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Purpose: The purpose of this paper is to evaluate the efficacy of a multimodal, outpatient neuromuscular protocol in treating remaining sensitization and myofascial pain in endometriosis patients post-surgical excision. Patients and Methods: A retrospective longitudinal study was conducted for women aged 22 to 78 with a history of surgically excised endometriosis. 60 women with an average duration of pain of 8.63 ± 7.65 years underwent a treatment protocol consisting of ultrasound guided trigger point injections, peripheral nerve blocks, and pelvic floor physical therapy for 6 weeks. Concomitant cognitive behavioral therapy once weekly for a total of 12 weeks was also undertaken. Pain intensity and pelvic functionality were assessed at new patient consults and 3-month follow ups using Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS). Results: At new patient consults, average VAS and FPPS were 7.45 ± 2.11 (CI 6.92-7.98) and 14.35 ± 6.62 (CI 12.68 -16.02), respectively. At 3-month follow ups, average VAS and FPPS decreased to 4.12 ± 2.44 (CI 3.50-4.73; p < 0.001) and 10.3 ± 6.55 (CI 8.64-11.96; p < 0.001), respectively. Among FPPS categories, sleeping, intercourse, and working showed the highest statistical significance. Conclusion: Data suggests the multimodal protocol was effective in treating the remaining underlying sensitization and myofascial pain seen in Endometriosis patients post-surgical excision, particularly in decreasing pain and improving function during work and intercourse.
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STUDY OBJECTIVE: To determine the safety and feasibility of same-day discharge (SDD) in patients undergoing vaginal hysterectomy with pelvic floor reconstruction. DESIGN: Prospective cohort pilot study. SETTING: Single academic medical center. PATIENTS: Women undergoing vaginal hysterectomy with pelvic floor reconstruction were considered for inclusion in the study. INTERVENTIONS: SDD or overnight hospitalization after surgery. MEASUREMENTS AND MAIN RESULTS: A total cohort of 55 women undergoing vaginal hysterectomy and pelvic floor reconstruction for pelvic organ prolapse and/or urinary incontinence was identified. The control group consisted of 19 women who were planned for overnight hospitalization. The intervention group had 36 women who were planned for SDD. In the intervention group 63.9% of patients (nâ¯=â¯23) were successfully discharged home and 36.1% (nâ¯=â¯13) required an unplanned overnight admission. Reasons for unplanned admission included persistent anesthetic effects (dizziness/nausea/drowsiness, nâ¯=â¯9, 69%), uncontrolled pain (nâ¯=â¯1, 7.7%), fever (nâ¯=â¯1, 7.7%), anemia (nâ¯=â¯2, 15.4%), with return to operating room for hematoma evacuation (nâ¯=â¯1, 7.7%). A voiding trial was passed on the first attempt in 30 patients (54.5%). The percentage of successful voiding trials on the first attempt was 30.8% for patients requiring unplanned admission and 78.9% for patients with planned overnight hospitalization (pâ¯=â¯.011). There were no significant differences in the number of emergency department visits (pâ¯=â¯.677) or unplanned office visits (pâ¯=â¯.193) between the control and intervention groups. CONCLUSION: SDD after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible. Patients who were discharged the same day did not require a higher volume of emergency department or office evaluations.
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Procedimientos Quirúrgicos Ambulatorios , Recuperación Mejorada Después de la Cirugía , Histerectomía Vaginal , Diafragma Pélvico/cirugía , Prolapso de Órgano Pélvico/cirugía , Procedimientos de Cirugía Plástica , Incontinencia Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Estudios de Cohortes , Femenino , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Histerectomía Vaginal/efectos adversos , Histerectomía Vaginal/métodos , Histerectomía Vaginal/estadística & datos numéricos , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Prolapso de Órgano Pélvico/epidemiología , Proyectos Piloto , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Incontinencia Urinaria/epidemiologíaRESUMEN
STUDY OBJECTIVE: To provide surgeons with techniques for preemptive analgesia during minimally invasive gynecologic surgery. Postoperative pain management is an important component of patient care after gynecologic surgery. There have been numerous advances in pain management, including studies that show that preoperative administration of analgesics decreases postoperative pain scores and narcotic medication requirements [1-3]. However, there is limited information on the techniques for preemptive analgesia [4,5]. DESIGN: An instructional video showing a variety of preemptive analgesia techniques and the corresponding neuroanatomy (Canadian Task Force classification III). Mayo Clinic Institutional Review Board approval was not required for this video article. SETTING: Academic Medical Center INTERVENTIONS: Relevant abdominopelvic neuroanatomy is reviewed. This is followed by a demonstration of the preemptive analgesia techniques based on neuroanatomy principles. CONCLUSION: Techniques for preemptive analgesia are simple and effective. These tools can be used for patients undergoing gynecologic surgeries via a vaginal or abdominal approach and can help optimize postoperative pain and narcotic usage.
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Analgesia/métodos , Procedimientos Quirúrgicos Ginecológicos , Dolor Postoperatorio/prevención & control , Atención Perioperativa/métodos , Analgésicos/uso terapéutico , Femenino , Humanos , Manejo del Dolor , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
Whether Pneumocystis colonization is transmitted in families with human immunodeficiency virus (HIV)-infected members is unknown. Using nested polymerase chain reaction of oropharyngeal or nasopharyngeal samples, we detected colonization in 11.4% of HIV-infected adults and in 3.3% of their children, but there was no evidence of clustering.