October 10, 2008
Devotees of oriental medicine will not be surprised by the finding, in the British Journal of Anaesthesia, that acupuncture reduces pain after surgery. More unexpected is that chili powder applied to the skin below the knee can produce the same effect!
In this meta-analysis fifteen studies were analysed – over 1100 patients. In each study, acupuncture was compared with control “sham” acupuncture (acupuncture applied to non-acupuncture points).
- Acupuncture patients needed less opioid (morphine-like) pain treatment at 8, 24 and 72 hours after surgery
- Postoperative pain was also significantly less in the acupuncture group at 8 and 72 h compared with the control group.
- The acupuncture treatment group had a lower incidence of opioid-related side-effects such as nausea, dizziness, sedation, pruritus (itching), and urinary retention (inability to urinate).
The authors conclude that “perioperative acupuncture may be a useful adjunct for acute postoperative pain management”. I was intrigued, and decided to explore the methods used in one of the 15 studies in a bit more detail (Kim KS, Nam YM. The analgesic effects of capsicum plaster at the Zusanli point after abdominal hysterectomy. Anesth Analg 2006; 103: 709–13). Read the rest of this entry »
September 28, 2008
Whether anesthesia, or surgery, or some combination of the two, have long-lasting effects on the brain of children is an important question which researchers are trying very hard to answer. Three new studies provide some cause for concern.
In a non-clinical, (epidemiologic), study from Columbia University the authors used databases to review cases in which children had hernia surgery in the first four years of life. They found that these children, compared with a control group, had almost twice as much risk of subsequently developing behavioral or developmental disorders.
In a second study, from the Mayo Clinic, the risk of learning disabilities in children after a single anesthetic was not different from a control group but the risk did increase after two or three anesthetics and in the cases where the duration of the anesthetic was longer than 2 hours.
Finally, a Dutch study of children who had urologic surgery. “Neurocognitive” development was evaluated by means of a questionnaire completed by parents. Children who had their procedures before the age of two years had lower scores but the study wasn’t large enough to say with any certainty that this age cut-off is important. Read the rest of this entry »
September 26, 2008
Deep vein thrombosis (DVT) and pulmonary embolism (PE) – “blood clots” – kill about 100,000 Americans each year. Many blood clots occur after routine elective surgery – especially spine surgery and major surgery on the hip or knee.
An excellent consumer guide to the risks, prevention and treatment of blood clots can be found here.
The Office of the Surgeon General in the US recently called for action to address this major public health problem. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism documents the problems DVT and PE pose, as well as strategies to reduce the risk of developing the conditions. Clearly we need to improve public knowledge about risk factors, triggering events, and symptoms of the disease, which is often silent.
Before any surgical procedure, particularly those requiring more than a day or so in hospital, you should be evaluated for any risk factors for a blood clot. People at risk need preventive measures, which can include anticoagulants, like heparin, special stockings, or the use of automated calf compression devices.
Rapid mobilisation – i.e. getting out of bed – is one of the best ways to avoid blood clots and is one of the reasons why patients having outpatient or day surgery very seldom need specific preventive treatments. Read the rest of this entry »
September 24, 2008
Ten Eight Rules for Safe Drug Use
Before surgery the medications you take should be listed accurately and in detail – their names, doses, and the times at which you take them. Medications that you purchase without a prescription may be as important as those prescribed by your doctor.
Why is a medication history important before surgery? Read the rest of this entry »
September 23, 2008
A study in the Canadian Medical Journal, accompanied by a commentary, looks at statins and postoperative delirium.
This condition (“an acute change in mental status that is worrisome to patients and families”) is a big concern for many elderly patients (and their families) having major surgery. Unfortunately we don’t yet know enough about the predisposing factors and direct causes to do very much about preventing postoperative delirium, apart from avoiding some things which are obviously bad for all patients (e.g. low blood pressure, inadequate oxygen, etc). Delirium increases the average length of a hospital stay by about a week, is associated with a variety of complications and increased costs, and may even be linked to permanent brain deficits.
This study suggests that statin drugs predispose to postoperative delirium. Is the conclusion correct? Should it change medical practice, which currently strongly favors the continuation of statins after surgery because of their protective effect on the heart? Read the rest of this entry »
September 10, 2008
Statins – the drugs like Lipitor, Crestor, Zocor, Lescol and others – do more than reduce your cholesterol. Several studies have shown that these drugs protect people with heart disease having major non-heart surgery. The beneficial effect seems to come from anti-inflammation properties common to all statins.
The latest, and perhaps strongest piece of evidence so far comes from a new study in the Netherlands in which patients having vascular (blood vessel) surgery – known to have the highest risk of heart attack after surgery – were given a long-acting statin – fluvastatin – and continued on it after leaving the hospital. The statin cut the rate of heart attack and of myocardial ischemia (angina, or where the heart muscle doesn’t get enough blood supply) by about 50%. Read the rest of this entry »
September 8, 2008
How much can you learn all in one go? Cognitive science has established that on average we can hold only seven or so “chunks” of new information.
In this Sept 2008 study in Anesthesia & Analgesia, patients interviewed in a pre-anesthesia clinic in Boston were heavily overloaded with information by nurses and doctors. Audio recordings showed that nurse practitioners attempted to transmit on average more than 110 pieces of information during the interview. The doctors came in with roughly 50 apiece. Read the rest of this entry »