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ABSTRACT: The optimal pain management in relation to laparoscopic colonic surgery remains unclarified. This article presents studies concerning the analgesic effects of paracetamol, NSAIDs, opioids, spinal and epidural blockade, transversus abdominis plane-block, infiltration and intraperitoneal local analgesics, intravenous lidocaine, gabapentinoids and corticosteroids after laparoscopic colonic resection. Moreover, side effects of the analgesics are presented and individually discussed in relation to the specific procedure. We present recommendations for pain management in relation to laparoscopic colonic resection.
Ugeskrift for laeger 03/2013; 175(11):721-725.
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ABSTRACT: Surgical procedures are mentally and physically demanding, and stress during surgery may compromise patient safety. We investigated the impact of surgical experience on surgeons' stress levels and how perioperative sleep quality may influence surgical performance.
Eight experienced and 8 inexperienced surgeons each performed 1 laparoscopic cholecystectomy. Questionnaires measuring perioperative mental and physical strain using validated visual analog scale and Borg scales were completed. Preoperative and postoperative sleep quality of the surgeon was registered and correlated to perioperative strain parameters.
Preoperative to postoperative frustration among experienced surgeons was significantly reduced and this was not found in the inexperienced surgeons (visual analog scale: preoperative 13 (2-65) mm, postoperative 4 (0-51) mm vs. preoperative 5(0-10) mm, postoperative 5(1-46) mm; P=0.04). Physical strain was significantly induced in both groups in the upper extremities. Preoperative and postoperative sleep quality was significantly correlated to postoperative mental strain parameters.
Perioperative frustration levels were different among inexperienced and experienced surgeons. Perioperative sleep quality may influence postoperative mental strain and should be considered in studies examining surgeons' stress.
Surgical laparoscopy, endoscopy & percutaneous techniques 02/2012; 22(1):73-8. · 1.23 Impact Factor
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ABSTRACT: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect psychological and physiological stress in experienced laparoscopic surgeons.
This was a prospective case-controlled study including 10 experienced surgeons. Surgery was performed in 2 different ORs: a standard room and a modern room (OR1-suite, Karl Storz). The surgeons filled out questionnaires concerning physical and psychological wellbeing before and after surgery and had their heart rate variability registered during surgery.
Preoperative to postoperative physical strain and pain measurements revealed a systematical difference with 14 of 15 parameters favoring the modern OR. Two of these parameters reached statistical significance. We did not find any significant differences in the subjective parameters of surgeon satisfaction or the measured heart rate variability parameters.
Physical strain on the surgeon was reduced when performing laparoscopic cholecystectomy in a modern OR compared with a standard room.
Surgical laparoscopy, endoscopy & percutaneous techniques 08/2010; 20(4):237-42. · 1.23 Impact Factor
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ABSTRACT: Over a period our department experienced an unexpected high frequency of anastomotic leakages. After diclofenac was removed from the postoperative analgesic regimen, the frequency dropped. This study aimed to evaluate the influence of diclofenac on the risk of developing anastomotic leakage after laparoscopic colorectal surgery.
This was a retrospective case-control study based on 75 consecutive patients undergoing laparoscopic colorectal resection with primary anastomosis. In period 1, patients received diclofenac 150 mg/day. In period 2, diclofenac was withdrawn and the patients received an opioid analgesic instead. The primary outcome parameter was clinically significant anastomotical leakage verified at reoperation.
1/42 patients in the no-diclofenac group compared with 7/33 in the diclofenac group had an anastomotic leakage after operation (p = 0.018). In a multivariate regressional analysis, none of the recorded factors were significantly associated with the frequency of anastomotical leakages when diclofenac treatment was omitted from the model.
We found an increased number of clinically significant anastomotic leakages in patients receiving oral diclofenac for postoperative analgesia. There is an urgent need to test our hypothesis in prospective randomized clinical trials and to examine whether our findings can be extended to open surgery and to other NSAIDs.
Digestive surgery 02/2009; 26(1):27-30. · 1.37 Impact Factor
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ABSTRACT: The introduction of laparoscopic surgery has put focus on the assessment of the technical abilities of the surgeon. Studies on learning curves have often focused on operative time, conversion rate, complication rate and length of hospital stay as effect parameters. Learning is a complex process, and the interpretation of learning curves is not straight-forward. This paper addresses the problems concerning the analysis of learning curves in surgery.
Ugeskrift for laeger 06/2008; 170(21):1823-5.
