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Latest & greatest articles for surgery
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on surgery or other clinical topics then use Trip today.
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Ultrasound-guided serratus anterior plane block for analgesia after thoracic surgery Patients who undergo surgical procedures that impair the integrity of the chest wall frequently experience extremely severe postoperative pain. Opiates and weaker analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are not sufficiently effective in achieving control of severe pain and might cause respiratory and gastrointestinal complications. In the past decade, there has been an increased (...) interest in the use of regional nerve blocks for post-thoracoscopy and post-thoracotomy analgesia.This is a prospective, randomized, double-blind and single-center study. We recruited 104 patients who underwent elective thoracoscopy. Prior to surgery, the participating patients were randomized into one of two study groups: Group 1- the "standard control group" that received standard postoperative pain control with intravenous opioids, NSAIDs and acetaminophen (paracetamol) and Group 2- the "block group
Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Anaemia and iron deficiency are frequent in patients scheduled for cardiac surgery. This study assessed whether immediate preoperative treatment could result in reduced perioperative red blood cell (RBC) transfusions and improved outcome.In this single-centre, randomised, double-blind, parallel-group controlled study, patients undergoing elective cardiac (...) surgery with anaemia (n=253; haemoglobin concentration (Hb) <120 g/L in women and Hb <130 g/L in men) or isolated iron deficiency (n=252; ferritin <100 mcg/L, no anaemia) were enrolled. Participants were randomly assigned (1:1) with the use of a computer-generated range minimisation (allocation probability 0·8) to receive either placebo or combination treatment consisting of a slow infusion of 20 mg/kg ferric carboxymaltose, 40 000 U subcutaneous erythropoietin alpha, 1 mg subcutaneous vitamin B12
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients.We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major (...) abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second
Types of materials for frontalis sling surgery for congenital ptosis. Congenital ptosis is a drooping of one or both eyelids at birth, often due to poor development of the levator palpebrae superioris muscle. This can result in amblyopia, astigmatism, and ocular torticollis and therefore may necessitate surgical intervention in early childhood if visual development is compromised. Patients may have varied levels of levator function. Those with moderate to good function may elect to first (...) attempt ptosis repair with external levator advancement or mullerectomy/Fasanella-Servat procedures. For those with poor function, those procedures are less likely to be effective, so they may undergo frontalis sling surgery, in which the tarsal plate is coupled to the frontalis muscle, so that movement of the brow and forehead result in movement of the eyelid. The optimal material to use in this surgery is unknown.To evaluate the comparative effectiveness and safety of various materials used
Antifibrinolytic therapy for preventing oral bleeding in patients with haemophilia or Von Willebrand disease undergoing minor oral surgery or dental extractions. Minor oral surgery or dental extractions (oral or dental procedures) are widely performed and can be complicated by hazardous oral bleeding, especially in people with an inherited bleeding disorder such as haemophilia or Von Willebrand disease (VWD). The amount and severity of singular bleedings depend on disease-related factors (...) . However, a systematic review of trials reporting outcomes after oral surgery or a dental procedure in people with an inherited bleeding disorder, with or without, the use of antifibrinolytic agents has not been performed to date. This is an update of a previously published Cochrane Review.Primarily, we aim to assess the efficacy of antifibrinolytic agents to prevent bleeding complications in people with haemophilia or VWD undergoing oral or dental procedures.Secondary objectives are to assess
Robot-assisted surgery in gynaecology. This is an updated merged review of two originally separate Cochrane reviews: one on robot-assisted surgery (RAS) for benign gynaecological disease, the other on RAS for gynaecological cancer. RAS is a relatively new innovation in laparoscopic surgery that enables the surgeon to conduct the operation from a computer console, situated away from the surgical table. RAS is already widely used in the United States for hysterectomy and has been shown (...) to be feasible for other gynaecological procedures. However, the clinical effectiveness and safety of RAS compared with conventional laparoscopic surgery (CLS) have not been clearly established and require independent review.To assess the effectiveness and safety of RAS in the treatment of women with benign and malignant gynaecological disease.For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, and EMBASE via Ovid, on 8 January 2018. We searched
Transition from acute to chronic pain after surgery. Over the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause (...) of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Research into how and why this transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia, use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological interventions
Inappropriate opioid prescription after surgery. Worldwide, the use of prescription opioid analgesics more than doubled between 2001 and 2013, with several countries, including the USA, Canada, and Australia, experiencing epidemics of opioid misuse and abuse over this period. In this context, excessive prescribing of opioids for pain treatment after surgery has been recognised as an important concern for public health and a potential contributor to patterns of opioid misuse and related harm (...) . In the second paper in this Series we review the evolution of prescription opioid use for pain treatment after surgery in the USA, Canada, and other countries. We summarise evidence on the extent of opioid overprescribing after surgery and its potential association with subsequent opioid misuse, diversion, and the development of opioid use disorder. We discuss evidence on patient, physician, and system-level predictors of excessive prescribing after surgery, and summarise recent work on clinical and policy
Kendall DL for ECG monitoring in people having cardiac surgery K Kendall DL for ECG monitoring in people ha endall DL for ECG monitoring in people having ving cardiac surgery cardiac surgery Medtech innovation briefing Published: 18 March 2019 nice.org.uk/guidance/mib177 pathways Summary Summary The technology technology described in this briefing is Kendall DL, a single-patient-use electrocardiogram (ECG) cable and lead wire system. It is used for diagnostic and ongoing patient monitoring (...) . This briefing focuses on its use for people having cardiac surgery. The inno innovativ vative aspects e aspects are the single-use design of the ECG cable and lead wire, which decreases the risk of cross-contamination, and allows patients to use a single set of ECG cables when in acute care. The system also has a button to secure the lead wire to the electrode, to reduce the chance of 'lead-off' false alarms. The intended place in ther place in therap apy y would be for anyone who needs ECG monitoring
Nonobstetric Surgery During Pregnancy Nonobstetric Surgery During Pregnancy - ACOG Menu ▼ Nonobstetric Surgery During Pregnancy Page Navigation ▼ INTERIM UPDATE Number 775 (Replaces Committee Opinion No. 696, April 2017) Committee on Obstetric Practice American Society of Anesthesiologists This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice and the American Society of Anesthesiologists. This document reflects emerging (...) to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. INTERIM UPDATE: The content on nonobstetric surgery in this Committee Opinion has been updated as highlighted (or removed as necessary) to reflect a limited, focused change in the language regarding sedative drugs, medically necessary surgery, antenatal corticosteroids, and venous thromboembolism. Nonobstetric Surgery During
Day-case surgery Guidelines Guidelines for day-case surgery 2019 April 2019 Published by the Association of Anaesthetists and the British Association of Day SurgeryGuidelines Guidelinesforday-casesurgery2019 GuidelinesfromtheAssociationofAnaesthetistsandtheBritishAssociationofDay Surgery C.R.Bailey, 1 M.Ahuja, 2 K.Bartholomew, 3 S.Bew, 4 L.Forbes, 5 A.Lipp, 6 J.Montgomery, 7 K.Russon, 8 O.Potparic 9 andM.Stocker 10 1Consultant,DepartmentofAnaesthesia,Guy’sandStThomas’NHSFoundationTrust (...) members of a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery (BADS). It has been seen and approvedbytheAssociationofAnaesthetist’sBoardofDirectorsandtheCouncilofBADS.Ithasbeenendorsedbythe Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) and the Royal College of Anaesthetists (RCoA). Twitter:@drcrbailey Re-use of this article is permitted in accordance with the Creative Commons Deed
Closed Wound Subfascial Suction Drainage in Posterior Fusion Surgery for Adolescent Idiopathic Scoliosis: A Prospective Randomized Control Study A prospective randomized control study.The aim of this study was to compare the complication rate in adolescent idiopathic scoliosis (AIS) posterior spinal fusion (PSF) surgery with and without drainage.PSF is the mainstay of surgical treatment for AIS. Drains are commonly used despite contradictory findings in the literature for their having any clear
Ab interno trabecular bypass surgery with iStent for open-angle glaucoma. Glaucoma is a leading cause of irreversible blindness worldwide. In early stages, glaucoma results in progressive loss of peripheral (side) vision; in later stages, it results in loss of central vision leading to blindness. Elevated intraocular pressure (IOP) is the only known modifiable risk factor for glaucoma. Minimally invasive glaucoma surgical (MIGS) techniques, such as ab interno trabecular bypass surgery (...) with iStent (Glaukos Corporation, Laguna Hills, CA, USA), have been introduced as a new treatment modality for glaucoma. However, the effectiveness of MIGS on keeping people 'drop-free' (i.e. not having to use eye drops to control IOP) and other outcomes is uncertain.To assess the effectiveness and safety of ab interno trabecular bypass surgery with iStent (or iStent inject) for open-angle glaucoma in comparison to conventional medical, laser, or surgical treatment.Cochrane Eyes and Vision's Information
Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. This an update of the review first published in 2009.Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE). The efficacy of thromboprophylaxis with low molecular weight heparin (LMWH) administered during the in-hospital period is well-documented, but the optimal duration of prophylaxis after surgery remains controversial. Some studies suggest that patients undergoing (...) major abdominopelvic surgery benefit from prolongation of the prophylaxis up to 28 days after surgery.To evaluate the efficacy and safety of prolonged thromboprophylaxis with LMWH for at least 14 days after abdominal or pelvic surgery compared with thromboprophylaxis administered during the in-hospital period only in preventing late onset VTE.We performed electronic searches on 28 October 2017 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS and registered trials
Blood & Clots Series: How do you stop warfarin for surgery? Blood & Clots Series: How do you stop warfarin for surgery? - CanadiEM Blood & Clots Series: How do you stop warfarin for surgery? In , by Kerstin de Wit March 19, 2019 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Medical Expert, Scholar Case Description You are assessing a 76 year old lady who takes warfarin for stroke prevention because she had a mechanical aortic valve replacement 4 years ago (...) . She was at the preoperative clinic this morning because she will have a knee replacement surgery in a weeks time. The anesthesiologist said they would like to perform a spinal block for the surgery, and the surgeon says the patient must come off her warfarin before he can operate. She tells you she is worried about having a stroke if she stops her warfarin. You are wondering how to advise her. Can you stop the warfarin for a week before her surgery? Do you need to prescribe ‘bridging
A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery. Surgical intervention is needed in some cases of spontaneous abortion to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries.We conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous (...) abortion would reduce pelvic infection among women and adolescents in low-resource countries. We randomly assigned patients to a single preoperative dose of 400 mg of oral doxycycline and 400 mg of oral metronidazole or identical placebos. The primary outcome was pelvic infection within 14 days after surgery. Pelvic infection was defined by the presence of two or more of four clinical features (purulent vaginal discharge, pyrexia, uterine tenderness, and leukocytosis) or by the presence of one
Subfascial endoscopic perforator surgery (SEPS) for treating venous leg ulcers. Venous leg ulcers are complex, costly, and their prevalence is expected to increase as populations age. Venous congestion is a possible cause of venous leg ulcers, which subfascial endoscopic perforator surgery (SEPS) attempts to address by removing the connection between deep and superficial veins (perforator veins). The effectiveness of SEPS in the treatment of venous leg ulcers, however, is unclear.To assess (...) the benefits and harms of subfascial endoscopic perforator surgery (SEPS) for the treatment of venous leg ulcers.In March 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of included studies as well as reviews, meta-analyses
Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. General anaesthesia combined with epidural analgesia may have a beneficial effect on clinical outcomes. However, use of epidural analgesia for cardiac surgery is controversial due to a theoretical increased risk of epidural haematoma associated with systemic heparinization. This review was published in 2013, and it was updated in 2019.To determine the impact of perioperative epidural analgesia (...) in adults undergoing cardiac surgery, with or without cardiopulmonary bypass, on perioperative mortality and cardiac, pulmonary, or neurological morbidity.We searched CENTRAL, MEDLINE, and Embase in November 2018, and two trial registers up to February 2019, together with references and relevant conference abstracts.We included all randomized controlled trials (RCTs) including adults undergoing any type of cardiac surgery under general anaesthesia and comparing epidural analgesia versus another modality