As modern surgical and anaesthetic techniques develop even greater capabilities, the time in which to adequately undertake such nurse/patient discussions has past and will never return. Information provision is thus a ch...As modern surgical and anaesthetic techniques develop even greater capabilities, the time in which to adequately undertake such nurse/patient discussions has past and will never return. Information provision is thus a challenge for day surgery. Many studies have suggested patients require differing levels of information i.e. full, partial and minimal disclosure. Future information booklets may need to be constructed in a more patient centred manner. This article attempts to provide a methodical approach to the required level of information, a guide to the construction of information booklets and suggestions for their application in day surgery.
A retrospective study to evaluate a clinical guide for the treatment of postoperative pain in our One Day Surgery Unit (ODSU) is presented. A total of 2783 patients, treated during 1 year, were studied. Postoperative pai...A retrospective study to evaluate a clinical guide for the treatment of postoperative pain in our One Day Surgery Unit (ODSU) is presented. A total of 2783 patients, treated during 1 year, were studied. Postoperative pain was evaluated 24 h after surgery by phone-call using a visual analogue scale (VAS) and a verbal response scale (VRS). Results were analysed by groups of analgesia and pain scale values. Admissions due to insufficient analgesia were also evaluated. Mean values obtained in all analgesic groups in relation to the VAS were lower than 2.5. It was found that 86% of patients presented a value of VAS<3, while 84.6% had a VRS value 2. Only two patients were admitted for uncontrolled postoperative pain. The level of postoperative analgesia in our patients was satisfactory. Despite this continuous evaluation of the clinical guides for the treatment of postoperative pain, the use of new powerful analgesic drugs is necessary because the surgical complexity in ODSU is increasing and patients with associated diseases are increasingly accepted.
Background: Day surgery for breast disease is becoming popular but a key limiting factor of success is the development of postoperative nausea and vomiting (PONV). Methods: A prospective study of PONV was conducted on 62...Background: Day surgery for breast disease is becoming popular but a key limiting factor of success is the development of postoperative nausea and vomiting (PONV). Methods: A prospective study of PONV was conducted on 62 patients undergoing breast surgery under general anaesthesia. Lumpectomy was performed in 40 patients. The other 22 patients underwent major breast operations including modified radical mastectomy and wide local excision and axillary dissection. A total of 10 mg of metoclopramide was injected intravenously on induction of anaesthesia and oral metoclopramide was prescribed as required to treat PONV. Results: PONV occurred in six (15%) and 14 (63.6%) patients undergoing minor and major operations respectively. The onset of PONV occurred earlier following minor than major operations. Eleven patients required antiemetics. Univariate analysis showed that the incidence and the first onset of PONV was significantly associated with major breast operation and duration of operation. Multiple regression analysis demonstrated that duration of operation was the only independent factor that affects the rate of PONV. However, the onset of nausea was associated with major surgery and the onset of vomiting with the duration of the operation. Patients with minor breast surgery were all discharged on the day of surgery. None of the six patients with PONV required readmission. Conclusion: Minor breast surgery can be readily performed as a day case. More effective antiemetic measures against PONV may be required in major breast surgery.
Ambulatory inguinal hernia repair is the commonest day case general surgery operation. The present study was conducted to evaluate factors influencing the contemporary pattern of convalescence following ambulatory inguin...Ambulatory inguinal hernia repair is the commonest day case general surgery operation. The present study was conducted to evaluate factors influencing the contemporary pattern of convalescence following ambulatory inguinal hernia repair in Hong Kong. A total of 271 consecutive ambulatory inguinal hernia repairs were performed at a day surgery centre from December 1995 to December 1998. The convalescent period prior to resuming work was analysed by multi-variate analysis with respect to significant clinical variables. A sick leave of 3 weeks was adequate for most patients following uncomplicated ambulatory inguinal hernia repairs. Factors associated with early return to work included age </=50 years, indirect inguinal hernia and sedentary occupation. Occupation was the only independent factor affecting the duration of time off work on multi-variate analysis.
Bladder hernia is very uncommon. It tends to affect patients over the age of 50 and is predisposed by cervico-urethral obstruction. The condition is often diagnosed during inguinal hernia surgery. The authors report a ca...Bladder hernia is very uncommon. It tends to affect patients over the age of 50 and is predisposed by cervico-urethral obstruction. The condition is often diagnosed during inguinal hernia surgery. The authors report a case of massive inguino-scrotal bladder herniation. The different types of bladder hernia are described, and the clinical-radiological findings and surgical management are discussed.
To obtain an objective basis for a policy on the advice to patients on when to drive after anterior tension-free hernia repair. Foot reaction time before operation and on the 2nd postoperative day in 20 skilled male driv...To obtain an objective basis for a policy on the advice to patients on when to drive after anterior tension-free hernia repair. Foot reaction time before operation and on the 2nd postoperative day in 20 skilled male drivers with a right inguinal hernia was measured and compared with that of 30 normal subjects. The tests in a car simulator indicated that an untreated right inguinal hernia had no effect on emergency stop reaction time and that a plug-mesh hernia repair did not impair reaction time on the 2nd postoperative day (P>0.30). Average visual analogue pain scores on the 2nd and 4th postoperative days were 2.3 and 1.7, respectively. On the 8th postoperative day 18 patients had returned to normal activity and work. There was no recurrences after a mean postoperative time of 18 months. These data suggest that open tension-free hernia repair allows return to normal activities and car driving within a few days of the operation.
Post-operative nausea and vomiting (PONV) are complications of surgical procedures, and are of particular relevance in the day-case setting. The aim of this study was to examine the incidence and impact of PONV before an...Post-operative nausea and vomiting (PONV) are complications of surgical procedures, and are of particular relevance in the day-case setting. The aim of this study was to examine the incidence and impact of PONV before and after discharge from day surgery units. Patients recorded the incidence, severity and impact of PONV for 5 days following surgery. The incidence of PONV in the 561 eligible patients was 17% upon waking, 14% travelling home and 3% by the 5th day post-surgery. PONV was most common in gastrointestinal, obstetric and gynaecological surgery. Although freedom from pain and PONV are requirements for discharge after ambulatory surgery, PONV is still a problem post-discharge.
A prospective study was conducted to evaluate the efficacy of prior application of topical eutectic mixture of local anesthetics, EMLA, in alleviating the pain associated with infiltration local anesthetic (LA) for circu...A prospective study was conducted to evaluate the efficacy of prior application of topical eutectic mixture of local anesthetics, EMLA, in alleviating the pain associated with infiltration local anesthetic (LA) for circumcision in children and to assess its impact on the outcome. A total of 173 children aged 3-13 years requiring circumcision were randomly assigned to have EMLA or placebo cream applied over the root of the penis 1 h before subcutaneous ring block. A blinded observer rated the pain response on a 10-point visual scale during needle insertion, injection of local anesthetic and circumcision. Children needing conversion to general anesthesia (GA) were counted as failures. A total of 89 and 82 boys were included in the EMLA group and placebo group, respectively. Significantly lower pain scores were recorded for needle puncture in the former group (P<0.001), whilst pain scores for injection and during circumcision were not statistically different between the two groups (P=0.037 and 0.138, respectively). A total of 88 out of the 89 boys pre-treated with EMLA completed the procedure, whereas seven boys in the placebo group necessitated conversion to GA (P=0.022). The converted cases had higher values for all pain scores and tended to be younger. Therefore, EMLA cream is a useful adjunct to LA for childhood circumcision because it effectively reduces the sharp pain induced by needle puncture. However, careful patient selection is required for a low conversion rate to GA.