Category Archives: Postoperative care

Should capnography be used in postoperative, unventilated patients?

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There isn’t a consensus on whether capnography should be used in postoperative patients.

Eichhorn, John H. “Review article: practical current issues in perioperative patient safety.” Canadian journal of anesthesia 60.2 (2013):111-118.
The first paragraph of page 116 discusses the lack of consensus on how best to monitor postoperative patients for hypoventilation from postoperative pain medication.

Jarzyna, Donna, et al. “American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.” Pain management nursing 12.3 (2011):118-145.e10.
Article states, “there is a paucity of information and no consensus about the benefits of technology supported monitoring, such as…capnography.”

Hutchison, Rob, and LesRodriguez. “Capnography and respiratory depression.” American journal of nursing 108.2 (2008):35-39.
This randomized prospective study of 54 postoperative orthopedic patients found a significantly higher rate of respiratory depression in the capnography group, concluding that “capnography may be more appropriate for use with postsurgical high-risk patients taking opioids” and “may have the added advantage of indicating those patients who may be at risk for obstructive sleep apnea.”

What evidence exists regarding femoral nerve block in joint surgery (hip,knee) and length of hospital stay?

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Crowley, Conor, et al. “Impact of regional and local anaesthetics on length of stay in knee arthroplasty.” ANZ journal of surgery 82.4 (2012):207-214.

Systematic review: According to Crowley’s systematic review, 23 studies  using CONSORT 2001, (consolidated standards of reporting trials), were identified.  There were deficiencies in these studies as far sample size calculation and randomization concerning under reporting of blinding.  Neither  regional and local anesthesia  nor epidural and femoral nerve block has reduced hospital length of stay.

RCTs published after the review

Ward, James P, et al. “Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy?.” Arthroscopy 28.8 (2012):1064-1069.
shed after the Crowley article based on a small sample size of 36 subjects, concludes that based on all criteria the femoral nerve block is a good  alternative to routine narcotic pain medication for hip arthroplasty.

Spangehl MJ, et al. The Chitranjan Ranawat Award: Periarticular Injections and Femoral Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial. Clin Orthop Relat Res 473.1 (2015 Jan):45-53.
160 patients undergoing knee arthoplasty received either femoral block or periarticular injection (PAI). LOS was 2.44 days for the PAI group and 2.84 days for the femoral block group.

Mahadevan D, et al. Combined femoral and sciatic nerve block vs combined femoral and periarticular infiltration in total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2012 Dec;27(10):1806-11.
Fifty-two patients undergoing total knee arthroplasty all received femoral nerve block.  They were randomized to also receive either sciatic block or periarticular injection.  LOS was 5.5 v. 6 days.

What has been written on early removal of urinary catheters in surgical patients during the last five years?

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Murphy, Miles, et al. “Postoperative management and restrictions for female pelvic surgery: a systematic review.” International urogynecology journal and pelvic floor dysfunction 24.2 (2013):185-193.

Zaouter, C, et al. “Early removal of urinary catheter leads to greater post-void residuals in patients with thoracic epidural.” Acta anaesthesiologica Scandinavica 56.8 (2012):1020-1025.

Chai, Joyce, and Ting-ChungPun. “A prospective randomized trial to compare immediate and 24-hour delayed catheter removal following total abdominal hysterectomy.” Acta obstetricia et gynecologica Scandinavica 90.5 (2011):478-482.

Mentler, Ellie, et al. “High incidence of acute urinary retention associated with immediate catheter removal after laparoscopic Nissen fundoplication.” Surgical endoscopy 25.5 (2011):1611-1616.

Huang, Chih C, et al. “Optimal duration of urinary catheterization after anterior colporrhaphy.” International urogynecology journal and pelvic floor dysfunction 22.4 (2011):485-491.

Das Bhagia S, et al. “Is it necessary to remove foleys catheter late after transurethral prostatectomy in patients who presented with acute urinary retention secondary to benign prostatic hyperplasia?” JPMA. The journal of the Pakistan Medical Association 60.9 (2010):739-741.

Kamilya, Gourisankar, et al. “A randomized controlled trial comparing short versus long-term catheterization after uncomplicated vaginal prolapse surgery.” Journal of obstetrics and gynaecology research 36.1 (2010):154-158.

Chia, Yuan-Yi, et al. “Optimal duration of urinary catheterization after thoracotomy in patients under postoperative patient-controlled epidural analgesia. Acta anaesthesiologica Taiwanica 47.4 (2009):173-179.

Zaouter, Cedrick, PepaKaneva, and FrancoCarli. “Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia.” Regional anesthesia and pain Medicine 34.6 (2009):542-548.

de Moya, Marc A, et al. “Colovesical fistula repair: is early Foley catheter removal safe?” The Journal of surgical research 156.2 (2009):274-277.

Ozu, Choichiro, et al. “Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: our experience.” International journal of urology 16.5 (2009):487-492.

Sekhavat, Leila, TahminahFarajkhoda, and RobabDavar. “The effect of early removal of indwelling urinary catheter on postoperative urinary complications in anterior colporrhaphy surgery.” The Australian and New Zealand journal of obstetrics and gynaecology 48.3 (2008):348-352.

What does the literature say regarding postoperative care for uterine embolization patients?

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Patient care issues surrounding the uterine artery embolization procedure for the treatment of uterine fibroids. Images. 1999 vol:18 iss:3 pg:4

“Uterine artery embolization.” AORN journal 73.4 (2001):790-2, 794-8.

Uterine artery embolization in the management of vaginal bleeding from cervical pregnancy: a case series. Journal of reproductive medicine 2005 vol:50 iss:11 pg:844

Baakdah, Hanadi, and TogasTulandi. “Uterine fibroid embolization.” Clinical obstetrics and gynecology 48.2 (2005):361-368.

Siskin, Gary P, et al. “III. Uterine fibroid embolization: pain management.” Techniques in vascular and interventional radiology 5.1 (2002):35-43.

Searched CINAHL & PubMed. Keywords: postoperative care and uterine embolization

Is there evidence-based research to support using ice packs for postoperative pain management?

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Adie S, Kwan A, Naylor JM, Harris IA, Mittal R.  Cyrotherapy following total knee rcplacement.  Cochrane Database Syst Rev. 2012 Sep 12;9:CD007911
Bottom Line:  In regard to postoperative pain following total knee replacement,this Cochrane Systematic Review  had 11 randomized controlled trials  and one controlled trial with  a  total of 809 participants which met its inclusive criteria.  The author found that potential benefits of cryotherapy  on blood loss, postoperative pain and range of motion was too small to justify its use and the quality of evidence was low or very low for all main outcomes. Additionally another Cochrane Systemic Review,  Bala, MM, Riemsma, RP, Woff, R,  Kleijnen  J.  Cryotherapy for liver metastases. Cochrane Database for Syst. Rev. 2013 June 5;6 , stated there is  insufficient evidence that cyotherapy benefited patients with liver metastases from various primary sites in terms of survival or recurrence compared with conventional surgery.

The databases searched were PubMed, CINAHL and Joanna Briggs.   My search stratedy was the following: (ice packs OR cyrotherapy)  AND postoperative pain limited from 2000-present and human and English language.

Eight randomized controlled trials  results saw benefits from cold therapy relieving postoperative pain from different parts of the body.    Lastly another randomized controlled trial, Modabber A, Rana M, Ghassemi A,  Gerressen M,  Gellrich NC, Holzle  F, Rana M.  Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods:  a randomized observer-blind prospective study.  Trials. 2013 Jul 29;14:238,  found that hilotherapy was a more efficient cooling method than conventional cooling in relieving postoperative pain and swelling.



Reviewed by John Nemeth 4/14

							

		
		
	


				
					
	

		

						
Use of betadine on postoperative surgical sites

			
						

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“Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.” Spine (Philadelphia, Pa. 1976) 30.15 (2005):1689.


Lid scrub may reduce endophthalmitis rate when used with topical Betadine… including commentary by Trattler WB. Ocular Surgery News 2009 vol:27 iss:19 pg:16


Swenson BR ; Hedrick TL ; Metzger R ; Bonatti H ; Pruett TL ; Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infection Control & Hospital Epidemiology, 2009 Oct; 30 (10): 964-71.


Giordano, Salvatore, et al. “Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.” Aesthetic surgery journal 33.5 (2013):675-680.


Haas, David Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database of Systematic Reviews. 2014 Dec 21;(12):CD007892. doi: 10.1002/14651858.CD007892.pub5.


Spinal Surgery: Prevention and Management of Infection. [Recommended Practices] 2013


Searched CINAHL, PubMed & Joanna Briggs. Keywords: Betadine or Povidone-iodine, postoperative


Reviewed by John Nemeth 4/14


Updated links for last two items, 10/16/2017 ldt