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Adult Cleft Lip Repair under local anaesthesia: The Ghana Experience

Modern Plastic Surgery 2016年第4期6卷 27-32页

作者： Solomon Obiri-Yeboah Micheal Yeliborah Alexander Oti Acheampong Samuel Kodjo Ansah John H. Grant Peter Donkor Kwame Nkrumah University of Science and Technology Kumasi Ghana Komfo Anokye Teaching Hospital Kumasi Ghana University of Alabama at Birmingham Alabama Children’s Hospital Birmingham AL USA

Background: Unlike developed countries where adult primary cleft lip and palate cases are barely nonexistent, developing countries still have a backlog of adults with unrepaired cleft lip and palate. Method: A retrospective review of adult/adolescent cleft lip repair under local anesthesia was performed between 2012 and 2015. Results: Fifty six (56) adolescent and adults were seen comprising 35 females and 21 males. Forty two patients presented with unrepaired unilateral cleft lip of which only 6 were complete;4 were unrepaired bilateral cleft lip and 10 were revisions. The lowest age was 13 years (two patients) and the highest age was 66 years (one patient). The mean weight was 54 kg. The mean anaesthetic time including waiting time was 12.94 minutes and mean operation time was 56.52 minutes. Majority of the patients were discharged same day except for five who needed to stay overnight because of distance from their home. There were no reported early postoperative complications and wound healing was uneventful for all the patients. Conclusion: Cleft lip repair in adults under local anesthesia is safe, effective and less expensive. A modification in technique with minimal dissection and efficiency is essential in such cases.

关键词： Adult Adolescent Cleft Lip local anaesthesia

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Thyroidectomy under local anaesthesia: A Viable Option in a Resource Limited Community

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International Journal of Otolaryngology and Head & Neck Surgery 2021年第5期10卷 383-391页

作者： Enoch Auta Dahilo David Femi Folorunsho Fredrick M. Damtong Olumide Akitoye Ibeneche Onyemuchechi Gbujie Semen Stephen Yikawe Emmanuel Sara Kolo Titus Sunday Ibekwe Department of ENT/Head & Neck Surgery University of Abuja Teaching Hospital Abuja Nigeria Department of ENT/Head & Neck Surgery Nigerian Air Force Hospital Abuja Nigeria Department of ENT/Head & Neck Surgery Aminu Kano Teaching Hospital Kano Nigeria

Background: In most centers worldwide, thyroidectomy is performed under general anaesthesia as a result of advances in anaesthetic technique, consideration for patients’ safety and surgeons’ convenience. However, in some developing countries such as Nigeria, facilities and expertise for general anaesthesia are not equitably distributed. As such, they are not available in some health centers especially in the rural communities. Hence, the need to explore other suitable alternatives such as operating under local anaesthesia. Aim: This study aims to highlight the feasibility and safety of thyroidectomy under local anaesthesia at a surgical outreach in a rural community in Nigeria. Patients and Methods: The study site was conducted at Bethany Medical Centre, Gboko, Benue State, Nigeria. It was a one-week surgical outreach. Neck infiltration with local anaesthesia was carried out using 2% xylocaine with adrenaline 1:200,000 and a standard open technique was used to carry out all thyroidectomies. Results: Out of seventy (70) patients that presented during the study period, 31 (44.3%) met the inclusion criteria and were operated within the seven (7) days period. There were 3 (10.7%) males and 28 (89.3%) females. There ages ranged between 22 to 65 years, average was 43 years. The average duration of surgery was 90 minutes, and 3 days’ hospital stay. Those followed up two weeks post-operation recuperated well with no notable complications. Conclusion: Thyroidectomy under local anaesthesia is safe and feasible in our rural communities and in selected cases can be a suitable alternative to general anaesthesia.

关键词： Thyroidectomy local anaesthesia Goiter Nigeria

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Continuous wound infusion of local anaesthetic agents following colorectal surgery:Systematic review and meta-analysis

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World Journal of Gastroenterology 2008年第34期14卷 5301-5305页

作者： Alan Karthikesalingam Stewart R Walsh Sheraz R Markar Umar Sadat Tjun Y Tang Charles M Malata Department of General Surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation Trust Department of Plastic and Reconstructive Surgery Addenbrooke’s HospitalCambridge University Hospitals Foundation Trust

AIM:To provide a specifi c review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparoto-my for major colorectal surgery. METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes. RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a sig- nificant decrease in post-operative pain VAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. local anaesthetic infusion was associated with a signifi cant reduction in pain VAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). local an- aesthetic wound infusion was associated with a signifi - cant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no signifi cant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45). CONCLUSION: The results of this systematic re- view and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major color- ectal surgery is a promising technique but do not pro- vide conclusive evidence of benefi t. Further research is required including cost-effectiveness analysis.

关键词： Colorectal surgery Laparotomy local anaesthesia Infusion Wound healing

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Combined incisional ropivacaine infiltration and pulmonary recruitment manoeuvre for postoperative pain relief after diagnostic hysteroscopy and laparoscopy

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Chinese Medical Journal 2014年第5期127卷 825-829页

作者： Liu Huili Ma Caihong Zhang Xiaoqing Yu Chen Yang Yan Song Xueling Tang Yi Guo Xiangyang Department of Anesthesiology Peking University Third Hospital Beijing 100191 China

Background Preoperative incisional local anaesthesia with ropivacaine is a common method of providing postlaparoscopy pain *** pulmonary recruitment manoeuvre also provides pain relief,but the combined effect of these two methods on pain following laparoscopic procedures has not been *** investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and *** This prospective,randomized,controlled study involved 60 patients divided into two groups （n=30,each）.Group 1 received 20 ml of 0.5％ ropivacaine injected peri-incisionally preoperatively,with intra-abdominal carbon dioxide removed by passive *** 2 received 20 ml of 0.5％ ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of *** last inflation was held for 5 *** intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0,2,4,8,12,24 and 48 hours postoperatively by an independent blinded *** was given postoperatively for *** Compared with group 1,incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour,4 hours,and 24 hours postoperatively （4.1 ± 2.2 vs.2.1 ± 1.9,P=0.002;2.7 ± 2.7 vs.1.2 ± 1.3,P=0.035; and 3.5 ± 2.1 vs.2.1 ± 1.8,P=0.03,respectively）.Static incisional pain was significantly relieved at 0 hour,2 hours,and 24 hours postoperatively （3.1 ± 1.7 vs.1.6 ± 1.3,P=0.001; 1.4 ± 1.3 vs.0.5 ± 0.8,P=0.012;and 2.3 ± 1.9 vs.1.0 ± 1.5,P=0.038,respectively）.Group 2 had more patients without shoulder pain （P＜0.05） and fewer requiring tramadol （P＜0.05）.Conclusion Ropivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy.

关键词： analgesia postoperative care ropivacaine local anaesthesia pulmonary recruitment manoeuvre

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