ObjectiveTo systematically review the efficacy of opioid-sparing analgesic techniques in terms of analgesic potential, incidence of complications and quality of recovery in liver surgery. MethodsThe PubMed, Embase and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to August 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 20 RCTs involving 1 347 patients were included. The results of meta-analysis showed that opioid-sparing techniques could significantly reduce pain scores at rest and during movement from 2h to 48h postoperatively, opioid consumption within 24h (MD=?11.17, 95%CI ?14.62 to ?7.71, P<0.01) and 48h (MD=?7.19, 95%CI ?10.06 to ?4.33, P<0.01), postoperative nausea and vomiting (PONV) (OR=0.68, 95%CI 0.50 to 0.91, P=0.01) and wound infection (OR=0.42, 95%CI 0.18 to 0.98, P=0.04), as well as reduced time to bowel recovery (MD=?12.92, 95%CI ?21.24 to ?4.61, P<0.01) and decreased length of hospital stay (LOS) (MD=?0.90, 95%CI ?1.32 to ?0.49, P<0.01). No significant difference was observed between the two groups in the incidence of excessive sedation, pruritus, hypotension, headache and respiratory depression. Time to out-of-bed activity and patient satisfaction were also similar between groups. ConclusionOpioid-sparing techniques are effective in relieving postoperative pain and reducing opioid use, with additional potential in reducing postoperative nausea or vomiting, wound infection, time to bowel recovery and length of hospital stay.
ObjectiveTo analyze the effect and incidence rate of major postoperative complications of pericardial devascularization in treatment of portal hypertension.
MethodsEnglish and Chinese literatures about pericardial deva-scularization in treatment of portal hypertension were searched through Medline, Elsevier, PubMed, CNKI, and WanFang database, and meta analysis was taken in the process by using R-2.15 software.
ResultsIn total of 671 literatures were searched and 23 were selected finally according to inclusion criteria and exclusion criteria.The results of meta analysis showed that, the effect of pericardial devascularization in treatment of portal hypertension were as follows:the incidence rate of rebleeding was 21%(95% CI: 0.18-0.24), the incidence rate of hepatic encephalopathy was 4%(95% CI: 0.02-0.06), the incidence rate of ascites was 29%(95% CI: 0.14-0.47), mortality of operation was 3%(95% CI: 0.02-0.04), mortality was 23%(95% CI: 0.15-0.33).
ConclusionsThere is a certain incidence rate of complications of pericardial devascularization, of which the most common complication is rebleeding.So, it is necessary to do further improvement and development of pericardial devascularization.
ObjectivesTo investigate the status quo of follow-up services for patients with cervical spondylosis, to explore its influencing factors, and to provide reference for the follow-up management model after postoperative discharge of patients with cervical spondylosis.MethodsA total of 220 patients with cervical spondylosis were selected by using convenient sampling from October 2018 to May 2019, and the general information questionnaire and the follow-up service needs questionnaire were used for the investigation.ResultsThe score of follow-up service content requirement for patients with cervical spondylosis was 54.87±7.56, and the rehabilitation training instruction was the highest. Multiple linear regression analysis showed that the follow-up service content score was influenced by education level [non-standardized partial regression coefficient (b)=3.186, 95% confidence interval (CI) (2.490, 3.882), P<0.001], length of hospital stay [b=5.140, 95%CI (3.914, 6.365), P<0.001], Neck Disability Index [b=1.326, 95%CI (0.189, 2.463), P=0.022], and age [≥75 years as the reference, 45-59 years: b=3.766, 95%CI (0.671, 6.860), P=0.017; 60-74 years: b=4.081, 95%CI(0.849, 7.314), P=0.014]. The method of obtaining follow-up services was mainly based on outpatient follow-up (85.5%), telephone follow-up (50.5%), and established a follow-up service center (40.5%) for discharged patients. The executives were multidisciplinary teams (60.5%) and hospital-community integration teams (48.2%). There were 19.1% of discharged patients who were willing to pay for relevant follow-up services.ConclusionsPatients with postoperative cervical spondylosis have strong demand for post-discharge follow-up services, which are affected by many factors. Medical staff should pay attention to this and develop a personalized follow-up service plan according to patient characteristics to meet different discharged patients and improve the quality of medical services.
Objective
To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures.
Methods
A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected.
Results
There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05).
Conclusion
For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.
In order to observe electrolyte changes before and after scheduled abdominal surgery and effect of prompt potassium supplement on the recovery of gastrointestinal function, electrolytes in 69 patients were tested before and after surgery, and the recovery of the gastrointestinal function was observed.The results showed that after surgery the levels of K＋, Na＋ and Cl＋ were decreased dramatically (Ｐ＜0.05) but still within the normal range, with no distinctive change in Ca２＋ and Mg２＋. No correlation between the amount of blood transfusion and potassium was detected. Prompt potassium supplement contributed to the quick recovery of gastrointestinal function.This suggests that with normal renal function, blood transfusion during the operation will not cause hyperkalemia, potassium supplement might begin on the first day when the patient begins to urinale.
ObjectiveTo analyze the related risk factors of influencing on postoperative severe complications (PSC) in elderly patients with gastric cancer. MethodsAltogether 202 cases of elderly patients with gastric cancer who received surgical treatment between January 2003 and December 2008 in this hospital were analyzed. On the basis of the degree of complications, the patients were divided into the group with PSC and the group without PSC. The relevant clinical and laboratory data were evaluated, and compared with statistical analysis. ResultsClinically the preoperative comorbidity, total gastrectomy, more than 800 ml intraoperative blood loss, intraoperative transfusion, and combined organ resection were significantly correlated with PSC (Plt;0.05). In laboratory data, the lower preoperative serum albumin and the blood glucose level on the first day after operation were significantly correlated with PSC (Plt;0.05). ConclusionThe preoperative comorbidity, lower serum albumin, and extended radical resection are the danger factors leading to PSC.
Objective To explore the factors associated with clinic follow-up of old patients with colorectal cancer and provide more evidence to improve the efficiency and quality of clinic follow-up after sugery. Methods The data of 253 patients who were underwent sugery because of old colorectal cancer in our hospital from January 2009 to May 2010 were reviewed. Data about the rate and times of clinic follow-up within 6 months after operation were collected via Hospital Information Systerm,??then the follow-up rate was calculated,??and to analyse the possible factors associated with follow-up times and rate. Results The total follow-up rate was 84.2%（213/253）,??and the total times of follow-up was between 0 to 24 times per one,??（4.08±0.03）times on average. On the times of follow-up,??patients inside the city was higher than that outside,??patients with medical or postoperative complications were higher than those without,??and patients with a stoma was lower than that without,??and the differences were statistically significant （P＜0.05）.While on the follow-up rate,??patients underwent a radical sugery or with a stoma were lower than those not or without,??and the differences were statistically significant （P＜0.05）. Conclusions The clinic follow-up of old colorectal cancer patients is not satisfactory,??and the possible factors associated with follow-up times or rate are the distance between residence and hospital,?have medical complications or not,??have postoperative complications or not,??radical sugery or not,??and with a stoma or without.
Objective To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation. Methods 158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh. Results The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）. Conclusions Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.
Objective
To analyze the risk factors of no light perception (NLP) after vitreoretinal surgery for proliferative diabetic retinopathy (PDR).
Methods
Retrospectively analyzed the follow-up data of 882 patients (1000 eyes) with PDR who had undergone vitreoretinal surgery. The standard of NLP was: in a darkroom, one eye was covered, and the other one could not catch the candlelight 30 cm in front of the eye. The number of eyes with NLP was counted and the clinical data of the eyes with or without NLP were analyzed and compared. chi;2 test was used to analyze the risk factors of NLP.
Results
In these 1000 eyes with PDR,the postoperative visual acuity was NLP in 22 eyes (2.2%) and light perception in 978 eyes (97.8%). Comparing with the patients with light perception, the patients with NLP had severer disease condition, including ante-operative neovascular glaucoma (NVG)(36.4%), tension combined with retinal detachment 50%, and a need for lens excision during the surgery (45.5%) and for silicone oil filling at the end of the operation (63.6%). After the surgery, NVG was found in 14 eyes, un-reattached retina in 5 eyes (before the surgery was VI stage of PDR), and optic nerve atrophy and retinal vessel atresia in 3 eyes, which significantly differed from which in the patients with light perception (Plt;0.001，P=0.004, (Plt;0.001). The differences of sex, diabetes type and PDR stage between the NLP group and non-NLP group were not significant (P=0.136, P=0.681, P=0.955).
Conclusions
The incidence of NLP after vitreoretinal surgery for proliferative diabetic retinopathy is low. The direct causes were NVG, optic nerve atrophy, retinal vessel atresia and retinal redetachment, while the sex, type of diabetes mellitus and stage of PDR show no statistical relation to the occurrence of NLP after surgery.
(Chin J Ocul Fundus Dis,2007,23:244-247)
Objective?To evaluate the efficacy and safety of 5 HT-3 receptor inhibitor tropisetron injected in the postoperative nausea and vomiting (PONV) after general anesthesia. Methods?We searched the PubMed, EBSCO, Springer, Ovid, and CNKI to identify randomized controlled trials (RCTs) about tropisetron in preventing PONV after general anesthesia from January 1995 to September 2009. We also consulted references of the included studies for omission. The methodological quality of the included RCTs was assessed and data were extracted according to the standard of the Cochrane Handbook 5.0.1. The meta-analyses were performed by RevMan 4.2.10 software. Results?A total of 17 RCTs involving 4 678 patients were included. The results of meta-analyses showed that: (1) Efficacy: tropisetron injected could decrease the incidence of PONV after general anesthesia (RR=0.41, 95%CI 0.29 to 0.60), and decrease the incidence of PONV after general anesthesia with opioid drugs in patient controlled analgesia (RR=0.30, 95%CI 0.15 to 0.60); tropistron injected once or more could decrease the incidence of PONV in combination of PCA with tramadol (RR=0.41, 95%CI 0.29 to 0.56; RR=0.10, 95%CI 0.06 to 0.19); and tropisetron combined with dexamethasome could also lessen the incidence of PONV (RR=0.27, 95%CI 0.13 to 0.57). (2) Safety: Tropisetron injected could lessen the incidence of postoperative headache and dizziness (RR=0.35, 95%CI 0.16 to 0.75), but could not significantly decrease the pruritus and somnolence. Conclusion?Tropisetron injected can significantly decrease the incidence of PONV after general anesthesia, and it will not increase the adverse effect and the incidence of postoperative complications. Furthermore, it has also the advantage of decreasing postoperative headache and dizziness.
