RESUMEN
INTRODUCTION: We report the results of an observational study of pain intensity before and after implementation of an algorithm for postoperative pain management. The algorithm included multiple factors for treatment. METHODS: Data of 130âconsecutive patients with defined surgical procedures were extracted from charts before and after implementation of the algorithm. Our patients documented pain intensity at rest and on movement on a numerival rating scale (NRS) from 0 (=âno pain) to 10 (=â worst pain). A successful pain management was definded as maximum pain intensity at rest ≤â3 and on movement ≤â5 on the NRS. For statistical analysis we used the Wilcoxon and the chi squared test. RESULTS: The frequency of a successful pain management increased from 49â% (individual pain management) to 85â% (algorithm) at rest 8 (pâ<â0.001), on movement the rates were 42â% and 86â%, respectively (pâ<â0.001). In the total group, we found a reduction of maximum pain intensity at rest (meanâ±âsd) from 4.05â ±â 2.54 to 2.18â±â1.82 (pâ<â0.001) and with movement from 6.04â±â2.51 to 3.5â±â2.08 (pâ<â0.001). CONCLUSION: Implementing an algorithm for postoperative pain management resulted in a clinically relevant reduction of postoperative pain. Our findings reflect the result of a complex change in pain management, and therefore cannot be attributed to any single factors involved.
Asunto(s)
Algoritmos , Analgésicos Opioides/uso terapéutico , Analgésicos/uso terapéutico , Procedimientos Quirúrgicos del Sistema Digestivo , Hernia Inguinal/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Cirugía Torácica Asistida por Video , Procedimientos Quirúrgicos Torácicos , Acetaminofén/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Aminas/administración & dosificación , Analgesia Epidural , Ácidos Ciclohexanocarboxílicos/administración & dosificación , Dipirona/administración & dosificación , Etoricoxib , Femenino , Gabapentina , Alemania , Humanos , Capacitación en Servicio , Ketamina/administración & dosificación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/clasificación , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Pirinitramida/administración & dosificación , Piridinas/administración & dosificación , Garantía de la Calidad de Atención de Salud , Sulfonas/administración & dosificación , Resultado del Tratamiento , Adulto Joven , Ácido gamma-Aminobutírico/administración & dosificaciónRESUMEN
The fixed combination of ampicillin (2 g)/sulbactam (1 g) was administered as perioperative prophylaxis at induction of anesthesia in 20 patients undergoing spinal microneurosurgery. It was noteworthy that after the short infusion ampicillin and sulbactam penetrated rapidly from blood into the different tissues affected by the surgical procedures. The following mean concentrations were measured in tissues: muscle 32.3+/-6.5 mg/kg ampicillin and 18.6+/-2.9 mg/kg sulbactam (11.1 min), ligament 39.5+/-11.1 mg/kg ampicillin and 25+/-6.5 mg/kg sulbactam (13.8 min), bone 12+/-3.6 mg/kg ampicillin and 7+/-0.8 mg/kg sulbactam (20.6 min), disk 10.2+/-3.3 mg/kg ampicillin and 7.3+/-1.8 mg/kg sulbactam (44.2 min). The mean time of sampling is given in brackets. For a period of at least 2 h the levels of both drugs measured in serum and in the different tissues were above the MICs for bacteria involved in postoperative wound infections. The administration of ampicillin/sulbactam apparently achieved sufficiently, high antibiotic concentrations, even in bradytrophic tissues such as ligament, bone, and disk, and seemed to meet the pharmacological criteria for perioperative prophylaxis in spinal microneurosurgery.
Asunto(s)
Ampicilina/farmacocinética , Antibacterianos/farmacocinética , Profilaxis Antibiótica , Penicilinas/farmacocinética , Médula Espinal/cirugía , Sulbactam/farmacocinética , Adulto , Anciano , Ampicilina/administración & dosificación , Antibacterianos/administración & dosificación , Combinación de Medicamentos , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Penicilinas/administración & dosificación , Atención Perioperativa , Sulbactam/administración & dosificaciónRESUMEN
The iliacus compression syndrome has a kind of exceptional position--as to genesis, development and therapy--in comparison with the other compartment-compression syndromes of the limbs. Indeed there exist similar pathophysiological, rules, but the special anatomic facts enlarge the etiological, differential-diagnostic and therapeutic spectrum. Thus, concerning the frequency of causes, not the trauma but the spontaneous bleeding in coagulation disturbances takes the first place, and unusual causes, such as rupturing aortic aneurysms, have to be included in the differential diagnostic discussion. The finest diagnostic sign besides pain is the palsy of the Nervus Femoralis. As to the treatment, operative measures are possible. The exact knowledge of the anatomy is important for the understanding of the specialties mentioned above.
Asunto(s)
Síndromes Compartimentales/diagnóstico , Fascia , Nervio Femoral , Síndromes de Compresión Nerviosa/diagnóstico , Adulto , Síndromes Compartimentales/patología , Diagnóstico Diferencial , Fascia/patología , Femenino , Nervio Femoral/patología , Hemorragia/complicaciones , Humanos , Conducto Inguinal/patología , Músculos/patología , Síndromes de Compresión Nerviosa/patologíaRESUMEN
Carcinomas of the adrenal cortex show a high degree of malignancy. Although one would expect their endocrinal activity to permit early diagnosis, reports of complete cures are rare, despite radical removal of the primary tumour. We are reporting on the case of a boy, born in 1965, who 12 years after removal of a carcinoma from the left adrenal cortex may be regarded as cured.