SUMMARY -Th e aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. Th is prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. Th e secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side eff ects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p<0.001) and resumption of dietary intake was achieved earlier (p<0.001) in TEA group. Intensity of pain during the first 3 postoperative days was significantly lower at rest, on coughing and during mobilization (p<0.001), and mobilization was much more effi cient (p<0.005) in TEA than in IV-PCA group. Satisfaction scores were better in TEA group (p<0.001). Nausea, sedation and postoperative delirium occurred less frequently in TEA group (p<0.05, p<0.001 and p<0.05, respectively). TEA demonstrated significantly better eff ectiveness than IV-PCA after open colorectal cancer surgery and had a positive impact on bowel function, dietary intake, patient satisfaction and early mobilization. Th e results of this study demonstrated the importance of implementation of TEA as a preferred method for postoperative pain control after major open colorectal surgery.
Based on skeleton examination, cave-paintings and mummies the study of prehistoric medicine tells that the surgical experience dated with skull trepanning, male circumcision and warfare wound healing. In prehistoric tribes, medicine was a mixture of magic, herbal remedy, and superstitious beliefs practiced by witch doctors. The practice of surgery was first recorded in clay tablets discovered in ancient rests of Mesopotamia, translation of which has nowadays been published in Diagnoses in Assyrian and Babylonian Medicine. Some simple surgical procedures were performed like puncture and drainage, scraping and wound treatment. The liability of physicians who performed surgery was noted in a collection of legal decisions made by Hammurabi about the principles of relationship between doctors and patients. Other ancient cultures had also had surgical knowledge including India, China and countries in the Middle East. The part of ancient Indian ayurvedic system of medicine devoted to surgery Sushruta Samhita is a systematized experience of ancient surgical practice, recorded by Sushruta in 500 B.C.E. Ancient Indian surgeons were highly skilled and familiar with a lot of surgical procedures and had pioneered plastic surgery. In the ancient Egyptian Empire medicine and surgery developed mostly in temples: priests were also doctors or surgeons, well specialized and educated. The Edwin Smith Papyrus, the world’s oldest surviving surgical text, was written in the 17th century B.C.E., probably based on material from a thousand years earlier. This papyrus is actually a textbook on trauma surgery, and describes anatomical observation and examination, diagnosis, treatment, and prognosis of numerous injuries in detail. Excavated mummies reveal some of the surgical procedures performed in the ancient Egypt: excision of the tumors, puncture and drainage pus abscesses, dentistry, amputation and even skull trepanation, always followed by magic and spiritual procedures. Various types of instruments were innovated, in the beginning made of stone and bronze, later of iron. Under the Egyptian influence, surgery was developed in ancient Greece and in Roman Empire. Prosperity of surgery was mostly due to practice in treating numerous battlefield injuries. Records from the pre-Hippocrates period are poor, but after him, according to many writings, medicine and surgery became a science, medical schools were formed all over the Mediterranean, and surgeons were well-trained professionals. Ancient surgery closed a chapter when Roman Empire declined, standing-by up to the 18th century when restoration of the whole medicine began
by the Editorial Board of the Vojnosanitetski Pregled. They have not yet been copy edited and/or formatted in the publication house style, and the text could still be changed before final publication. Although accepted manuscripts do not yet have all bibliographic details available, they can already be cited using the year of online publication and the DOI, as follows: article title, the author(s), publication (year), the DOI.
FIBRIN GLUE MESH FIXATION UNDER LOCAL ANAESTHESIA FOR THE TREATMENT OF INGUINAL HERNIA IN ELDERLY PATIENTS R LionettF, A Cesaro 1 , E NapolitanoI, L Caruso 1 , B Neola1, M Rutigliano1, 0 P Ferulano1 iDpt. Specialistic Surgeries and Nephrology Policlinic Federico II, Naples, ITALY \ud Introduction: Inguinal hernia repair is one of the most common operations performed in general surgery, especially among elderly patients, due to age-related loss of muscle mass and increase of co-morbidities associated with high intra-abdominal pressure. The purpose of our trial was to assess the safeness and the impact on quality of life of tension free, sutureless hernia repair technique with the use of fibrin glue under local anesthesia in elderly patients. Methods: From January 2010 to December 2012,53 male patients aged 70 and above (mean age 73.9 years) were enrolled; complicated, recurrent, scrotal hernia and ASA IV patients were excluded. Furthermore diabetic patients with glycated hemoglobin level 7% or more were ruled out for presumable neuropathy. Informed consent and data from SF36 questionnaire were collected preoperatively. The Visual Analogue Scale (VAS) for postoperative pain and a new SF36 questionnaire for overall satisfaction at one year, were administered postoperatively. Chronic pain was classified according to Cunningham's criteria. Operative time, length of hospitalization, postoperative use of nonsteroidal anti-inflammatory drugs, complications and recurrences were also assessed. Results: All patients were operated under local anaesthesia (2% Mepivacaine Cloridrate and 7,5mg!ml Ropivacaine) with light sedation; in all cases partially absorbable mesh and plug (polypropylene! polyglecaprone 25) have been implanted and fixed with I ml of fibrin glue. 50 out of 53 patients completed the 2 years follow-up, one died for not related comorbidity. Mean operative time was 54.8 minutes; 46 patients were discharged at home the same day, 5 the following day, 2 patients had to stay one more day for postoperative complications (I haematoma, I urinary retention), no major complications were observed; at two years follow-up, 2 recurrences (4%) have been observed; mean VAS score for post-operative pain, assessed at 6, 12, 24 hours and 7 days after surgery, was 4 or less for 50 (94,3%) patients, only 3 (5,6%) patients referred a score> 4. At one year follow up only 2 (4%) patients suffered of chronic postoperative pain (I mild and I moderate), no severe chronic postoperative pain has been reported. Data from pre and postoperative SF36 questionnaires, analysed by using the Student's t test, showed significant increase of the score both in the Physical Component Summery (PCM) and in the Mental Component Summary (MCS) with a p-value < 0.0001. Conclusion: Inguinal hernia repair with use of fibrin glue and partially absorbable prosthesis under local anaesthesia is a safe technique in elderly patient
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