Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy: A randomised controlled trial

BACKGROUND Adenotonsillectomy is a frequently performed procedure in paediatric day-case surgery. Postoperative pain can be significant and standard analgesia protocols are often insufficient. OBJECTIVE Our primary objective was to investigate if infiltration of the peritonsillar space with bupivacaine would reduce the need for postoperative opioids compared with pre-emptive intravenous tramadol. DESIGN A double-blind, randomised controlled trial. SETTING Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from January 2012 to September 2016. PATIENTS Two hundred children, between 4 and 10 years old, undergoing elective adenotonsillectomy were included in the study. INTERVENTION Children were randomly allocated to receive either a bolus of 3 mg kg−1 intravenous tramadol or infiltration of the tonsillar lodge with 5-ml bupivacaine 0.25%. Reasons for exclusion were American Society of Anesthesiologists classification greater than 2, allergies to the investigated products, psychomotor retardation, bleeding disorders and lack of proficiency in Flemish. MAIN OUTCOME MEASURES The primary endpoint was the number of children in need of piritramide postoperatively. Secondary outcomes included the cumulative dose of postoperative piritramide, pain scores and the incidence of postoperative nausea and vomiting during the first 24 postoperative hours, time to discharge and adverse effects. RESULTS The proportion of children in nee...
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Paediatric anaesthesia Source Type: research

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Postoperative management of hallux valgus varies widely. Setting preoperative expectations is an important aspect of attaining a successful outcome, but this is not routinely reviewed in the literature. This chapter offers suggestions on successfully navigating this area of patient care. Current concepts focus on pain control, immobilization, and return to activities. This chapter also reviews the current literature in these areas and sets out the authors ’ preferred management in the postoperative setting.
Source: Foot and Ankle Clinics - Category: Orthopaedics Authors: Source Type: research
Publication date: Available online 23 January 2020Source: Journal of Minimally Invasive GynecologyAuthor(s): Prathiba M. De Silva, Ayesha Mahmud, Paul P. Smith, T. Justin ClarkAbstractObjectiveTo identify the most effective analgesia for women undergoing office hysteroscopy.Data sourcesMedline, Embase, CINAHL and the Cochrane library were searched from inception until August 2019 investigating the effect of different analgesics on pain control in office hysteroscopy.Methods of study selectionRandomised controlled trials were included that investigated the effect of analgesics on pain experienced by women undergoing diagnos...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
Publication date: Available online 23 January 2020Source: Journal of Minimally Invasive GynecologyAuthor(s): Whitney Trotter Ross, Jordan M. Newell, Richard Zaino, Allen R. Kunselman, Gerald J. Harkins, Andrea S. BentonAbstractStudy ObjectiveTo evaluate the diagnosis of appendiceal endometriosis in coincidental appendectomy specimens using a standard versus modified histopathologic analysis.DesignProspective analysis of 300 consecutive patients undergoing coincidental appendectomy at time of a primary gynecologic procedure.SettingAcademic tertiary referral hospital in the Northeastern United States.PatientsWomen ages 22 to...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
Authors: Monsalve Alonso S, Miranda García P, Santander Vaquero C Abstract Cap-polyposis is a rare benign condition characterized by inflammatory colorectal polyps covered by a "cap" of fibrinopurulent exudate. Mucous diarrhea and rectal bleeding are frequent symtoms. It can be difficult to diagnose and it is necessary to make a differential diagnosis from other entities. Its pathogenesis is unknown and it has a variable clinical course. The optimal treatment has not been established. PMID: 31960689 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
CONCLUSIONS: acromegaly may be associated with more polyps in SB. PMID: 31960686 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
We present the case of a 74-year-old man, with a history of residual schizophrenia, who underwent abdominal-pelvic CT with intravenous contrast, due to abdominal acute pain, that showed a stenosis at the origin of the celiac trunk and a large aneurysm of the hepatic artery, secondary to a mediam arcuate ligament syndrome, of the diaphragm was observed. PMID: 31960685 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
We report the case of a 60-year-old male with a giant colorectal laterally spreading tumor at the recto-sigmoid junction. A single tunnel-assisted endoscopic submucosal dissection was performed that constructed a submucosal tunnel along the longitude axis of the tumor. An en bloc resection was achieved with no perforation or post-operative bleeding and a comparatively low procedure time. PMID: 31960681 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
Postoperative pain is not adequately managed in greater than 40% of surgical patients and is a high priority for perioperative research. In this meta-analysis, we examined studies comparing postoperative opioid consumption and pain scores in surgical patients who received methadone by any route vs those who received another opioid by any route. Studies were identified from PubMed, Cochrane, Web of Science, EMBASE, and Scopus from January 1966 to November 2018. Pooled odds ratios were calculated for a primary outcome of postoperative opioid consumption and secondary outcomes of time-to-extubation, time-to-first postoperativ...
Source: Pain - Category: Anesthesiology Tags: Systematic Review and Meta-Analysis Source Type: research
There has been an explosion of interest in the utility of cannabinoids as potential analgesics. This systematic review critically synthesizes the evidence for cannabinoid analgesic effects on quantitative sensory testing outcomes in both healthy adults and patients with chronic noncancer pain. Our systematic review protocol is preregistered on PROSPERO (CRD42018117367). An electronic search was made in PsycINFO, Cochrane, Google Scholar, Embase, and Pubmed of all literature published until August 2018. Of the 1217 studies found from the search, a total 39 placebo-controlled studies that met the eligibility criteria were sy...
Source: Pain - Category: Anesthesiology Tags: Systematic Review and Meta-Analysis Source Type: research
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Source: Pain - Category: Anesthesiology Tags: Topical Review Source Type: research
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