lunes, 30 de enero de 2017

Cirugía ginecológica / Gynecologic surgery

Enero 29, 2017. No. 2584

Libro sobre Cirugía Reproductiva Femenina Orientada a la Fertilidad
Book on Fertility-oriented Female Reproductive Surgery
Edited by Atef Darwish, ISBN 978-953-51-2878-6, Print ISBN 978-953-51-2877-9, 144 pages, Publisher: InTech, Chapters published January 18, 2017 under CC BY 3.0 license
DOI: 10.5772/62748
Edited Volume
In modern practice, the role of female reproductive surgery is declining apparently due to the widespread availability of assisted reproductive technology as an attractive option for infertile couples. To be more precise, prevention of female infertility should be the ultimate goal of all obstetricians and gynecologists during operating on females in the reproductive age. This book concentrates on different issues of fertility preservation both in obstetrics and gynecology. Not a matter of kindly or courtesy, but the core of obstetricians and gynecologists' work is to restore normal anatomy and to preserve fertility for all women in the reproductive age.
El parecoxib aumenta el umbral del dolor muscular y alivia el dolor del hombro después de cirugía laparoscópica ginecológica
Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial.
J Pain Res. 2016 Sep 13;9:653-660. eCollection 2016.
OBJECTIVES: Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. MATERIALS AND METHODS: The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery.
RESULTS: Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01).
CONCLUSION: Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologiclaparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.
KEYWORDS: laparoscopic surgery; nonsteroidal anti-inflammatory drugs; pain threshold; sensitization; shoulder pain
Efecto del neumoperitoneo en el dolor postoperatorio en cirugía laparoscópica ginecológica: estudio randomizado, doble ciego y controlado
The effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery: a double-blinded randomized controlled trial.
Int J Womens Health. 2016 Aug 10;8:373-9. doi: 10.2147/IJWH.S109568. eCollection 2016.
OBJECTIVES: To compare the effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery and the amount of postoperative analgesic dosage. METHODS: The trial included 45 females who had undergone operations during the period December 2014 to October 2015. The patients were block randomized based on operating time (<2 and ≥2 hours). The intervention group (n=23) was treated with postoperative intraperitoneal gas drain and the control group (n=22) was not. The mean difference in scores for shoulder, epigastric, suprapubic, and overall pain at 6, 24, 48 hours postoperatively were statistically evaluated using mixed-effect restricted maximum likelihood regression. The differences in the analgesic drug usage between the groups were also analyzed using a Student's t-test. The data were divided and analyzed to two subgroups based on operating time (<2 hours, n=20; and $2 hours, n=25). RESULTS: The intervention had significantly lower overall pain than the control group, with a mean difference and 95% confidence interval at 6, 24, and 48 hours of 2.59 (1.49-3.69), 2.23 (1.13-3.34), and 1.48 (0.3-2.58), respectively. Correspondingly, analgesic drug dosage was significantly lower in the intervention group (3.52±1.47 mg vs 5.72±2.43 mg, P<0.001). The three largest mean differences in patients with operating times of ≥2 hours were in overall pain, suprapubic pain at 6 hours, and shoulder pain at 24 hours at 3.27 (1.14-5.39), 3.20 (1.11-5.26), and 3.13 (1.00-5.24), respectively. These were greater than the three largest mean differences in the group with operating times of <2 hours, which were 2.81 (1.31-4.29), 2.63 (0.51-4.73), and 2.02 (0.68-3.36). The greatest analgesic drug requirement was in the control group with a longer operative time. CONCLUSION: The use of intraperitoneal gas drain was shown to reduce overall postoperative pain in benign gynecologiclaparoscopic surgery. The effects were higher in patients who had experienced longer operating times.
KEYWORDS: gynecology; intraperitoneal gas drain; laparoscopic surgery; postoperative pain
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.

Curso Internacional de Actualidades en Anestesiología
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Cuidad de México, Febrero 9-11, 2017
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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