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PubMed2000

Pain after gynecologic surgery.

This article provides a descriptive profile of pain in 80 women during the first 2 days after gynecologic surgery in 4 hospitals. Surgical procedures included abdominal hysterectomy, oophorectomy, and laparotomy. Average pain was moderate on both days, but paired t tests indicated that pain increased significantly during ambulation on day 1 (P = .009, sensation; P < .001, distress) and on day 2 (P = .007, sensation; P = .030, distress). They both (P = .001) decreased significantly during rest on day 1, but not on day 2. Analysis of quartiles indicated that one fourth of the sample suffered severe sensation pain at all points on day 1 (60 to 74 mm on a 100-mm visual analogue scale), and moderate to severe sensation on day 2 (40 to 60 mm). The lowest quartile had mild pain on both days (11 to 28 mm on day 1, and 7 to 14 mm on day 2). Some patients (30%) reported that pain interrupted their sleep on the first 2 nights, and difficulty sleeping on the first postoperative night for any reason (65%) was related to greater pain during the next 2 days (r = .25 to .43). Although 41% of the women had previously used relaxation techniques for stress or pain, only 9% used it for pain after surgery. Results suggest that postoperative patients have moderate to severe pain that is incompletely relieved with patient-controlled analgesia. Nurses should encourage patients to press the patient-controlled analgesia button more often, report unrelieved pain, and use nonpharmacologic interventions.

Adult↗
PubMed1989

Effect of interventions on prescribing of antimicrobials for prophylaxis in obstetric and gynecologic surgery.

The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported. Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility. The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN). An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines. The projected annual cost of this nonconformity was $26,500. After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines. A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000. Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases. Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy.

Adolescent↗
PubMed1991

Epidural sufentanil for postoperative analgesia: dose-response in patients recovering from major gynecologic surgery.

To determine the lowest effective dose of epidural sufentanil given for analgesia, 41 patients undergoing elective abdominal gynecologic surgery during continuous epidural anesthesia (lidocaine 2%) were randomly assigned to one of four postoperative treatment groups. Patients received an epidural bolus of either 25 (group A), 40 (group B), 55 (group C), or 70 micrograms (group D) sufentanil in 10 mL of saline. They were evaluated for the next 8 h using a 10-cm visual analogue scale. Except for two individuals in group A, all patients achieved a visual analogue scale score of 1 cm or less during the study interval. The onset of analgesia was most rapid in the two higher dose groups (A vs C and D; P less than 0.05). Pairwise comparison between groups showed a significant difference in the time needed to achieve maximum pain relief between the lowest and highest treatment groups (A vs D; P less than 0.05). Duration of analgesia was also significantly longer in groups C and D than in group A (208.0 +/- 21.1 and 224.0 +/- 14.7 vs 140.0 +/- 10.7 min; P less than 0.05). There were no differences among groups with regard to mean respiratory rate, level of sedation, 24-h narcotic requirements, or incidence of nausea, vomiting, and pruritus (P = NS). A single patient in group D suffered profound respiratory depression within seconds of administration. We conclude that, in patients recovering from lower abdominal surgery, a single 40-55-micrograms epidural bolus of sufentanil provides 3-3.5 h of effective analgesia, and that larger doses are not warranted.

Abdomen↗
PubMed2002

Thomas Addis Emmet, the vesicovaginal fistula, and the origins of reconstructive gynecologic surgery.

Thomas Addis Emmet (1828-1919), the foremost pupil of J. Marion Sims and his successor as chief surgeon at The Woman's Hospital in New York City, was probably the pre-eminent American gynecological surgeon of the last quarter of the 19th century. Among his many achievements were the first critical study of vescovaginal fistula repair, authorship of the first modern scientific textbook of gynecology, the invention of numerous special surgical instruments, pioneering the use of surgical scissors in vaginal operations, and the development of "staged" procedures for surgical reconstruction of the vagina. He was an active writer, a renowned collector of American historical documents and memorabilia, a devout Catholic and a steadfast Irish patriot. This article reviews his life and contributions to gynecologic surgery.

Female↗
PubMed1997

Prevention of thromboembolic complications in women undergoing gynecologic surgery.

Our objective was to identify those patients particularly at risk of deep vein thrombosis (DVT) before they underwent extensive gynecologic surgery and to control if, a correct diagnostic analysis and a right pre-operative prophylaxis of patients with risk of developing DVT, was enough to improve post-operative prognosis. Of 2704 patients undergoing gynaecological surgery, 74 were pre-operatively considered at risk of developing DVT. Seventy percent of the patients received pre- and postoperative heparin, while 28% of the women received only postoperative heparin. Nonetheless, seven women receiving this prophylaxis developed DVT. The final results of our study demonstrate that there is a close correlation between incidence of DVT and the presence of risk factors. This incidence can be reduced by prophylactic measures such as elastic stockings for the lower legs, early post-operatory mobilization, hematocrit and volemy control, ending with pharmacological therapy with heparin.

Fallopian Tubes↗
PubMed1998

Medical clearance for gynecologic surgery.

Physicians are charged to "foremost do no harm." Thus, before doing any surgical procedure, surgeons must convince themselves that the risk to the patient does not outweigh the benefit. The patient with multiple medical problems has additional risk factors for elective surgery. In the past, that patient would be sent to their general practitioner for "medical clearance." With gynecologists now assuming that role for the patient, it is increasingly important for us to understand what comprises medical clearance to better assess hazards. Studies concerning medical clearance for surgery obtained in a MEDLINE search through March 1997 were reviewed; the recent advances that apply to gynecologic surgery are covered in this article.

Adult↗
PubMed2000

Transdermal ketamine as an adjuvant for postoperative analgesia after abdominal gynecological surgery using lidocaine epidural blockade.

UNLABELLED: We examined the postoperative analgesia of a controlled delivery ketamine transdermal patch after minor abdominal gynecological surgery using lidocaine epidural blockade. Fifty-two patients were randomized to one of two groups. Epidural anesthesia was performed with 25 mL 2% plain lidocaine. At the end of the surgical procedure, a controlled delivery transdermal patch containing either ketamine (25 mg/24 h) (Ketamine group) or placebo (Placebo group) was applied. Pain and adverse effects were assessed hourly postoperatively for 24 h. IM dipyrone was available at patient request. The two groups were demographically similar. The time to first rescue analgesic was longer in the Ketamine group (230+/-112 min) compared with the Placebo group (94+/-54 min); (P<0.00001). There were more dipyrone dose injections in 24 h in the Placebo group compared with the Ketamine group (P<0.0001). The incidence of adverse effects was similar between groups. We conclude that the transdermal-controlled delivery of ketamine prolonged the duration of analgesia after minor gynecological procedures. IMPLICATIONS: Transdermal delivery of ketamine was an useful adjuvant to postoperative analgesia after epidural lidocaine blockade in the population studied.

Administration, Cutaneous↗
PubMed2001

[Prevention of postoperative nausea and vomiting in gynecologic surgery with 3 fixed doses of metoclopramide, droperidol or placebo].

OBJECTIVES: To compare the efficacy and side effects of three doses of metoclopramide, droperidol or placebo administered every 8 h to prevent nausea and vomiting during the first 24 h after surgery. MATERIAL AND METHODS: Prospective, double blind study of 104 patients scheduled for major intraabdominal gynecological surgery under general anesthesia. The patients were randomly assigned to three groups: group M received 10 mg of metoclopramide, group D received 1.25 mg of droperidol and group P received a saline solution. The patients were premedicated with oral diazepam. All patients were anesthetized using similar techniques, with fentanyl, thiopental, vecuronium, oxygen/nitrogen protoxide and isoflurane. Muscle relaxation was reversed with atropine and neostigmine. Postoperative analgesia was given with endovenous morphine and metamizol. Immediately after surgery each patient received an endovenous dose of the assigned antiemetic drug. Patients were monitored for 24 h and observations were recorded every hour on the following scale: 0, for no emetic symptoms, 1 for nausea and 2 for vomiting. RESULTS: Fifteen patients (42.9%) in group D, 21 (60% in group M and 19 (54.3%) in group P experienced nausea during the 24 h after surgery, with no significant differences. However, the incidence of vomiting was significantly lower in group D, with 7 patients (20%) vomiting in group D versus 11 patients (31.43%) in group M and 17 (50%) in group P. Side effects were mild and required no treatment. CONCLUSIONS: Droperidol at a dose of 1.25 mg every 8 h is effective and safe for preventing postoperative nausea and vomiting and has minimal side effects. Metoclopramide at a dose of 10 mg every 8 h, in our study, was no better for the same purpose than placebo.

Adult↗
PubMed1989

[Use of buprenorphine as a cornerstone in narcosis and as analgesic in the postoperative period in gynecologic surgery].

In a clinical trial buprenorphine (0.3 mg i.v.) was administered, 20-45 minutes before the surgical operation, to 220 women undergoing gynecological surgery. If necessary buprenorphine (0.2-0.3 mg i.m.) was administered also in the post-operative period. By the pre-operatory administration of buprenorphine, a great stability of life parameters was observed during the surgical operation. In the post-operative period most of the patients showed absence of pain or mild pain.

Analgesia↗
PubMed1994

[Treatment in the event of antibiotic prophylaxis failure in gynecologic surgery. A retrospective study of 20 cases].

A retrospective study was performed of the type of treatment used in 20 patients undergoing gynecological surgery in whom antibiotic prophylaxis with Mezlocillin (2 g i.v.) had failed. Patients were subdivided into three groups: A) Initial therapy with Mezlocillin (8 patients, 2 g/die i.m.) or Cefotetan (2 patients, 2 g/die i.m.) and subsequent addition of Gentamicin (8 patients, 240 mg/die i.m.) or Tobramycin (2 patients, 200 mg/die i.m.) and subsequently Metronidazole (7 patients, 1.5 g/die per os). B) Therapy with Imipenem/Cilastatin (6 patients, 1.5 g/die i.m.). C) Therapy with Imipenem/Cilastatin (4 patients, 1.5 g/die i.m.) after a variety of antibiotics: Cotrimoxazole (Trimethoprim 160 mg/die and sulphamethoxazole 800 mg/die per os), Pefloxacin (800 mg/die per os), Cefotetan (2 g/die i.m.) and Mezlocillin (2 g/die i.m.). Time taken to lower temperature was shorter in Group B (3.5 days) compared to Group A (6.8 days) and Group C (10 days). Postoperative hospital stay was also shorter in Group B (9 days) compared to Group C (16.5 days) and Group A (11.1 days). The immediate administration of an antibiotic active against Gram+ and Gram- germs, aerobes and anaerobes is therefore useful in the event of failure of antibiotic prophylaxis, rather than the use in succession of associations of antibiotics with a limited spectrum.

Adult↗
PubMed1995

A comparison of the effects of the propofol versus midazolam during total intravenous anesthesia for gynecological surgery procedures.

The effects of propofol and midazolam as an intravenous anesthetic were compared in 40 ASA I-II patients undergoing gynecological surgery during total intravenous anesthesia (TIVA). They were divided into propofol group (P n = 20) and midazolam group (M n = 20) randomly. The anesthesia was designed for each group respectively. Here, we discuss the experimental method and the results, which indicate that propofol is not only an effective anesthetic but also has more rapid and head-clear recovery properties than midazolam.

Adult↗
PubMed1999

Bloodless surgery: establishment of a program for the special medical needs of the Jehovah's witness community--the gynecologic surgery experience at a community hospital.

OBJECTIVE: My purpose was to describe the rationale behind the establishment of a hospital-based program instituted to enhance the health of the Jehovah's Witness community and to evaluate patient profiles and outcomes of gynecologic patients treated surgically at our institution, during the past 5 years, whose intake was through the Bloodless Surgery Program and who were not accepting of blood or most blood products. I further describe how a coordinated program dedicated to serving this particular population might improve outcomes and patient satisfaction. STUDY DESIGN: A retrospective review of the charts of 89 patients, all Jehovah's Witnesses, who were enrolled through the Bloodless Surgery Program and underwent gynecologic surgery involving at least 1 night's hospitalization at our institution between January 1, 1993, and December 31, 1997, was performed. A comparison of patient length of stay, hospital charges, and surgical blood loss, in a subset of 41 patients who underwent abdominal hysterectomy, with a cohort of patients not affiliated with the Jehovah's Witnesses or the Bloodless Surgery Program was performed. Data regarding patient satisfaction were obtained through surveys and are presented. RESULTS: Patients enrolled through the Bloodless Surgery Program and undergoing abdominal hysterectomy were significantly younger (average age 43.4 vs 47.7 years) and incurred significantly lower hospital charges (average cost $8754 vs $9539). No significant difference between the group studied and the control group could be found in average length of stay or the average change between preoperative and postoperative hemoglobin levels. Data from patient satisfaction surveys suggest a high level of satisfaction with the Bloodless Surgery Program. CONCLUSION: A program dedicated to the special needs of the Jehovah's Witness community can be instituted in a community-based hospital with no evidence of increased morbidity, as evidenced by length of stay, hospital charges, and surgical blood loss, in a gynecologic patient population. Development of such programs is associated with a high level of patient satisfaction and the potential for improved patient care.

Adult↗
PubMed1980

Incidence of thrombosis after gynecologic surgery evaluated by an improved 125I-fibrinogen uptake test.

Two hundred and seventy-six women over 50 years of age who had gynecologic surgery were followed postoperatively with the 125I-fibrinogen uptake test (125I-FUT) to detect deep venous thrombosis (DVT). By using a newly devised technique based on conventional 125I-FUT, the exact depth of thrombi could be determined. The correlation between the results with our new technique and those from phlebography was almost 100%. Forty-seven (17%) of the women developed DVT postoperatively, 60% of them occurring in the calf muscle veins. Patients subjected to abdominal hysterectomies for malignant diseases had the highest incidence of DVT (36%), whereas those operated on for benign diseases with the same technique had the lowest (11%). Patients operated on for uterine prolapse had an intermediate DVT frequency of 15% but advanced age and estrogens given preoperatively increased the frequency. Neither the type of anesthesia (epidural or general), nor the duration of the operation, significantly influence the incidence of DVT in this study.

Age Factors↗
PubMed1988

Drainage in gynecologic surgery.

Our predecessors' almost universal use of drains is gradually being replaced by a more scientific approach--selective use of more appropriate types of drains. Each application of drains must be evaluated in the context of other improvements in wound care and construction. Randomized, well-controlled studies are essential. Radical surgery is the strongest indication for the use of drains. There are few strong indications in benign gynecologic surgery.

Abscess↗
PubMed2004

A clinical trial demonstrates the analgesic activity of intravenous parecoxib sodium compared with ketorolac or morphine after gynecologic surgery with laparotomy.

OBJECTIVE: The purpose of this study was to compare the analgesic activity of 2 doses of parecoxib sodium, ketorolac, and morphine with placebo after gynecologic surgery that requires laparotomy. STUDY DESIGN: In a randomized, controlled, double-blind, parallel-group study, 208 patients, after surgical hysterectomy, received single-dose intravenous placebo, parecoxib sodium 20 mg or 40 mg, ketorolac 30 mg, or morphine 4 mg followed by multiple-dose parecoxib sodium or ketorolac as needed. Primary efficacy variables were time to onset of analgesia, pain intensity differences, pain relief, time to first rescue/remedication, and global evaluation of study medication. RESULTS: Single-dose parecoxib sodium 40 mg provided significantly better pain responses to placebo or morphine 4 mg and was comparable to ketorolac 30 mg. Multiple-dose parecoxib sodium 20 mg, 4 times daily, or 40 mg, twice daily, was comparable to ketorolac 30 mg, 4 times daily. Parecoxib sodium was well tolerated. CONCLUSION: Parecoxib sodium is an effective analgesic in the management of acute postoperative pain after laparotomy surgery.

Adult↗
PubMed1980

[Conservative treatment of ureteral lesions caused by gynecological surgery (author's transl)].

Conservative treatment with long lasting success is possible in many cases of ureteral lesions of different etiology, esp. after complications with gynecological surgery. Both fistulas and stenoses of the ureter can be treated conservatively by placing long term indwelling PVC ureteral splints ("endoprothesis") of FR 8 or 10 with smooth surface and without hooks or the like to keep them place. In a considerable number of cases such treatment is a true and even superior alternative to open surgery with its consecutive longer lasting hospitalization, because it can be done as outpatient-care and, of course, has a lower rate of complications.

Adult↗