Abstract:
OBJECTIVE:Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS:140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS:The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [Q1, Q3]: 0 [0, 0]) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS:Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain. KEY WORDS:Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain. :L’acetaminofene (paracetamolo) è efficace nel trattamento del dolore chirurgico acuto, ma non è noto se riduce il dolore persistente delle incisioni. Abbiamo esaminato una prima ipotesi che la somministrazione perioperatoria dell’acetaminofene riduce il dolore dell’incisione tre mesi dopo l’interventi. Le nostre ipotesi secondarie erano che pazienti randomizzati al paracetamolo avessero minore dolore postoperatorio e minore consumo di analgesici, e migliore recupero funzionale a tre mesi. Sono state utilizzate 140 pazienti sottoposte ad isterectomia per via addominale, suddivise a random e in doppio cieco tra un gruppo sottoposto alla somministrazione endovenosa per 72 ore nel postoperatorio di 4 g/die di paracetamolo, ed un secondo gruppo trattato con semplice placebo (soluzione fisiologica). Come controllo primario è stata usata la scala analogica visiva (VAS) del dolore incisionale a tre mesi dopo l’intervento. Il controllo secondario sono stati la VAS del dolore 1) in posizione sdraiata, 2) in posizione seduta, 3) il consumo totale di tramandolo endovena richiesto dalla paziente nelle prime 24 ore dall’intervento , 4) il questionario Diagnostico del Dolore Neuropatico (DN4), e 5) il questionario sullo stato di salute SF-12 a tre mesi dopo l’intervento chirurgico . Risultati: il punteggio del dolore persistente a tre mesi a livello dell’incisione è significativamente inferiore nel gruppo trattato con paracetamolo (in media [Q1, Q3]: 0 [0, 0]) a paragone col gruppo trattato con placebo (0 [0, 1]) (P = 0.002). Più specificamente 89%, 9%, e 2% delle pazienti trattate con paracetamolo hanno presentato un punteggio 0, 1 e 2 o più nel VAS del dolore a tre mesi, a paragone col 66%, 23%, e 10% delle pazienti trattate con placebo (rapporto di probabilità : 2.19 (95% CI: 1.33, 3.59), P = 0.002). secondariamente i punteggi del dolore postoperatorio sia in posizione sdraiata che seduta sono stati sifgnificativamente inferiori nel gruppo trattato con paracetamolo. Questo gruppo ha presentato un DN4 significativamente migliore e correlata ad un migliore DF-12, ma non una qualità di vita correlata alla salute fisica. Da questi risultati si conclude che il paracetamolo riduce richio ed intensità del dolore persistente a livello dell’incisione chirurgica. Però esistono altri meccanismi con cui il paracetamolo potrebbe ridurre il dolore persistente.
journal_name
Ann Ital Chirjournal_title
Annali italiani di chirurgiaauthors
Koyuncu O,Hakimoglu S,Ugur M,Akkurt C,Turhanoglu S,Sessler D,Turan Asubject
Has Abstractpub_date
2018-01-01 00:00:00pages
357-366eissn
0003-469Xissn
2239-253Xpii
S0003469X18028026journal_volume
89pub_type
杂志文章,随机对照试验abstract:OBJECTIVE:Primary hyperparathyroidism (pHPT) is often accompanied by underlying thyroid pathology and 1 to 36% of these thyroid pathologies are malignant. How the identification of these lesions affects patient management is unclear. We present a single-center experience with the prevalence of concomitant thyroid cance...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2017-01-01 00:00:00
abstract::Gas within the wall of the stomach (emphysematous gastritis) is a rare condition associated with systemic toxicity and very often mortal end. The etiology includes firstly infections with gas-foaming organisms, other predisposing causes are the ingestion of corrosive substances, alcohol abuse and immunosuppression. Bu...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2005-05-01 00:00:00
abstract::The intraoperative localization of residual parathyroid tissue during re-operations for persistent or recurrent secondary hyperparathyroidism (HPT) could have difficult due to cicatricial phenomena, anatomic modifications, ectopic or super-numerous glands. The use of intraoperative localisatin methods, as ultrasonogra...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2006-11-01 00:00:00
abstract:AIM:Poland syndrome is a constellation of rare congenital anomalies of the chest wall, with or without alterations to the ipsilateral superior extremity. Actually Foucras' classification is commonly used to choose the most appropriate surgical treatment, but often only a radiological classification proves unsatisfactor...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2014-05-01 00:00:00
abstract::Gastric hyperplastic polyps are often asymptomatic and are found incidentally at upper endoscopy performed for unrelated reasons. Although they are considered a benign lesion, all symptomatic polyps should be removed for a more reliable histological diagnosis, resolution of symptoms and to prevent potential malignant ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2011-07-01 00:00:00
abstract::The authors review the results of clinical experiences regarding arterial and venous homografts. For the treatment of mycotic aneurysms and infected prostheses, in situ repair with vascular homografts represents a valuable alternative to conventional surgical treatments. In fact the large caliber arterial homografts a...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2001-03-01 00:00:00
abstract:AIM:The prognosis of locally advanced gastric cancer (T3-T4) is bad. The presence of lymph nodes (N3-N4) or haematogenous metastases (liver, lung) gets worse the evolution; principally the hepatic malignancies are cause of scarce survival. The possible use of a palliative treatment as radiofrequency ablation (the good ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2005-01-01 00:00:00
abstract::High gastrointestinal hemorrhage represents the more frequent (12-71.1%) and heavy complication of hepatic cirrhosis and correlates to portal hypertension; it is weighed by global mortality which sways from 30 to 50%. High gastrointestinal hemorrhage gives, therefore, a serious of diagnostic and therapeutic problems n...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2000-03-01 00:00:00
abstract::The association between carotid artery stenosis and brain meningioma is rather rare. Indeed, data in literature about this association are scarce and potential risks of carotid artery stenting using different protection devices are not known. We describe the endovascular treatment of severe carotid stenosis in two pat...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2014-01-01 00:00:00
abstract:AIM:Many methods have been described for the reconstruction of the lower lip, but each has its own advantages and its disadvantages. The purpose of this study is to evaluate the results obtained with the use of different methods in order to choose the most appropriate method, according to the characteristics of the los...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2012-07-01 00:00:00
abstract::The early rectal cancer which needs conservative surgical treatment should present some pathological characters: intramucosal site without muscularis invasion (pT1), high or moderate differentiated grading (GI-G2), no lymph node metastasis or vascular invasion. Total mesorectal excision is the gold standard for these ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2003-05-01 00:00:00
abstract::Hemosuccus pancreaticus is a rare clinical condition, defined as a bleeding from an artery around the pancreas or a lesion on the pancreas, to the pancreatic duct. The intensity of bleeding can vary from occult bleeding to life threatening massive acute bleeding. In this article, we aimed to present a 68-year-old man ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2020-01-01 00:00:00
abstract::Dear Editor, We read with great interest the paper entitled "Laparoscopic organ-preserving gastric resection improves the quality of life in stromal tumor patients: an observational study with 23 patients" written by Ozcan et al. in Ann Ital Chir. 2018 Oct 23;7 1. We agree with the Authors that preserving the stomach ...
journal_title:Annali italiani di chirurgia
pub_type: 评论,信件
doi:
更新日期:2019-01-01 00:00:00
abstract:CASE REPORT:A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity,...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2020-01-01 00:00:00
abstract::The authors examine the value of different imaging techniques (CT, MRI) in the diagnosis of the involvement of the mesenteric-portal vessels in the pancreatic cancer. In 20 jaundiced patients they obtained in all cases a correct diagnosis about the etiology of the jaundice. The correspondence of the preoperative imagi...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2002-07-01 00:00:00
abstract:AIM OF THE STUDY:The superior pedicle mammaplasty is a technique frequently employed in the treatment of breast ptosis, associated or not with hypertrophy of the gland, followed by satisfactory results. This technique is normally not indicated in severe breast ptosis (pendulous breast) because of the excessive length o...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2007-11-01 00:00:00
abstract::The authors present clinical and instrumental results of N. 543 operations executed by CHIVA system. These cases are the result of trial performed in seven SIOC (Italian Society of CHIVA Operators) centers executed from November '87 to July '89. Functional and aesthetic results had been very good on over 85% of all ca...
journal_title:Annali italiani di chirurgia
pub_type: 临床试验,杂志文章,多中心研究
doi:
更新日期:1990-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to review the characteristics, intraoperative and radiological findings of abdominal wall endometriosis (AWE). METHODS:This retrospective observational cohort study was executed through analysis of the medical records of patients who underwent excision of AWE between January 2000 and...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2018-01-01 00:00:00
abstract::The paper reports the author's experience of the use intraperitoneal of Gore-Tex Dual Mesh Biomaterial in large incisional hernia operations in patients over seventy. From January 1999 to December 1999 we operated on 24 patients for treatment of abdominal wall defect. In all patients we used a Dual Mesh Plus Biomateri...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2001-07-01 00:00:00
abstract::Removal of a giant fibroid during a caesarean section is very rare. We report a case of multiple myomectomy among which a huge myomas (cm 22, weight 3.000 g) in a 44 years old nullipara at 38 weeks. A 10 cm long suprapubic transversal incision according to Pfannenstiel on spinal anaesthesia was done; a female baby wei...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract::The authors report on a case of a hemophilic male patient, aged 43, HIV positive, HCV positive, who had an episode of intracerebral hemorrhage after a car accident. Intracranial hemorrhage is the most feared complication of hemophilia, especially among HIV positive, who now are considered to be a group at high risk fo...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVES:Acute hypercalcemia is a serious condition and represents a physician-surgical emergency: the difficulty in setting a precise diagnosis is due to several possibilities that can cause the condition. It is our purpose to critically evaluate the most actual schemes of treatment and the conditions that could fav...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Desmoid-type fibromatosis (DTF) is a "locally aggressive, but not metastasizing" proliferation of soft tissues that is difficult to diagnose pre-operatively. Surgical en bloc resection of abdominal DTF can be difficult or an overtreatment. The diagnosis is therefore crucial for the decision making to minimiz...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2014-12-12 00:00:00
abstract::21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the one year follow-up, 6 of the eleven incontinent patients (54 per cent) regained full continence and while three of the remaining 5 patients improved they still referred occasional imperfection of continence. Resting anal pre...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1994-03-01 00:00:00
abstract:AIM:We propose our experience in soft tissue reconstruction in Hemifacial microsomia using a free fascioadiposal flap. MATERIAL OF STUDY:Hemifacial microsomia (HFM) is a congenital disorder characterized by craniofacial malformation of one or both sides of the lower face. A 18-year-old female presented with hemifacial...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2017-01-01 00:00:00
abstract:INTRODUCTION:Prognosis of colon cancer is worse if complications are present at the moment of diagnosis. The high mortality rate with surgery in emergency in such cases needs a careful reflection about the best suitable operation to perform. MATERIALS AND METHODS:107 consecutive patients observed along a 9 year-period...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:An increase in intra-abdominal pressure causes a decrease in the splanchnic blood flow and the intramucosal pH of the bowel, as well as increasing the risk of ischemia in the colon. The aim of the present study is to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the ischemia caused by laparoscop...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2016-01-01 00:00:00
abstract:AIM OF THE STUDY:To estimate our 3-year experience on the diagnosis and monitoring of the spleen traumatic lesions with the employment of ultrasound microbubbles contrast. METHOD:From the 174 patients who were joints to our department in regimen of urgency for abdominal traumatic lesions, we have estimated 24 patiens ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:In the pediatric age, mediastinal teratomas are an infrequent observation, accounting for only 7%-11% of extragonadal teratomas. Mainly located in the anterior mediastinum arising from the thymic gland, or exceptionally, from ectopic thyroid tissue, they may rarely be observed in the posterior mediastinum, s...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章,评审
doi:
更新日期:2013-07-01 00:00:00
abstract::The acute acalculous cholecystitis (A.A.C.) is a disease with high rates of morbidity and mortality and risk and promoting factors are very important. Pathogenesis has not completely explained, diagnosis is difficult, and there is no agreement on the more effective therapy. The authors present two cases of A.A.C. and ...
journal_title:Annali italiani di chirurgia
pub_type: 杂志文章
doi:
更新日期:1997-05-01 00:00:00