nível mais alto no canal anal e a inserção do dispositivo elástico. O coxim hemorroidal deve ser ligado a um nível mais alto no canal anal (4 cm acima da linha de pectinato). É preferível o tratamento de todas as hemorróidas em uma única sessão (máximo de três zonas submetidas à ligadura). Resultados: a análise foi retrospectiva, sem qualquer comparação com a ligadura convencional. O período de avaliação variou de de um a doze anos. A análise dos resultados mostrou edema perianal em 1,6% dos pacientes, tenesmo imediato em 0,8%, dor intensa (necessidade de Analgesia Parenteral) em 1,6%, retenção urinária em 0,1% dos pacientes e uma taxa de recorrência sintomática de 4,2%. Todos os pacientes com recorrência sintomática foram tratados com uma nova sessão de macro ligadura elástica. Nenhum dos pacientes desenvolveu septicemia anal ou retal. Uma pequena hemorragia pós-ligadura foi observada em apenas 0,8% dos pacientes. Conclusões: a técnica de macro ligadura elástica alta representa um método alternativo para o tratamento da doença hemorroidal classe II ou III, com bons resultados a um baixo custo. A análise dos resultados observados mostrou uma pequena incidência de complicações menores, com alto índice de alívio sintomático. Keywords: Hemorrhoids, Ambulatory treatment, Non surgical treatment, Palavras-chave: Hemorroidas, Tratamento ambulatorial, Tratamento não cirúrgic
Faraj W Abdallah - One of the best experts on this subject based on the ideXlab platform.
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statistically significant but clinically unimportant a systematic review and meta analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery
Regional Anesthesia and Pain Medicine, 2021Co-Authors: Nasir Hussain, Faraj W Abdallah, Richard Brull, Colin J L Mccartney, Jordan Noble, Tristan Weaver, Michael EssandohAbstract:The novel erector spinae plane block (ESPB) has been reported to provide important postoperative analgesic benefits following a variety of truncal and abdominal surgical procedures. However, evidence of its analgesic efficacy following breast cancer surgery, compared with Parenteral Analgesia, is unclear. This meta-analysis evaluates the analgesic benefits of adding ESPB to Parenteral Analgesia following breast cancer surgery.Databases were searched for breast tumor resection trials comparing ESPB to Parenteral Analgesia. The two co-primary outcomes examined were 24-hour postoperative oral morphine equivalent consumption and area-under-curve of rest pain scores. We considered reductions equivalent to 3.3 cm.h and 30 mg oral morphine in the first 24 hours postoperatively for the two co-primary outcomes, respectively, to be clinically important. We also assessed opioid-related side effects and long-term outcomes, including health-related quality of life, persistent postsurgical pain and opioid dependence. Results were pooled using random effects modeling.Twelve trials (699 patients) were analyzed. Moderate quality evidence suggested that ESPB decreased 24-hour morphine consumption and area-under-curve of rest pain by a mean difference (95% CI) of -17.60 mg (-24.27 to -10.93) and -2.74 cm.h (-3.09 to -2.39), respectively; but these differences were not clinically important. High-quality evidence suggested that ESPB decreased opioid-related side effects compared with Parenteral Analgesia by an OR (95% CI) of 0.43 (0.28 to 0.66). None of the studies evaluated long-term block benefits.Adding ESPB to Parenteral Analgesia provides statistically significant but clinically unimportant short-term benefits following breast cancer surgery. Current evidence does not support routine use of ESPB. Given the very modest short-term benefits and risk of complications, the block should be considered on a case-by-case basis.
E. Morau - One of the best experts on this subject based on the ideXlab platform.
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Patient-controlled oral Analgesia versus nurse-controlled Parenteral Analgesia after caesarean section: a randomised controlled trial
Anaesthesia, 2016Co-Authors: A. Bonnal, A. Dehon, N. Nagot, V. Macioce, E. Nogue, E. MorauAbstract:We assessed the effectiveness of early patient-controlled oral Analgesia compared with Parenteral Analgesia in a randomised controlled non-inferiority trial of women undergoing elective caesarean section under regional anaesthesia. Seventy-seven women received multimodal paracetamol, ketoprofen and morphine Analgesia. The woman having patient-controlled oral Analgesia were administered four pillboxes on the postnatal ward containing tablets and instructions for self-medication, the first at 7 h after the spinal injection and then three more at 12-hourly intervals. Pain at rest and on movement was evaluated using an 11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The pre-defined non-inferiority limit for the difference in mean pain scores (patient-controlled oral Analgesia minus Parenteral) was one. The one-sided 95% CI of the difference in mean pain scores was significantly lower than one at all time-points at rest and on movement, demonstrating non-inferiority of patient-controlled oral Analgesia. More women used morphine in the patient-controlled oral Analgesia group (22 (58%)) than in the Parenteral group (9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the patient-controlled oral Analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1 [1-2]); p = 0.006) in the Parenteral group. Minor drug errors or omissions were identified in five (13%) women receiving patient-controlled oral Analgesia. Pruritus was more frequent in the patient-controlled oral Analgesia group (14 (37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other adverse events and maternal satisfaction. After elective caesarean section, early patient-controlled oral Analgesia is non-inferior to standard Parenteral Analgesia for pain management, and can be one of the steps of an enhanced recovery process.
A. Bonnal - One of the best experts on this subject based on the ideXlab platform.
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Patient-controlled oral Analgesia versus nurse-controlled Parenteral Analgesia after caesarean section: a randomised controlled trial
Anaesthesia, 2016Co-Authors: A. Bonnal, A. Dehon, N. Nagot, V. Macioce, E. Nogue, E. MorauAbstract:We assessed the effectiveness of early patient-controlled oral Analgesia compared with Parenteral Analgesia in a randomised controlled non-inferiority trial of women undergoing elective caesarean section under regional anaesthesia. Seventy-seven women received multimodal paracetamol, ketoprofen and morphine Analgesia. The woman having patient-controlled oral Analgesia were administered four pillboxes on the postnatal ward containing tablets and instructions for self-medication, the first at 7 h after the spinal injection and then three more at 12-hourly intervals. Pain at rest and on movement was evaluated using an 11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The pre-defined non-inferiority limit for the difference in mean pain scores (patient-controlled oral Analgesia minus Parenteral) was one. The one-sided 95% CI of the difference in mean pain scores was significantly lower than one at all time-points at rest and on movement, demonstrating non-inferiority of patient-controlled oral Analgesia. More women used morphine in the patient-controlled oral Analgesia group (22 (58%)) than in the Parenteral group (9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the patient-controlled oral Analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1 [1-2]); p = 0.006) in the Parenteral group. Minor drug errors or omissions were identified in five (13%) women receiving patient-controlled oral Analgesia. Pruritus was more frequent in the patient-controlled oral Analgesia group (14 (37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other adverse events and maternal satisfaction. After elective caesarean section, early patient-controlled oral Analgesia is non-inferior to standard Parenteral Analgesia for pain management, and can be one of the steps of an enhanced recovery process.
Josef E Fischer - One of the best experts on this subject based on the ideXlab platform.
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prospective randomized comparison of epidural versus Parenteral opioid Analgesia in thoracic trauma
Annals of Surgery, 1999Co-Authors: Ryan M Moon, Fred A Luchette, Scott W Gibson, James Crews, G Sudarshan, James M Hurst, Kenneth L Davis, Jay A Johannigman, Scott B Frame, Josef E FischerAbstract:Thoracic trauma is a significant cause of morbidity and mortality in our society. It ranks second only to head injury as a cause of traumatic death in the United States. One of every four deaths resulting from trauma is attributable to a thoracic etiology. 1 Pain associated with flail chest or multiple rib fractures can result in voluntary splinting and muscle spasms, which subsequently leads to decreased ventilation and atelectasis. Compromise of pulmonary function can also cause hypoxemia, an increase in shunt fraction, or pneumonia, which may require mechanical ventilation. 2 Adequate relief of rib and chest-wall pain allows the patient to breathe deeply, avoid intubation, 3 and clear secretions effectively, minimizing pulmonary complications. 4 We havepreviously shown that the epidural route of Analgesia is superior to intrapleural administration for Analgesia and improves pulmonary function in patients with thoracic trauma. 5 Any acute injury produces a spectrum of physiologic responses. The neuroendocrine system responds by increased activity, which includes autonomic control of cardiac contractility and peripheral vascular tone, hormonal response to stress and volume depletion, and local microcirculatory mechanisms that are organ-specific and regulate regional blood flow. Multiple stimuli associated with traumatic injury can initiate these responses, including pain, hypoxemia, hypercarbia, and emotional arousal, to name a few. 6,7 Somatic pain is generated by the response of nociceptors through the A-delta fibers, which are activated by high-intensity stimuli. These afferent signals then undergo central integration that modulates the efferent output, leading to sympathetically mediated vasoconstriction and secretion of corticotropin-releasing factor, the primary autonomic and endocrine responses to somatic pain, respectively. Repeated insults or hemorrhage potentiate this effect. Blocking afferent signals resulting from pain in patients undergoing elective thoracotomy has been shown to reduce systemic catecholamine levels significantly. 8 An additional host response to injury involves a coordinated expression of cytokines that act both systemically and locally with profound effects on organ function. Cytokines differ from the classic hormones in the following manner: 1. They are bioactive at very low concentrations locally that may not be detectable systemically. 2. They are produced by many cell types at many sites in the body. 3. They are induced based on the nature of the insult. 4. They have important autocrine, paracrine, and endocrine functions (Table 1). Table 1. Proposed Roles of Cytokines in Response to Injury 5. Serum levels of cytokines probably represent largely overflow rather than an endocrine function. 9 A traumatic wound, with or without hypotension, produces similar systemic immunomodulation. Levels of tumor necrosis factor-alpha (TNF-α) may increase after injury. 10 Serum levels of interleukin (IL)-1β are elevated, 11 IL-2 levels are decreased, 12,13 and IL-6 levels are elevated shortly after injury and remain elevated for several days. 14 Finally, within 8 hours of injury, circulating levels of IL-8 are increased. 15 Although many studies have characterized the inflammatory mediators associated with traumatic injury, 11–13 little is know about the effects of the route of Analgesia administration on pain relief, pulmonary function, and systemic inflammatory mediators in patients with significant thoracic injury. Randomized controlled studies of patients undergoing elective thoracotomy have proven that epidural anesthesia and postoperative continuous epidural Analgesia decrease the stress response associated with surgical trauma compared with Parenteral Analgesia. 8 However, in that study, epidural anesthesia was given before surgery, before the stress was initiated. The purpose of this study was to investigate the effect of route of Analgesia delivery after severe chest injury on Analgesia, pulmonary function, urinary catecholamine levels, and plasma cytokine levels by comparing Parenteral versus epidural opioid Analgesia. Effective pain control should improve pulmonary mechanics and reduce the neuroendocrine and immune response. Any of these outcomes may also reduce complications.
