Objective To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation. Methods 158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh. Results The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）. Conclusions Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.
ObjectiveTo compare the safety, effectiveness, and stability of 3D Max lightweight patch and standard patch in laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy. MethodsThe clinical data of 147 patients who underwent laparoscopic TAPP herniorrhaphy with 3D Max from May 2013 to May 2014 in this hospital were collected. Of all the patients, the lightweight patches were used in 75 patients (observation group), the standard patches were used in 72 patients (control group). The mean operative time, mean early postoperative ambulation time, mean bleeding volume, postoperative pain, postoperative foreign body sensation, complications, average hospital stay, and average costs were compared between these two groups. The postoperative pain point was determined by using visual analogue scale (VAS). The foreign body sensation of postoperative groin area was determined basing on the pain point. ResultsThere were no significant differences in the terms of the mean operation time, the mean early postoperative ambulation time, the mean bleeding volume, the average costs, and the average hospital stay between the observation group and the control group (P > 0.05). On postoperative 2 d, the pain point of the observation group was slightly lower than that of the control group, but there was no statistically significant difference between these two groups (P=0.132); On postoperative 1 month and 6 months, the postoperative pain points of the observation group were significantly lower than those of the control group, the differences were statistically significant (P=0.031, P=0.018). There was no recurrence of hernia and complications in the two groups. ConclusionsThe cost of 3D Max lightweight patch in laparoscopic TAPP herniorrhaphy application is slightly higher than that in standard patch, but it could alleviate postoperative pain, reduce postoperative foreign body sensation, and make patients feel more comfortable. It is safe, effective, and stable in clinical application of laparoscopic TAPP herniorrhaphy.
ObjectiveTo explore the causes and preventive measures of pain after laparoscopic cholecystectomy (LC). MethodsDomestic and international literatures were collected to summary the causes and preventions of pain after LC. ResultsPain after LC had several origins:the irritative effect of carbon dioxide (CO2) gas, residual pockets of CO2 in the abdominal cavity, peritoneal and diaphragmatic stretching and injury, and complications related to the operation. The main measures included:nitrous oxide (N2O) gas insufflation or abdominal wall lift, low-pressure of pneumoperitoneum, shortened the time of pneumoperitoneum, active gas aspiration, intra-abdominal instillation of isotonic saline, the use of local anesthesia as well as Traditional Chinese medicine. ConclusionsThe causes of pain after LC are multifactorial. It is the key to reduce postoperative pain that we should pay more attention to every perioperative aspect.
Objective To describe the situation of postoperative pain management in colorectal cancer patient in enhanced recovery after surgery (ERAS) mode, and explore its influenceing factors. Methods From March to December 2017, colorectal cancer patients in ERAS mode in Department of Gastrointestinal Surgery, West China Hospital of Sichuan University were selected. On the third day after surgery, a total of 74 patients with acute pain completed a questionnaire, which was composed of a demographic form, the Houston Pain Outcome Instrument (HPOI), Self-Rating Anxiety Scale, and Social Support Rating Scale. Mean±standard deviation and percentage were used to describe the total score of pain experience, t test, analysis of variance, Spearman correlation analysis were used for single-factor analysis, and multiple linear regression was used for multi-factor analysis. Results The mean total score of pain experience was 15.1±3.8. Single-factor analysis results showed that the affection of pain on daily life (rs=0.270, P=0.020), satisfaction of pain controlling education (rs=–0.283, P=0.015), subjective support (rs=–0.326, P=0.005), and social support utilization (rs=–0.253, P=0.029) were correlated with the total score of pain experience. Multi-factor analysis results showed that satisfaction of pain controlling education (P<0.001) and subjective support (P=0.005) were negative influencing factors of postoperative pain experience score, and severe anxiety (P=0.001) and pain expectation after surgery (P=0.016) were positive influencing factors of postoperative pain experience score. Conclusions Pain management situation is not so bad in these patients. High satisfaction of pain controlling education and high subjective social support are helpful to decrease pain. The medical staff should pay more attention to patients with severe anxiety, and help patients to establish reasonable pain expectation after surgery.
ObjectiveTo investigate the effect of preoperative gum chewing on the postoperative rehabilitation of patients undergoing gynecologic laparoscopic surgery.MethodsA total of 160 patients undergoing elective gynecologic laparoscopic surgery between January and May 2013 were selected to participate in the study. Each patient was randomly assigned to one of the two groups: the trial group (n=80) or the control group (n=80). Thirty to sixty minutes before the surgery, the patients in the trial group chewed one piece of sugarless gum for at least 30 minutes, and then removed the gum before being taken to the operating room; while the patients in the control group chewed nothing. The time to first passage of flatus and the time to first defecation after surgery, length of hospital stay, the degrees of pain at 2-, 4-, 6-, 8-, 24-, 48-hour after surgery, the incidences of postoperative nausea, vomiting, and abdominal distension, postoperative analgesic and antiemetic drug requirement were recorded.ResultsThe mean time to first passage of flatus was significantly earlier in the trial group than that in the control group [(16.49±7.64) vs. (20.25±7.94) hours, P=0.003]. The mean time to first defecation was significantly earlier in the trial group than that in the control group [(48.16±15.25) vs. (55.80±18.97) hours, P=0.006]. The degree of pain at 2-hour after surgery was significantly lighter in the trial group than that in the control group (P<0.05). Fewer participants in the trial group than in the control group experienced postoperative nausea (43.75% vs. 61.25%, P=0.027). There were no significant differences in the length of hospital stay, the degrees of pain at 4-, 6-, 8-, 24- and 48-hour after surgery, incidences of postoperative vomiting and abdominal distension, postoperative analgesic, or antiemetic drug requirement between the two groups (P>0.05).ConclusionsGum chewing before surgery can promote the recovery of gastrointestinal function, reduce postoperative short-term pain, and promote postoperative rehabilitation in patients undergoing gynecologic laparoscopic surgery. Gum chewing before surgery can be used clinically as an easy, inexpensive, safe, and effective procedure.
ObjectiveTo explore the effect of rehabilitation training focusing on early exercise on the time of first getting out of bed after surgery, pain during early activities, postoperative infection rate and the length of hospital stay for renal transplant recipients.MethodsThe clinical data of patients undergoing allogeneic renal transplantation in West China Hospital of Sichuan University from June to August 2020 were analyzed retrospectively. According to the time of multidisciplinary postoperative management and the time of early rehabilitation intervention, the patients were divided into the conventional group (from June 2020 to the beginning of multidisciplinary postoperative management) and the rehabilitation group (after multidisciplinary postoperative management). The time to get out of bed for the first time after surgery, the Visual Analogue Score (VAS) during weight monitoring on the second day post operation, the number of days required to complete an independent walk of 100 meters, postoperative complications, the incidence of postoperative infection and the length of hospital stay were compared between the two groups.ResultsA total of 79 patients were included. There were 46 cases in the conventional group and 33 cases in the rehabilitation group. Among the included patients, 14 patients had postoperative infection, 1 patients in the conventional group developed thrombosis, no catheter shedding or bleeding after exercise occurred. The differences between the rehabilitation group and the conventional group in the time to get out of bed for the first time after surgery [(1.1±0.2) vs. (2.2±0.4) d; t=13.224, P<0.001], the VAS during weight monitoring on the day post operation (2.5±0.9 vs. 3.4±1.4; t=3.267, P<0.001), the number of days required to complete an independent walk of 100 meters [(2.2±0.4) vs. (4.0±0.8) d; t=11.312, P<0.001], and the incidence of postoperative infection (6.1% vs. 26.1%; χ2=5.285, P=0.022) were statistically significant. There was no significant difference in the length of stay between the rehabilitation group and the conventional group [(19.8±5.8) vs. (20.7±7.4) d; t=0.584, P=0.561].ConclusionEarly postoperative rehabilitation training reduces the time required for renal transplant recipients to get out of bed for the first time post operation and to walk 100 meters independently, reduce the pain response during early activities, and reduce the incidence of postoperative infection.