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Article
Infiltrative Technique in Post-Tonsillectomy Pain Reduction with 0.5% Bupivacaine & 1/200000 Adrenaline
طريقةارتشاح البيوبيفاكين 0.5% مع الادرينالين 1/200000 في تقليل الالم الناتج من عملية استئصال اللوزتين

Author: Nasir U. Hassen د. ناصراسامة حسن
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 3 Pages: 204-207
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background Tonsillectomy is one of the commonly performed surgical procedures in otolaryngology. Postoperative morbidity, including pain, bleeding, inadequate oral intake and dehydration can create problems. Pain after tonsillectomy still remains to be a frequent problem. In an effort to reduce post-tonsillectomy morbidity, numerous modifications and adjuncts to standard surgical technique have been proposed. Objective: To determine the effectiveness of 0.5% bupivacaine and 1/200000 adrenaline in post tonsillectomy pain using an intra-individual design.Methods: 47 patients aged 8-35 years were included in a prospective study, diagnosed clinically as chronic tonsillitis in Karama teaching hospital. Patients received a local infiltration of 0.5% bupivacaine and 1/200000 adrenaline solution on the right tonsillar bed, and received a local infiltration of normal saline on the left tonsillar bed as control, at the end of the operation in the theatre. Postoperative pain was assessed with a visual analog scale at 4,6,8,12,24 hours after the procedure.Result: According to visual analog scale results, the severity of pain was less in the site infiltrated with 0.5 bupivacaine and 1/200000 adrenaline than the site infiltrated the normal saline.Conclusion: local 0.5% bupivacaine and 1/200000 adrenaline infiltration in tonsillar bed can reduce post tonsillectomy pain.Key ward: Bupivacaine, Tonsillectomy Pain, Local anesthesia.

خلفية البحث:تعتبر عملية استئصال اللوزتين من اكثر العمليات التي تجرى في قسم الانف والاذن والحنجرة.ان العواقب ما بعد العملية هي : الالم , النزف , صعوبة تناول السوائل عن طريق الفم و فقدان سوائل الجسم.هناك جهد كبير من اجل تقليل عواقب الالم ما بعد العملية وتحويرات كثيرة في عمليات استئصال اللوزتين.الهدف:تحديد فعالية البيوبيفاكين 0.5% مع الادرينالين 1/ 200000 في التاثير على الالم ما بعد استئصال اللوزتين.الطريقة:اجري البحث على 47 مريضا, اعمارهم ما بين (8-35) سنة , دراسة تطلعية في مستشفى الكرامة التعليمي على مرضى يعانون من التهاب اللوزتين المزمن و تم علاجهم بعملية استئصال اللوزتين, تم اعطائهم البيوبيفاكين 0.5% مع الادرينالين 1/ 200000 في الجهة اليمنى من موقع اللوزتين , والمحلول المتعادل الملوحة في الجهة اليسرى من موقع اللوزتين عند نهاية العملية. تم تقييم الالم بعد العملية بواسطة مقياس التدرج المماثل البصري في24,12,8,6,4 ساعة.النتائج:استنادا الى نتائج مقياس التدرج المماثل البصري شدة الالم كان اقل في جهة الارتشاح بالبيوبيفاكين 0.5% مع الادرينالين 1/ 200000 عن الجهة التي تم وضع المحلول المتعادل الملوحة.الاستنتاجات:الزرق الموضعي بالبيوبيفاكين 0.5% مع الادرينالين 1/ 200000 بواسطة الارتشاح في موضع اللوزتين يقلل الالم بعد العملية.


Article
Randomized, Prospective Comparison of Post-Operative Pain In Low - Versus High -Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy
مقارنة عشوائية ، مستقبلية للألم بعد العملية الجراحية في منخفض - مقابل عالية الضغط Pneumoperitoneum في استئصال المرارة بالمنظار

Authors: Nabaz Hassan Ismaeel --- Ali A. Al-Dabbagh
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2010 Volume: 14 Issue: 2 Pages: 35-40
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: CO2 insuflation constitutes the commonest means of creat-ing the pneumoperitoneum (PP), but it is attributed to many post-laparoscopic cholecyste-comy adverse effects including pain triggering. The aim of this trial was to evaluate the effi-cacy of low-pressure CO2 PP during laparoscopic cholecystectomy (LC) in reducing the incidence of postoperative pain.Methods: A double-blind, randomized, clinical trial was conducted on 100 patients with symptomatic gall stones. Patients were randomized preoperatively into group A (n=50) who underwent LC with 8 mmHg CO2 PP throughout the procedure and those in group B (n=50) had LC with 12 mmHg CO2 PP. Abdominal and shoulder-tip pain were assessed with verbal rating scale (VRS) scoring at 4, 8, 12 and 24 hours postoperatively.Results: The low-pressure PP did not increase the duration of surgery. There were neither significant peri-operative complications nor conversion to open procedure in either group. A statistical comparison of mean cumulative VRS scores for abdominal and shoulder-tip pain in both groups shows statistical significance at 4, 8, 12 and 24 hours after operation.Conclusions: A CO2 PP at 8 mmHg reduces both the frequency and intensity of abdomi-nal and shoulder-tip pain following LC without increasing the rate of intra-operative compli-cations.


Article
Facial Pain and Intranasal Contact Pressure Zones

Author: Nada Kalil Yaseen
Journal: Diyala Journal For Pure Science مجلة ديالى للعلوم الصرفة ISSN: 83732222 25189255 Year: 2010 Volume: 6 Issue: 3 Pages: 167-177
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Patients with facial pain are commonly diagnosed as suffering from sinusitis and many of these patients do not have sinus disease and the pain can be attributed to other causes.Aim: To provide evidence by therapeutic trial whether mucosal contact pressure zones do cause facial pain and headache, Patients and methods: Clinical trial of Twenty four patients were complaining of facial pain or headache of at least moderate severity mucosal contact pressure zone(s) between middle or inferior turbinate and nasal septum and no evidence of sinus infection were included in this study which was carried out at Tikrit teaching hospital and private hospital by senior auther, during two years period from December.2007_december 2009 were visible endoscopically, and no evidence of sinus infection. All patients underwent initial treatment with topical nasal steroids for at least 6 weeks. Patients who failed to respond, or who only had partial response to topical nasal steroids, were offered surgery designed to eliminate the mucosal contact pressure zone. Surgery consisted of either septoplasty, subtotal resection of the turbinate, or both septoplasty and turbinate reduction. Patients followed up for between 6 months to one yearResults: Facial pain and headache were successfully relieved in 20/24 (83%) cases. Of the four failures, one had undiagnosed sphenoidal sinus infection which became apparent during follow-up nasendoscopy.Two patients were depressed. One patient persisted with pain and headache for unknown reasons. Conclusions: The technical success rate of treatment of headache and facial pain in eliminating mucosal contact pressure zones was 100%, but this does not automatically translate into a 100% success rate in relieving symptoms.


Article
Effect of subhepatic drainage after aparoscopic cholecystectomy
تأثير وضع صونده البزل تحت الكبد بعد عمليات رفع المرارة بالناظور

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Abstract

ABSTRACT:Background:Laparoscopic cholecystectomy is associated with a high incidence of postoperative pain, nausea, and vomiting. To determine whether a drain in the peritoneal cavity during laparoscopic cholecystectomy is both a clinical and cost-effective method of reducing postoperative pain, nausea, vomiting and hospital stay. Patients and methods:Ninety nine patients undergoing successful laparoscopic cholecystectomy, randomized blindly into two groups subhepatic drainage group and a control group, using a visual analogue scale to assess postoperative pain, nausea and vomitingResults:The incidence of nausea was lower in the drainage group at 72 hours Although severity of pain was lower at 12, 24,72hours in the drainage group, the difference was not significant. There was also no difference between the groups regarding to hospital stay.Conclusion:There is no significant effect to put a subhepatic drain after laparoscopic cholecystectomy on postoperative pain, nausea, vomiting and hospital stay.

المقدمة:- في عمليات رفع المرارة بالناطور ,نسبة عالية من المرضى يشكون من الألم بعد العملية ,الغثيان والتقيؤ .الهدف من البحث :- لتقدير فيما اذ بزل البطن بعد العملية يؤثر في نسبة هذا المشاكل وكذلك بقاء المريض اكثر فتره من الزمن في المستشفى .طرق البحث :-تم إجراء 99عملية رفع المرارة بالناظور تم تقسيمهم الى مجموعتين بصورة عشوائية المجموعة الأولى تم وضع صوندة بزل تحت الكبد بعد العملية والمجموعة الثانية بدون بزل وتم تقدير نسبة الألم , الغثيان , التقيؤ في كلا المجموعتين النتائج:- نسبة الألم والغثيان بعد العملية اقل في مجموعة البزل لكن الاختلاف ضئيل لايوجد فرق بين المجموعتين فيما يتعلق ببقاء المريض في المستشفى .الاستنتاج : ـــلا يوجد اختلاف واضح فيما يخص الألم ، الغثيان ، التقيؤ ، والبقاء في المستشفى فيما وضع او لم يوضع أنبوب البزل تحت الكبد في عمليات رفع المرارة بالناظور .

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