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Biomedical subjects

H Kehlet

Publications and source records attributed to H Kehlet.

At least 127 records · Page 7Linked to original sources
PubMed1999

Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones.

BACKGROUND: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. METHODS: One hundred and two patients were referred to elective cholecystectomy in a prospective study. Median age was 45 years; range, 20-81 years. A preoperative questionnaire on pain, symptoms, and history was completed, and the questions on pain and symptoms were repeated 1 year postoperatively. Preoperative cholescintigraphy and sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without postcholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. RESULTS: Eighty patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an introverted personality and by the absence of 'agonizing' pain and of symptoms coinciding with pain (P < 0.000001). In a constructed logistic regression model 15 of 18 predicted patients had postoperative pain (PVpos = 0.83). Of 62 patients predicted as having no pain postoperatively, 56 were pain-free (PVneg = 0.90). Overall accuracy was 89%. CONCLUSION: From this prospective study a model based on preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the model should be validated in future studies.

Adult↗
PubMed1999

Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work.

OBJECTIVE: To provide a detailed description of post-herniorrhaphy convalescence. DESIGN: Prospective, descriptive, consecutive questionnaire case series. SETTING: Public university hospital, Denmark. PATIENTS: 100 consecutive patients treated for inguinal hernia. INTERVENTION: Elective open inguinal herniorrhaphy under local anaesthesia. One day convalescence for light/moderate and three weeks for strenuous physical activity was recommended. MAIN OUTCOME MEASURE: Duration of absence from work or main recreational activity. RESULTS: Overall median absence (including the day of operation) was 6 days (interquartile range 1-16). For unemployed patients it was 1 day (0-7), for patients with a light or moderate workload 6 days (3-12), and for those with a heavy workload 25 days (21-37). Among the 64 patients, who did not follow the recommendations, pain was contributory in 33 and advice from the general practitioner in 12. Pain was the main cause of impairment of activities of daily living. CONCLUSION: Well-defined recommendations for convalescence may, together with improved management of postoperative pain, shorten convalescence; they are essential in the evaluation of effects of different surgical techniques of herniorrhaphy on convalescence.

Absenteeism↗
PubMed1999

Levobupivacaine vs bupivacaine as infiltration anaesthesia in inguinal herniorrhaphy.

We have compared the anaesthetic and analgesic efficacy of levobupivacaine with that of racemic bupivacaine in 66 male patients undergoing ambulatory primary inguinal herniorrhaphy. Patients were allocated randomly in a double-blind manner to local infiltration anaesthesia (0.25% w/v 50 ml) with either racemic bupivacaine (n = 33) or levobupivacaine (n = 33). Scores for intraoperative pain and satisfaction with anaesthesia were recorded, together with perception of postoperative pain and need for supplementary postoperative analgesic medications in the first 48 h after operation. Intraoperative satisfaction with the infiltration anaesthesia was similar, with median scores of 77 (levobupivacaine) and 80 (bupivacaine) (VAS; 100 mm = extremely satisfied). Time averaged postoperative pain scores (48 h) were 8 (levobupivacaine) and 10 (bupivacaine) in the supine position, 13 (levobupivacaine) and 12 (bupivacaine) while rising from the supine position to sitting, and 9 (levobupivacaine) and 13 (bupivacaine) while walking (VAS; 100 mm = worst pain imaginable) (ns). There was no difference in the use of peroral postoperative analgesics between the two groups. We conclude that racemic bupivacaine and its S-enantiomer levobupivacaine had similar efficacy when used as local infiltration anaesthesia in inguinal herniorrhaphy.

Adult↗
PubMed1999

Combined field block and i.p. instillation of ropivacaine for pain management after laparoscopic sterilization.

We have studied the effect of ropivacaine for combined port site and mesosalpinx infiltration, and peritoneal instillation on pain, nausea and vomiting after laparoscopic sterilization, in a double-blind, placebo-controlled study in 80 patients. The total dose of ropivacaine was 285 mg. All patients received intra- and postoperative NSAID in fixed doses. Abdominal and shoulder pain, nausea and vomiting were recorded during the first 8 h after operation and in a diary for 3 days. In the ropivacaine group, abdominal pain scores were lower during the first 4 h (P < 0.00001), additional use of morphine was less (P < 0.001) and fewer patients had nausea or vomiting during the first 72 h (five vs 14; P < 0.05). There were no signs of local anaesthetic toxicity.

Adult↗
PubMed1999

Effect of riluzole on acute pain and hyperalgesia in humans.

Riluzole modulates several transmitter systems which may be involved in nociception. Antinociceptive effects have been shown in animal studies, but there are no human data. Therefore, we have examined the acute analgesic effect of riluzole in a human model of inflammatory pain induced by a thermal injury on the distal leg (47 degrees C, 7 min, 12.5 cm2) in 20 healthy volunteers. Hyperalgesia to mechanical and heat stimuli were examined by von Frey hairs and thermodes. We used a randomized, double-blind, placebo-controlled design, and subjects received riluzole 100 mg or placebo for 2 days with a 14-day interval. The burns produced significant hyperalgesia, but riluzole had no acute analgesic effects in normal or hyperalgesic skin.

Acute Disease↗
PubMed1999

Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy.

Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1 or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P < 0.01) but significantly lower pain scores during rest (P < 0.05) and mobilization (P < 0.01). More patients undergoing general anaesthesia received antiemetics (13 vs five; P < 0.05), but fewer received supplementary opioids on the ward (eight vs 16; P < 0.05). We conclude that opioid-free epidural-spinal anaesthesia for hysterectomy caused less PONV, but with less effective analgesia compared with general anaesthesia with postoperative continuous epidural morphine and bupivacaine.

Adult↗
PubMed1999

Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study.

UNLABELLED: Pain is the dominant complaint after laparoscopic cholecystectomy. No study has examined the combined effects of a somato-visceral blockade during laparoscopic cholecystectomy. Therefore, we investigated the effects of a somato-visceral local anesthetic blockade on pain and nausea in patients undergoing elective laparoscopic cholecystectomy. In addition, all patients received multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3 postoperative h, the use of morphine and antiemetics was registered, and pain and nausea were rated hourly. Daily pain intensity, pain localization, and supplemental analgesic consumption were registered the first postoperative week. Ropivacaine reduced overall pain the first two hours and incisional pain for the first three postoperative hours (P < 0.01) but had no apparent effects on intraabdominal or shoulder pain. During the first 3 postoperative h, morphine requirements were lower (P < 0.05), and nausea was reduced in the ropivacaine group (P < 0.05). Throughout the first postoperative week, incisional pain dominated over other pain localizations in both groups (P < 0.01). We conclude that the somato-visceral local anesthetic blockade reduced overall pain during the first 2 postoperative h, and nausea, morphine requirements, and incisional pain were reduced during the first 3 postoperative h in patients receiving prophylactic multi-modal analgesic treatment. IMPLICATIONS: A combination of incisional and intraabdominal local anesthetic treatment reduced incisional pain but had no effect on deep intraabdominal pain or shoulder pain in patients receiving multimodal prophylactic analgesia after laparoscopic cholecystectomy. Incisional pain dominated during the first postoperative week. Incisional infiltration of local anesthetics is recommended in patients undergoing laparoscopic cholecystectomy.

Abdominal Pain↗
PubMed1999

Effect of oxygen treatment on heart rate after abdominal surgery.

BACKGROUND: Cardiac complications are common during the postoperative period and may be associated with hypoxemia and tachycardia. Preliminary studies in high-risk patients after operation have shown a possible beneficial effect of oxygen therapy on arterial oxygen saturation and heart rate. METHODS: The authors studied the effect of oxygen therapy on arterial oxygen saturation and heart rate in 100 consecutive unselected patients randomly and double blindly allocated to receive air or oxygen therapy between the first and fourth day after major abdominal surgery. RESULTS: The median arterial oxygen saturation rate increased significantly from 96% to 99% (P < 0.0001) and the heart rate decreased significantly from 85 beats/min to 81 beats/min (P < 0.0001) during oxygen supplementation compared with air administered by a binasal catheter. The greatest decrease in heart rate occurred in patients with the lowest oxygen saturation or the highest heart rate values before oxygen supplementation. Overall, 73% of this unselected group of patients responded with decreased heart rate during supplemental oxygen therapy. No significant differences in changes in heart rate after oxygen supplementation were found between patients with or without an epidural catheter or between the postoperative day studied. CONCLUSION: Postoperative oxygen therapy increased arterial oxygen saturation and decreased heart rate after uncomplicated abdominal surgery in a consecutive unselected group of patients who received routine postoperative care.

Abdomen↗
PubMed1999

Does effective postoperative pain management influence surgical morbidity?

It has been assumed that adequate postoperative pain relief will improve outcome from surgery, but several controlled trials have demonstrated that pain treatment with nonsteroidal anti-inflammatory drugs, patient-controlled analgesia or epidural techniques will not significantly improve outcome after major procedures. In lower body procedures, however, intra- and early postoperative pain relief with epidural or spinal anaesthesia reduces blood loss and thromboembolic complications. It is hypothesized that effective postoperative pain relief may significantly improve outcome only if integrated into a multimodal rehabilitation program.

Analgesia, Epidural↗
PubMed1999

Balanced analgesia: what is it and what are its advantages in postoperative pain?

The concept of balanced analgesia was introduced to improve analgesic efficacy and reduce adverse effects. A large amount of clinical data has documented improved analgesia by combining different analgesics, but data on reducing adverse effects are inconclusive. Balanced analgesia should be used whenever possible, and future studies should be directed to define optimal combination regimens in individual surgical procedures.

Analgesics↗
PubMed1998

[New prognostic markers in colorectal cancer].

The majority of patients diagnosed as having colorectal cancer do not survive five years, although 70%-80% undergo curative surgery. Only a minority of the patients receive additional adjuvant chemo-, radio- and/or immunotherapy, which has proven its efficiency in a minor part of patients with Dukes C disease. Therefore, adjuvant therapy has only an insignificant impact on overall survival improvement. The present treatment of patients with colorectal cancer is far from sufficient, and this has led to considerations of how to optimize both surgical and adjuvant medical treatment strategy. Current biotechnological research in tumour biology has led to the development of several new treatment modalities, and within few years some of these will be tested clinically. It cannot be expected that all modalities may prove equally efficient in all patients. Furthermore, half the operated patients are cured by surgery alone, and these should not receive additional adjuvant treatment. Therefore, considerations are required of how to implement new modalities, and of selection of patients who are expected to benefit from a specific modality or a combination of modalities. It is suggested, that new biological markers of development, growth and dissemination of colorectal cancer can be used to predict prognosis either alone or in various combinations, and as selection markers to discriminate between patients who only need surgery and patients who may need adjuvant treatment.

Animals↗
PubMed1998

[The effect of prednisolone on the systemic response and wound healing after colonic surgery].

To study the effect of preoperative treatment with a single high-dose of glucocorticoid on the systemic and immunological response, wound healing, and convalescence after colonic surgery, thirty patients were double-blind randomized to receive either methylprednisolone 30 mg/kg intravenously 90 minutes prior to induction of anaesthesia (group 1, n = 12), or to receive placebo (group 2, n = 12). Six patients were excluded from the study. Assessments of pain, pulmonary function, convalescence, various injury and wound-healing factors were done until 10 days after surgery. Conventional reduction in pulmonary function and mobilization was improved in group 1. Interleukin-6 and C-reactive protein levels increased significantly less in group 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activation was significantly less pronounced in group 1. Reduction of collagen turnover was observed in group 1, but without detrimental effect on collagen accumulation. It is concluded that treatment with a single high dose of glucocorticoid before colonic surgery may improve postoperative pulmonary function and mobilization and reduce plasma cascade system activations, the inflammatory response, and immunofunction, but without detrimental effects on wound healing.

Anti-Inflammatory Agents↗
PubMed1998

[Lung physiotherapy as prophylaxis against atelectasis and pneumonia after abdominal surgery].

Postoperative pulmonary complications play a significant role for the postoperative morbidity after abdominal surgery. To prevent this, an array of methods, such as lung physiotherapy, incentive spirometry, or mask treatment with positive airway pressure are used. The available controlled studies indicate that none of these treatment modalities reduce the occurrence of postoperative atelectasis, but only lung physiotherapy is able to reduce the development of postoperative pneumonia. Thus, we recommend lung physiotherapy as prophylactic treatment after abdominal surgery. The value of optimized pain alleviation and mobilisation in addition to lung physiotherapy should be evaluated in future trials.

Clinical Trials as Topic↗
PubMed1998

[Ambulatory laparoscopic cholecystectomy. Feasibility and convalescence].

UNLABELLED: The purpose was to describe feasibility of and convalescence after laparoscopic cholecystectomy in a day case set up in this prospective, open, and descriptive study. Fifty consecutive patients referred for elective cholecystectomy participated. An overnight stay was planned for 13 patients, (12 because they lived alone, one because of pulmonary disease ASA III). The operation was in all cases performed under combined epidural-general anaesthesia. The primary issues were duration of hospital stay, reasons for delayed discharge, frequencies of nausea and vomiting, as well as duration of convalescence and reasons for postponement of return to work or recreational activities. Twenty-six patients (of 37 candidates for day case surgery) were discharged on the day of surgery and 16 on the first postoperative day. Eleven patients had nausea, and three vomited during the first three postoperative hours. Pain was the most common contributory reason for overnight stay (17 patients, eight of these being planned day-case patients who stayed overnight). The patients were recommended to resume work and recreational activities after 48 hours, but 35 patients did not observe this recommendation. The median number of days off work or recreational activity was four days (2-8), including the day of surgery. Pain was the most common contributory reason (19 patients). CONCLUSIONS: Laparoscopic cholecystectomy can be performed as an outpatient operation in more than half of all patients, in approximately 70% of patients not living alone, and with only 15% of the patients requiring more than one over-night stay. Postoperative pain is the primary reason for both delayed discharge and prolonged convalescence. Up to one week's duration of convalescence is recommended.

Adult↗
PubMed1998

[Recommendations for convalescence after hernia surgery. A questionnaire study].

To determine differences in recommendations for convalescence after inguinal herniorrhaphy, a questionnaire was mailed to 294 general practitioners in the Copenhagen area. Sixty-two percent returned the questionnaire. After primary hernia repair a period of 1-12 weeks off work was recommended (mean 2.6, 4.1 and 7.8 weeks in patients with light, moderate or heavy work load, respectively). After repair for recurrent hernia 1-24 weeks off work were recommended (mean 3.5, 5.4 and 8.3 weeks in patients with light, moderate or heavy work load, respectively). Restrictions in lifting (> 5 kg) were recommended for 1-16 weeks, mean 6.1 and 7.4 weeks after primary and recurrent repair, respectively. It is concluded that there is a need for propagation of new data regarding shortened convalescence after herniorrhaphy in order to maximise the advantages of new surgical and analgesic techniques.

Convalescence↗
PubMed1998

[Organization and results of ambulatory surgery for inguinal hernia].

The results of a reorganization of surgery for inguinal hernias within a department of surgical gastroenterology were assessed concerning staff simplifications, feasibility, patient satisfaction, safety, complications and resources. Five hundred consecutive, elective, open operations for unilateral reducible inguinal hernias were performed in 466 patients under local anaesthesia in an ambulatory setup. One hundred and fourteen of the operations were for a recurrent hernia. The median age was 60 years (44-74 years as 25% and 75% quartiles). Two of the operations were converted to general anaesthesia. The patients were discharged 85 min (median) post-operatively, but 12 patients were not discharged on the same day. Bleeding or wound infections in need of treatment were seen postoperatively in 1.6% and 1.6%, respectively. All patients were given a postoperative questionnaires with a response rate of 95%, 89% of the respondents were satisfied with the whole procedure, 11% were dissatisfied. A reorganization of surgery for inguinal hernias to a standardized ambulatory setup induced staff simplifications and saved resources with a preserved high patient satisfaction, safety and a low complication rate.

Adolescent↗
PubMed1998

[Effect of transcutaneous electric muscle stimulation on postoperative muscle mass and protein synthesis].

In an experimental study, 13 patients undergoing major elective abdominal surgery were given postoperative transcutaneous electrical muscle stimulation (TEMS) to the quadriceps femoris muscle on one leg, where the opposite leg served as a control. Changes in cross sectional area (CSA) and muscle protein synthesis were assessed by CT-scan and percutaneous muscle biopsies for ribosome analysis before surgery and on the sixth postoperative day. The percentage of polyribosomes in the ribosome suspension decreased significantly (p < 0.03) after operation in control legs, but not in stimulated legs (p > 0.16). The total concentration of ribosomes decreased significantly in TEMS legs (p < 0.03), but not in control legs (p > 0.16) CSA decreased significantly in both legs. The decrease in polyribosomes and CSA after operation was significantly less in TEMS legs than in controls (p < 0.05). TEMS may be a simple and effective method to improve muscle protein synthesis and muscle mass after abdominal surgery and should be evaluated in other catabolic states with muscle wasting.

Adult↗